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Birth Control Pills: Why Do I Get Breakthrough Bleeding?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on April 15, 2025.

Key Points

When any birth control pill is started, there is a chance of breakthrough bleeding (spotting) in the first few months as your body adjusts to different hormone levels. The chances for breakthrough bleeding are greater with progestin-only pills (POPs or "mini-pill"), continuous-cycle or extended-cycle birth control pills.

Breakthrough bleeding with birth control pills is common, temporary and usually just a small amount of spotting between your periods. If you experience unusual, painful or heavy bleeding, contact your healthcare provider right away.

Progestin-only pills (POPs or "mini-pill"), continuous-cycle or extended-cycle birth control pills can cause more frequently breakthrough bleeding. These types of contraceptive regimens may lead to more irregular bleeding than the traditional 28-day schedule (21 days of an active pill and 7 days of inactive pill).

What causes breakthrough bleeding?

You are more likely to have breakthrough bleeding if:

Most women have no ongoing problems with birth control pills and can continue to take them with few, if any, side effects. Continue to take your birth control as directed by your healthcare provider, even if you have breakthrough bleeding. Breakthrough bleeding usually subsides in two to three months.

Sore breasts, nausea or headaches are other temporary side effects you may experience early-on when starting birth control pills.

If breakthrough bleeding does not subside, becomes very heavy, lasts for more than seven days in a row, is painful or occurs after previously regular menstrual cycles, contact your healthcare provider. You may need to change the type of birth control or birth control pill that you use, or use a different method of birth control.

Benign (not cancerous) growths known as fibroids in the uterus can also lead to irregular spotting or heavy bleeding with your period, and your doctor can examine you to diagnose fibroids.

Related: Antibiotics and Birth Control Pill Interactions 

Can progestin-only pills (POPs) cause breakthrough bleeding?

About 50%-70% of women who use progestin-only birth control pills (POPs) may have breakthrough bleeding, irregular periods, or spotting.  Breakthrough bleeding is more likely to occur when you first start a POP as your hormone levels adjust. Women may eventually have less bleeding or stop having periods altogether while taking POPs, which may be helpful for women who have heavy or painful periods.

Progestin-only birth control pills (POPs), also called the "mini-pills", only contain a progestin and are estrogen-free. Some women choose POPs because they want or need to avoid estrogen or are breastfeeding. 

Ideally, you should take your birth control pill at the same time each day. However, for most POPs, you MUST take them within the same three hours every day, or you'll need to use a backup method of birth control for at least 2 days (48 hours).

Most POPs contain 28 pills that are "active" birth control pills (containing the progestin known as norethindrone) with no inactive pills. Always review your specific instructions on the Patient Information Leaflet found with your pills, or ask your pharmacist.

Progestin-only pills (POPs) include:

A new POP called Slynd (which contains 4 mg drospirenone) can be taken within 24 hours of missing one active tablet without using a backup method of birth control (instead of the 3 hour window with other POPs). Ask your doctor about this option. 

The Slynd package is different from most POPs as it contains 24 white active tablets and 4 green inactive tablets and a different active progestin called drospirenone.

Extended-cycle birth control pills

Extended-cycle birth control pills are combined oral contraceptives that contain both a progestin, like levonorgestrel, and an estrogen like ethinyl estradiol. With extended-cycle birth control pills your period occurs 4 times a years.

Extended-cycle dosing is typically given as 84 days of active pills and 7 days of inactive pills.

Options include:

Continuous-cycle birth control pill

The only continuous-cycle birth control pill in the U.S. currently is Amethyst (ethinyl estradiol and levonorgestrel). Amethyst has 28 active pills per pack, and you take one active pill every day. There are no inactive (placebo) pills.

Amethyst contains both an estrogen and a progestin and eliminates your period all together. You will not have full menstrual bleeding but you may have breakthrough bleeding or spotting for the first 3 to 6 months. This typically decreases over time.

Mini continuous-cycle pills

Mini continuous-cycle packs are also an option to lower the impact of a monthly period, but not completely eliminate it. A few extra active estrogen pills in these packs can lead to lighter and shorter periods and more stable hormone levels.

Examples of mini continuous-cycle pills (with 24 or 26 days of active pills) include:

Is it safe to use the pill to stop my period?

There is no known medical benefit to having a monthly period and it's generally safe to skip or delay your period. Discuss this option your healthcare provider to determine the best approach based on your medical history and lifestyle.

Breakthrough bleeding or spotting that may occur with continuous or extended-cycle birth control pills will typically decrease over time. Breakthrough bleeding can also occur when taking normal 28-day birth control pills in a continuous manner, with an active pill every day.

Contact your doctor if your spotting or bleeding is concerning for you. You may need to change to another type of pill or different contraceptive.

How do I get birth control pills?

See your doctor for a prescription, or ask your pharmacist if they can prescribe birth control pills. Not all pharmacists offer this service, but it is approved in some U.S. states, for example: Arizona, Arkansas, California, Colorado, Delaware, District of Columbia, Hawaii, Idaho, Illinois, Maryland, Minnesota, Nevada, New Hampshire, New Mexico, North Carolina, Oregon, Utah, Vermont, Virginia, and West Virginia. Call your pharmacy to check.

Opill (norgestrel 0.075 mg) is the first nonprescription, over-the-counter (OTC) birth control pill (oral contraceptive) approved in the United States for all ages.

Learn more: How effective is Opill OTC birth control?

If you decide to stop the pill, be sure you are protected right away with a new method of birth control or use a barrier method because you’ll greatly increase your risk of pregnancy.

And don't forget, birth control pills do not provide protection against sexually transmitted infections like HIV or gonorrhea. Use a male latex condom for female condom protection for that.

Combined oral contraceptives (with both a progestin and an estrogen) should NOT be used in women aged over 35 years who smoke because of a higher risk of serious side effects such as a heart attack, blood clot, or stroke. For a complete list of severe side effects, please refer to the individual drug monographs.

Learn More: See a full list of hormonal birth control pill options (in more detail)

This is not all the information you need to know about birth control pills and breakthrough bleeding and does not take the place of your healthcare provider's directions. Discuss any medical questions you have with your doctor, nurse or other health care provider.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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