Hormonal birth control options may have side effects, including irregular bleeding or spotting. This is common and is usually nothing to worry about, but you can try different options to avoid it.
Medically reviewed by Tahirah Redhead MPAS, PA-C, MPH
Hormonal birth control options, as the name suggests, contain hormones that prevent ovulation, which is when your ovary releases an egg. They come in many different forms, including pills, vaginal rings, intrauterine devices (IUDs), or an implant in your arm.
As you start using these methods, your body needs to adjust to the new hormonal levels. This can cause various side effects, including irregular menstrual bleeding and brown discharge, which is known as spotting.
The most common hormonal birth control option is the contraceptive pill. There are two main kinds of birth control pills:
Combination pills: These contain both progestin and estrogen.
Progestin-only pills: These contain only progestin and are not as common as the combination pills.
According to research from 2022, approximately 25% of women between the ages of 15 and 44 years in the United States use birth control pills as their contraceptive method of choice. Knowing more about your birth control choices can help you make the right decision for you.
Sex and gender exist on spectrums. This article uses the terms “female” and “women” when discussing people who are assigned female at birth to reflect language that appears in source materials.
What causes spotting?
Photography by Westend61/Getty Images
The hormones that you get from hormonal birth control methods can affect some people more than others or in different ways. Once you start using these contraceptives, you may notice certain side effects.
These can include:
nausea
sore breasts
headaches
mood changes
changes to your typical period cycle, like late or early menstruation
bleeding between periods, or spotting
Spotting, also called breakthrough bleeding, can happen in the first 1–3 months of taking your new medication. This is rarely a sign of something more serious or that your birth control is not working.
In fact, spotting or breakthrough bleeding is very common with low dose and ultra-low dose hormonal birth control pills, as well as with hormonal IUDs and the implant.
The cause for spotting is simply your reproductive system adjusting to the new hormone levels. The reasons why spotting happens are largely unknown.
It is known that progestin-only birth control medications are more likely to cause spotting. In a 2020 study, up to 25% of women cited irregular bleeding as the most common reason for stopping these medications.
Other possible reasons for spotting on hormonal birth control pills include:
missing a dose
experiencing vomiting or diarrhea, leading your body to not absorb the hormones correctly
taking new medications that are interring with the effectiveness of the pill, such as cholestyramine for high cholesterol
With time, the spotting should lessen and sometimes stop entirely. Some 2020 research found that the number of women experiencing spotting due to a birth control pill decreased significantly over the course of the study, which lasted for 9 menstrual cycles, or 9 months.
In some people, skipping a dose of birth control can cause spotting. This is because missing a dose can trigger hormone withdrawal, leading to breakthrough bleeding.
This is not the case if you are spotting after receiving the Nexplanon implant, as the bleeding pattern you experience in the first 3 months of the implant typically continues. This is the most common side effect of Nexplanon.
You can take steps to make sure your contraceptive pill is working the best it possibly can to prevent both pregnancy and spotting. These include:
Being consistent: Create a schedule for taking your daily dose of medication. This can help prevent you from accidentally skipping a dose and helps your body maintain a consistent level of hormones.
Continuing your medication: Even if you start spotting, continuing your daily dose is important, especially if you have been taking the pill for fewer than 6 months, to allow your body to fully adjust to the hormones.
Check your medications: If a doctor prescribes you a new type of medication while you’re taking the contraceptive pill, be sure to check with them that it will not interfere with its effectiveness.
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No hormonal birth control method is 100% effective. This means it’s still possible to get pregnant while using these methods.
For example, if you use the contraceptive pill perfectly, it can be 99% effective, but this number is likely closer to 93% if you miss doses, according to Planned Parenthood. This means there is still a chance that you can get pregnant while taking the contraceptive pill.
Spotting can be a symptom of early pregnancy. In this case, it is known as implantation bleeding.
But other causes of spotting have nothing to do with contraception or pregnancy. A pregnancy test is a more reliable way to know whether pregnancy is the cause of your spotting.
Contraceptive types
Plenty of different hormonal birth control options are available. If you are having difficulty with one method, such as the strict dosage schedule that contraceptive pills require, there is likely to be another option that will work for you.
All of these methods can have spotting as a side effect. But because your body may react differently to different types of birth control, not all may cause spotting for you.
Speak with a doctor about the other types of hormonal birth control options you want to try. These can include:
Type
What is it?
Names
the implant
Hormonal implants are small, thin rods that a doctor inserts just below your skin’s surface. This rod will contain progestin, which is absorbed into your bloodstream over 3 years.
This is a small plastic ring that slowly releases estrogen and progestin locally into your reproductive system. Depending on the brand of ring you choose, you wear this ring for 3 weeks at a time, with a 1-week break between 3-week periods.
You can also try nonhormonal birth control options like condoms if you mainly use birth control to avoid pregnancy, although this isn’t the case for everyone.
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Summary
It is common to experience spotting in the first 3 months after starting the hormonal contraceptive pill. Taking the progestin-only pill may increase your chances of spotting, as well as smoking, having an infection, and taking certain medications that interfere with the pill’s effectiveness.
If the spotting does not stop or if it gets heavier, speak with a doctor.
Although birth control pills are safe and effective, they are not always the right match for everyone. You may be better suited to an alternative type of hormonal birth control, and you can work with a doctor to determine the next one to try.
