Periods and spotting
Why am I spotting on the pill?
Quick answer
Spotting (Light bleeding between periods. Common in the first months on a pill.) is common in the first 3 months on any pill and usually settles on its own.[src] After that, the usual causes are missed or late pills, vomiting, low-dose or progestin-only pills, smoking, interacting medicines or skipping the break. Spotting with pain, after sex, or past 3 months is worth a doctor visit.
7 reasons for spotting on the pill
- Your body is adjusting. The womb lining takes a few cycles to settle on steady hormones. This is the most common reason, and the NHS says bleeding changes are common in the first months.[src]
- Missed or late pills. A dip in hormones can trigger bleeding a day or two later. It is a clue to check the missed pill rules, not proof you are unprotected.
- Vomiting or diarrhoea. The pill may not have been absorbed. See what if I vomit after my pill?
- A low-dose pill. Pills with 20 mcg ethinylestradiol, such as Yaz (drospirenone + ethinylestradiol) and Minipil (levonorgestrel + ethinylestradiol), give the lining less support, so spotting is more common for some people.
- A progestin-only pill. Irregular bleeding is the main side effect of Daphne (lynestrenol), Exluton (lynestrenol) and Cerazette (desogestrel), and of the implant and injectable too.[src]
- Skipping the break. Running packs back to back to delay a bleed often causes spotting. See can I skip the brown pills?
- Medicines and smoking. Some medicines, such as rifampicin for TB and certain epilepsy medicines, lower pill hormone levels and can cause bleeding and reduce protection.[src] Smoking is also linked with more spotting. [TODO: source: smoking and breakthrough bleeding on combined pills (FSRH or NHS)] Do antibiotics stop the pill?
Find your reason
| If this fits | Likely reason | What to do |
|---|---|---|
| Pack 1 to 3, no missed pills | Adjusting | Keep going. Track it. |
| Started after a late or missed pill | Hormone dip | Use the Missed Pill Helper. |
| On Yaz, Minipil or a progestin-only pill, past 3 months | Low dose or progestin only | Ask your doctor about other options. |
| New medicine started | Interaction | Tell the prescriber you are on the pill; use condoms until checked. |
| Bleeding after sex, pain, or unusual discharge | Not the pill until proven otherwise | See a doctor. |
Logging bleeding days for 3 months gives your doctor a clear picture. The side effect tracker keeps it on your phone and can make a PDF for your visit.
Does spotting mean pregnancy?
Not on its own. Spotting neither confirms nor rules out pregnancy.[src] If you missed pills and had sex, or your withdrawal bleed does not come, a home pregnancy test answers the question. Use the test timing tool.
When to see a doctor
- Spotting that continues after 3 months on the same pill with no missed pills.
- Bleeding after sex, or pain in the lower belly or during sex. These can be signs of an infection, including STIs, which pills do not protect against.[src]
- Heavy bleeding, soaking pads every hour, or feeling faint: go to the ER.
- Spotting with a positive pregnancy test.
More detail in our spotting guide. If unsure, talk to a doctor or pharmacist.
Frequently asked questions
Bakit may spotting ako kahit nag-pi-pills?
Karaniwan ang spotting sa unang 3 buwan ng kahit anong pills. Puwede rin ito dahil sa nakalimutang pills, pagsusuka, low-dose na pills o progestin-only pills. Kung tuloy pa rin pagkalipas ng 3 buwan, o may sakit o dugo pagkatapos ng sex, magpatingin sa doktor.
Should I stop the pill if I am spotting?
No. Stopping mid-pack can cause more bleeding and leaves you unprotected. Keep taking your pills and talk to your doctor if it lasts beyond 3 months.
Is brown discharge on the pill normal?
Brown spotting is usually old blood and is common in the first months. If it smells bad, itches or comes with pain, see a doctor.
This guide is for information. Talk to a doctor before starting, stopping or switching birth control.
Sources
- Combined pill: risks and side effects, NHS
- Family Planning: A Global Handbook for Providers, WHO and Johns Hopkins CCP
- Drug interactions with hormonal contraception (guideline), FSRH (UK) Added during build. [TODO: link the exact guideline page]
- Family planning / contraception methods (fact sheet), World Health Organization