Table of ContentsView AllTable of ContentsDefinitionWhy it Happens on Birth ControlWhy it Happens In or After MenopauseBreakthrough Bleeding vs. Regular PeriodBreakthrough Bleeding vs. Implantation BleedingSelf-CareWhen to See a Healthcare Provider
Table of ContentsView All
View All
Table of Contents
Definition
Why it Happens on Birth Control
Why it Happens In or After Menopause
Breakthrough Bleeding vs. Regular Period
Breakthrough Bleeding vs. Implantation Bleeding
Self-Care
When to See a Healthcare Provider
Breakthrough bleeding, orspotting, is a common experience for people with female reproductive organs. While bleeding outside of yourmenstrual periodcan be concerning, it usually is not cause for worry. Birth control use and hormone changes duringpregnancyorperimenopauseare common causes of breakthrough bleeding, but sometimes, it is a sign of an underlying condition that requires treatment.
This article discusses the causes and characteristics of breakthrough bleeding, how to manage it, and when to discuss heavy or irregular uterine bleeding with a healthcare provider.
Liudmila Chernetska / Getty Images
First, Let’s Define Breakthrough Bleeding
Breakthrough bleeding is unexpected uterine bleeding between your regular menstrual periods.It can occur at various points in your menstrual cycle, during pregnancy, or when usingbirth control. It is also common during the years leading up to menopause (perimenopause) due to fluctuating hormones.
Some people may experience occasional light spotting, while others may experience heavy bleeding that lasts a day or more. The blood mayappearpink, red, or reddish-brown, and some people experience abdominal cramping (similar to period cramps) with the bleeding.
Why Am I Spotting Before My Period?
Why Breakthrough Bleeding Happens on Birth Control
Breakthrough bleeding is a common side effect ofbirth control, especially during the first few months after starting a new method. Any birth control containing hormones can cause breakthrough bleeding, including:
Factors that contribute to breakthrough bleeding while on birth control include:
Withdrawal vs. Breakthrough BleedingWithdrawal bleedingoccurs during the hormone-free interval of combined hormonal contraceptives, like birth control pills. It happens when you take the placebo pills or have a break between active pill packs. This bleeding mimics a menstrual period and is a response to the sudden drop in hormone levels when you pause or stop taking hormonal birth control.Breakthrough bleeding is unexpected uterine bleeding that occurs outside the regular menstrual cycle, often seen as spotting or light bleeding. It can happen at any time during the menstrual cycle.
Withdrawal vs. Breakthrough Bleeding
Withdrawal bleedingoccurs during the hormone-free interval of combined hormonal contraceptives, like birth control pills. It happens when you take the placebo pills or have a break between active pill packs. This bleeding mimics a menstrual period and is a response to the sudden drop in hormone levels when you pause or stop taking hormonal birth control.Breakthrough bleeding is unexpected uterine bleeding that occurs outside the regular menstrual cycle, often seen as spotting or light bleeding. It can happen at any time during the menstrual cycle.
Withdrawal bleedingoccurs during the hormone-free interval of combined hormonal contraceptives, like birth control pills. It happens when you take the placebo pills or have a break between active pill packs. This bleeding mimics a menstrual period and is a response to the sudden drop in hormone levels when you pause or stop taking hormonal birth control.
Breakthrough bleeding is unexpected uterine bleeding that occurs outside the regular menstrual cycle, often seen as spotting or light bleeding. It can happen at any time during the menstrual cycle.
Can Spotting on Birth Control Be a Sign of Pregnancy?
Why Breakthrough Bleeding Happens Around Menopause
Breakthrough bleeding can occur during the transition tomenopause(perimenopause). If bleeding occurs after menopause, it’s called postmenopausal bleeding. During perimenopause, your body undergoes significant hormonal shifts as it prepares for menopause.
During perimenopause, your ovaries begin to produce less estrogen and progesterone—hormones that regulate your menstrual cycle. These hormonal fluctuations lead to changes in the uterine lining, causing it to thicken and shed irregularly (breakthrough bleeding).
After menopause, the ovaries stop producing eggs, estrogen and progesterone levels drop significantly, and your period stops completely. Postmenopausal bleeding may be light brown or pinkish-gray spotting or heavy flow similar to a period. Several factors can lead to postmenopausal bleeding, including:
It can be difficult to differentiate between your regular menstrual period and breakthrough bleeding, especially if you are new to hormonal birth control or experiencing perimenopause. While both involve uterine bleeding, there are some key differences between breakthrough bleeding and a regular period.
Regular Period
Though menstrual cycles can vary from person to person, most have common characteristics, including:
Breakthrough Bleeding
Breakthrough bleeding is less predictable than a regular menstrual period.
Breakthrough Bleeding Risk FactorsCertain factors can increase the likelihood of experiencing breakthrough bleeding, including:Starting a new hormonal birth control methodChanging the dosage or type of hormonal birth controlSkipping birth control pills or taking them lateObesityCertain medical conditions, includingpolycystic ovarian syndrome (PCOS)orendometriosisSmokingSpecificherbsthat can thin the blood, including ginkgo biloba, ginger, chamomile, and St. John’s wort
Breakthrough Bleeding Risk Factors
Certain factors can increase the likelihood of experiencing breakthrough bleeding, including:Starting a new hormonal birth control methodChanging the dosage or type of hormonal birth controlSkipping birth control pills or taking them lateObesityCertain medical conditions, includingpolycystic ovarian syndrome (PCOS)orendometriosisSmokingSpecificherbsthat can thin the blood, including ginkgo biloba, ginger, chamomile, and St. John’s wort
Certain factors can increase the likelihood of experiencing breakthrough bleeding, including:
An Overview of Metrorrhagia
Implantation bleeding is light spotting or bleeding that occurs when a fertilized egg implants in the lining of the uterus. It typically occurs 10-14 days after ovulation—around the time you would expect your period—and is a common sign of early pregnancy. Implantation bleeding is usually very light, with small amounts of pale pink to rust-colored blood. It may be intermittent or constant but lasts only a few hours up to three days.
Self-Care With Breakthrough Bleeding
While breakthrough bleeding can be an unexpected and unsettling experience, it is often a harmless occurrence you can manage with some self-care practices once a healthcare provider has confirmed the cause of your bleeding. Self-care strategies for managing breakthrough bleeding include:
What Is Self-Care and Why Is It Important?
Heavy Uterine Bleeding and Symptoms to Discuss With a Provider
While breakthrough bleeding is common and usually not a reason to worry, it is important to see a healthcare provider if you experience breakthrough bleeding and any of the following symptoms:
Talk to a healthcare provider if you have concerns or questions about breakthrough bleeding, even if you don’t have other symptoms. They can provide reassurance, address your concerns, and offer guidance based on your situation.
Summary
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17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Farrukh JB, Towriss K, McKee N.Abnormal uterine bleeding: taking the stress out of controlling the flow.Can Fam Physician.2015;61(8):693-697.Villavicencio J, Allen RH.Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates.Open Access J Contracept. 2016;7:43-52. doi:10.2147/OAJC.S85565.American College of Obstetricians and Gynecologists.Perimenopausal bleeding and bleeding after menopause.American College of Obstetricians and Gynecologists.What you should know about breakthrough bleeding with birth control.American College of Obstetricians and Gynecologists.Progestin-only hormonal birth control: pill and injection.Buck E, McNally L, Jenkins SM.Menstrual suppression. In:StatPearls.StatPearls Publishing; 2023.American College of Obstetricians and Gynecologists.Bleeding after menopause could be a serious problem. Here’s what to know.NHS.Postmenopausal bleeding.Eunice Kennedy Shriver National Institute of Child Health and Human Development.About menstruation.Tang Y, Chen Y, Feng H, Zhu C, Tong M, Chen Q.Is body mass index associated with irregular menstruation: a questionnaire study?BMC Womens Health. 2020;20(1):226. doi:10.1186/s12905-020-01085-4Dinsdale NL, Crespi BJ.Endometriosis and polycystic ovary syndrome are diametric disorders.Evol Appl. 2021;14(7):1693-1715. doi:10.1111/eva.13244Tan CSS, Lee SWH.Warfarin and food, herbal or dietary supplement interactions: a systematic review.Br J Clin Pharmacol. 2021;87(2):352-374. doi:10.1111/bcp.14404American Pregnancy Association.What is implantation bleeding?U.S. Department of Health and Human Services. Office on Women’s Health.Your menstrual cycle and your health.U.S. Department of Health and Human Services. Office on Women’s Health.Iron-deficiency anemia.MedlinePlus.Abnormal uterine bleeding.Centers for Disease Control and Prevention.Heavy menstrual bleeding.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Farrukh JB, Towriss K, McKee N.Abnormal uterine bleeding: taking the stress out of controlling the flow.Can Fam Physician.2015;61(8):693-697.Villavicencio J, Allen RH.Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates.Open Access J Contracept. 2016;7:43-52. doi:10.2147/OAJC.S85565.American College of Obstetricians and Gynecologists.Perimenopausal bleeding and bleeding after menopause.American College of Obstetricians and Gynecologists.What you should know about breakthrough bleeding with birth control.American College of Obstetricians and Gynecologists.Progestin-only hormonal birth control: pill and injection.Buck E, McNally L, Jenkins SM.Menstrual suppression. In:StatPearls.StatPearls Publishing; 2023.American College of Obstetricians and Gynecologists.Bleeding after menopause could be a serious problem. Here’s what to know.NHS.Postmenopausal bleeding.Eunice Kennedy Shriver National Institute of Child Health and Human Development.About menstruation.Tang Y, Chen Y, Feng H, Zhu C, Tong M, Chen Q.Is body mass index associated with irregular menstruation: a questionnaire study?BMC Womens Health. 2020;20(1):226. doi:10.1186/s12905-020-01085-4Dinsdale NL, Crespi BJ.Endometriosis and polycystic ovary syndrome are diametric disorders.Evol Appl. 2021;14(7):1693-1715. doi:10.1111/eva.13244Tan CSS, Lee SWH.Warfarin and food, herbal or dietary supplement interactions: a systematic review.Br J Clin Pharmacol. 2021;87(2):352-374. doi:10.1111/bcp.14404American Pregnancy Association.What is implantation bleeding?U.S. Department of Health and Human Services. Office on Women’s Health.Your menstrual cycle and your health.U.S. Department of Health and Human Services. Office on Women’s Health.Iron-deficiency anemia.MedlinePlus.Abnormal uterine bleeding.Centers for Disease Control and Prevention.Heavy menstrual bleeding.
Farrukh JB, Towriss K, McKee N.Abnormal uterine bleeding: taking the stress out of controlling the flow.Can Fam Physician.2015;61(8):693-697.
Villavicencio J, Allen RH.Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates.Open Access J Contracept. 2016;7:43-52. doi:10.2147/OAJC.S85565.
American College of Obstetricians and Gynecologists.Perimenopausal bleeding and bleeding after menopause.
American College of Obstetricians and Gynecologists.What you should know about breakthrough bleeding with birth control.
American College of Obstetricians and Gynecologists.Progestin-only hormonal birth control: pill and injection.
Buck E, McNally L, Jenkins SM.Menstrual suppression. In:StatPearls.StatPearls Publishing; 2023.
American College of Obstetricians and Gynecologists.Bleeding after menopause could be a serious problem. Here’s what to know.
NHS.Postmenopausal bleeding.
Eunice Kennedy Shriver National Institute of Child Health and Human Development.About menstruation.
Tang Y, Chen Y, Feng H, Zhu C, Tong M, Chen Q.Is body mass index associated with irregular menstruation: a questionnaire study?BMC Womens Health. 2020;20(1):226. doi:10.1186/s12905-020-01085-4
Dinsdale NL, Crespi BJ.Endometriosis and polycystic ovary syndrome are diametric disorders.Evol Appl. 2021;14(7):1693-1715. doi:10.1111/eva.13244
Tan CSS, Lee SWH.Warfarin and food, herbal or dietary supplement interactions: a systematic review.Br J Clin Pharmacol. 2021;87(2):352-374. doi:10.1111/bcp.14404
American Pregnancy Association.What is implantation bleeding?
U.S. Department of Health and Human Services. Office on Women’s Health.Your menstrual cycle and your health.
U.S. Department of Health and Human Services. Office on Women’s Health.Iron-deficiency anemia.
MedlinePlus.Abnormal uterine bleeding.
Centers for Disease Control and Prevention.Heavy menstrual bleeding.
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