Irregular spotting, also known as breakthrough bleeding, is normal for the first few months after starting a new prescription for birth control pills (commonly called birth control pills). Usually, spotting bleeding only a small amount of blood and often does not require the use of feminine products, such as pads or tampons. If this problem persists, talk to your doctor.
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Part 1 of 3: Take the Pill Right
Step 1. Expect spotting for the first few months
Spotting bleeding often occurs three to four months after starting birth control pills for the first time. This also happens if you have taken birth control pills in the past, then took a break, and are now starting this form of birth control again, and if you have changed the brand or type of birth control pill you are taking.
- Clinical use of the term “spotting” refers to episodes of slight bleeding that do not require the use of pads or tampons.
- The term “bleeding discharge” usually indicates the level of bleeding that requires the use of sanitary products or tampons.
- However, these terms can be misleading because they are often used interchangeably, even in the medical literature.
Step 2. Take the pills at the same time
Create a schedule that works for you to help regulate your cycle. Taking birth control pills consistently at the same time every day reduces the incidence of spotting.
- Changing the timing by just a few hours is generally fine, but if you change your dose by four hours or more, you're changing the way your body absorbs birth control pills and naturally produces hormones.
- This can cause spotting bleeding. It can also reduce the effectiveness of birth control pills, which can increase your short-term chances of getting pregnant.
- Choose an appropriate time and a time that you are most likely to remember. Try taking the pill before bed, in the morning when you brush your teeth, or another time when you are consistently doing other daily activities, such as taking a shower or taking a morning walk.
- If you don't like the selected time and want to adjust it, wait until you start a new pack. Adjust the scheduled dosing time with the new package to ensure you are not interfering with the way the pill works in your body. Adjusting the time in the middle of your cycle can increase your chances of spotting and also getting pregnant.
Step 3. Store the pills in their original containers
Do not remove the tablet or remove the tablet from its original packaging or container. The pack is designed to help you track your current position on your cycle.
- If the package contains pills of different colors, it is very important to take the pills in the correct order in the order they appear on the package.
- The colored tablets contain hormones with different strengths to provide the amount of hormones the body needs at different times of the month.
- Even if the pills you have are all the same color, take them in the order on the package. This can help you and your doctor identify any problems you may have, such as spotting, in certain parts of your cycle.
Step 4. Be prepared if you forget to take a pill
Talk to your doctor beforehand to make sure you know what to do if you forget to take a pill. Forgetting to take a pill is a common reason for spotting or discharge bleeding.
- If you forget to take a pill, talk to your doctor about when you should take the missed dose and if additional protection is needed to prevent pregnancy.
- However, these questions do not have simple answers. The answer to this question varies, depending on three main factors. These factors include the type of pill you took, where you were in your cycle when you forgot to take the pill, and whether you forgot to take more than one pill in a row.
Step 5. Review general guidelines for forgetting to take a pill
Always check with your doctor to make sure you know what to do if you forget to take a pill. General guidelines used for women taking pills from a new pack every month, as opposed to packs designed for a three-month cycle, include the following:
- If you forget the first pill in the new pack, take the missed pill as soon as you remember and take the next pill at the normal time. It's okay to take two pills a day. Use a backup form of birth control until you have taken the next seven tablets on the schedule.
- If you forget a pill during your cycle, take it as soon as you remember. Take the next pill at the normal time. It's okay to take two pills in one day.
- If you have a pill pack for 28 days, and you forgot to take one dose during the last week, or tablets 21 through 28, then you are at risk of getting pregnant. Start a new pack of your own according to your usual schedule.
Step 6. Follow the instructions if you forget to take more than one pill
Each manufacturer provides additional information in their product literature to help guide you if you forget to take a pill during your cycle. You can also check this with your doctor to make sure you know what to do. Be aware that you may have to use another birth control method until you return to your pill schedule.
- If you forget to take two pills in a row during the first or second week, take two tablets on the day you remember and two tablets the next day. This will return you to a normal schedule. Use another birth control until you start a new cycle and a new pill pack.
- If you forget to take two pills in a row during the third week, use another birth control method until it's time to start a new pack. You can throw away the rest of the pack if you forget to take the two pills in your next cycle.
- If you forget to take three or more pills in a row at any time during your cycle, you will have to use another birth control method and you will have to start a new pack.
- Call your doctor for clear instructions on when to start a new pack. In some cases, you may have to wait until your menstrual cycle occurs and start a new pack as usual. Your doctor may ask you to start another pack sooner than that, but it will depend on the type of birth control pill you are taking and the time it will take for your menstrual cycle to start normally.
- Be sure to use other forms of birth control until you have gone seven days from the new pack.
Part 2 of 3: Adjusting Your Lifestyle
Step 1. Quit smoking
If you don't smoke, don't start. Cigarette smoking is a risk factor for serious problems when combined with birth control pills. Smoking can increase estrogen metabolism, resulting in lower estrogen levels and possibly causing spotting.
- Women who smoke more than 15 cigarettes a day and are over 35 years old should not take birth control pills.
- Smoking cigarettes while taking birth control pills has been shown to greatly increase the risk of serious side effects.
- Some examples of serious complications that can result from smoking and taking birth control pills include blood clots, liver tumors and strokes.
Step 2. Maintain a healthy weight
Weight gain or weight loss can affect the body's natural hormone balance. If you experience significant weight changes, check with your doctor to make sure the birth control pill regimen is still right for you.
- Recent research has shown that birth control pills are just as effective in overweight women as women who are of average weight.
- Questions remain about significant changes in body weight, be it weight gain or loss, and how they can alter the body's general metabolism, normal hormone production, and effects on the absorption and metabolism of birth control pills.
Step 3. Beware of vitamins and supplements
Research has shown that some vitamins and herbal supplements affect the effectiveness of birth control pills. Some of the published remedies for spotting include taking vitamins or other supplements to alter hormone levels to prevent spotting.
- While vitamins, supplements, and even food can really interfere with the way your body absorbs the hormones in birth control pills, this is not a recommended method of trying to adjust your dose yourself.
- Talk to your doctor before you take vitamins, supplements, and some foods and drinks to try to change the absorption of birth control pills.
- These methods are not well-established methods in scientific research and are not recommended. There are many carefully researched options available to balance the hormones in birth control pills to meet the body's needs.
- Some examples of vitamins, herbal supplements, and foods that alter hormone absorption in birth control pills include vitamin C, St. John's Wort (a type of medicinal plant), and grapefruit juice (a type of orange). If these ingredients are part of your habit, tell your doctor.
Step 4. Control stress in life
Stressful situations cause your body to alter the release and absorption of the stress hormone called cortisol. Cortisol can alter the normal production of natural hormones, and can have an impact on the absorption and effectiveness of birth control pills.
- Changes in cortisol levels affect the way the body uses available hormones. This can cause abnormalities in the menstrual cycle and can include spotting and discharge bleeding, even while taking birth control pills.
- Take steps to consistently manage the stress in your life. This could include engaging in new exercise habits or ways of managing stress such as yoga, meditation, and mindfulness exercises.
- Learn how to use breathing and relaxation techniques to control unexpected stressful situations.
Part 3 of 3: Seeking Medical Help
Step 1. Call your doctor if you have persistent spotting
If you have spotting or discharge bleeding for a long time, schedule an appointment with your doctor. Your doctor will need to know if you have spotting or discharge bleeding for more than seven days of your cycle or not. In addition, spotting or bleeding that persists for more than four months is a good reason to seek medical attention.
- See a doctor for a recent episode of spotting. Bleeding spotting or discharge can be caused by something unrelated to the birth control pill you are taking.
- If you continue the same pill regimen but start to bleed mid-cycle, this could be a symptom of another problem and should be evaluated by a doctor.
- Discharge bleeding may be a sign of other problems, including pregnancy or cervical changes. If you have made lifestyle changes, such as smoking, or have started taking a new medication that may interact with your birth control pill regimen, this can cause discharge bleeding as well.
Step 2. Consider other types of birth control pills
Many birth control pills are made to contain the lowest possible amounts of some hormones. Your doctor may change your pill to a type that contains slightly higher estrogen levels if he notices you have spotting problems. Changing to a pill formulated with a different type of progesterone, such as levonorgestrel, may also help.>
- If you continue to have problems with spotting or discharge bleeding with your current pill use, talk to your doctor about switching to a different strength pill or extending the number of days you take the active pill vs the placebo pill at the end of most packs.
- There are many types of pills that are effective at preventing pregnancy. Finding the best one to meet your body's hormonal needs is just a matter of patience and trying a few different pills.
- On a regular basis, doctors start with a product that contains the lowest possible amount of estrogen, progesterone, or both. Changing to a brand with a slightly higher dose of estrogen usually stops the problem of spotting and discharge bleeding.
- Currently, some packages are designed to extend active pill days by utilizing a 3-month cycle, as opposed to the usual 1-month pill packs.
- By switching to a 3-month cycle, you may experience fewer problems with your period and less problems with spotting and discharge bleeding. Talk to your doctor about this option.
Step 3. Work with your doctor
Many women stop taking birth control pills because they are frustrated by the ongoing problem of spotting or bleeding discharge.
- Be patient and open to trying other types of birth control pills.
- Realize that stopping birth control pills means you will have to find another birth control method.
- Birth control pills are the most effective and easy way to prevent pregnancy.
- The other methods are often less reliable, uncomfortable, and sometimes require interruptions during intercourse.
Step 4. Have regular Pap smears and cervical examinations
The doctor will schedule an appointment with you at the interval he deems best suited to your age and any risk factors you may have for other diseases. Many doctors may recommend an annual appointment to evaluate changes and to make sure your birth control pill is prescribed at the best dose for you.
- If you have trouble with new or persistent bleeding, make an appointment as soon as possible for an evaluation.
- Vaginal bleeding can be a symptom of a medical condition, including some serious conditions such as cervical cancer.
- In addition, your doctor may want to screen you for sexually transmitted diseases or other problems on a regular basis, possibly annually, depending on your individual condition.
- Birth control pills do not protect against sexually transmitted diseases. Tell your doctor as soon as possible if you think you may have contracted a sexually transmitted disease.
Step 5. Talk to your doctor about any other medicines you take
Many medications can interfere with the effectiveness of birth control pills. Make sure your doctor has a list of your medications. Keep your doctor up-to-date on changes made to your daily dose of medicines you take regularly, be it prescription medicines, over-the-counter medicines including aspirin and non-steroidal anti-inflammatory drugs such as naproxen and ibuprofen, vitamins, and herbal supplements.
- Medications that can interfere with the pill's effectiveness can include everything from over-the-counter herbal supplements to antibiotics.
- Short-term or longer-term use of some antibiotics can change the effectiveness of birth control pills. If you are prescribed antibiotics for any reason, it is important to tell your doctor because your birth control regimen may become less effective.
- Some anti-seizure medications can also interfere with the effectiveness of birth control pills. Seizure medications are sometimes used to treat mood disorders and chronic pain syndromes, such as migraines.
- Some herbal supplements, especially St. John's wort, can also interfere with birth control hormones.
- Always ask your doctor or pharmacist about the need to use a backup birth control when you take something new.
Step 6. Inform your doctor of any new or current medical conditions
Medical conditions can change how birth control pills work in your body and can put you at risk for other unwanted complications.
- Several medical conditions may provide reasons to closely monitor women taking birth control pills. Examples include diabetes, a history of cardiovascular disease, and a history of breast disease.
- If you have a virus, i.e. the flu, a stomach condition that includes nausea, vomiting and diarrhea, tell your doctor.
- The symptoms themselves can change the absorption of birth control pills. This means the pill may be less effective during this time and you may have to use another birth control method until you feel better for at least seven days.
Tips
- If you travel to an area in a different time zone after starting your pill, try to take the pill as close to the time before your trip as possible to stay on the same schedule.
- Keep a diary or calendar related to your spotting and include anything unusual that happened that day. This can help pinpoint some of the triggers associated with spotting and help your doctor choose the birth control pill that's more appropriate for you based on when the spotting occurs.
- Tell your doctor if your spotting is associated with other symptoms, such as headaches or cramps.
- Birth control pills are a very effective method of preventing pregnancy. However, sometimes pregnancy does happen. If you think you may be pregnant, contact your doctor as soon as possible.
