Spotting is common when first taking birth control pills. People can continue to take the pills but should seek medical advice if the bleeding does not stop after a few months.

Spotting will often subside with the continued and regular use of birth control pills. Anyone who is still experiencing spotting after a few months of taking the pill or is concerned about the bleeding should speak with a healthcare professional.

A doctor may recommend a different type of pill or investigate other possible causes of breakthrough bleeding.

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It is common to experience irregular bleeding, spotting, or breakthrough bleeding in the first several months of taking a new birth control pill.

It may take time for the pills to regulate the menstrual cycle, as the body needs to adjust to the new hormone levels. As a result, a person may still experience some irregular bleeding between periods initially.

Spotting with different pill types

There are two main types of birth control pills: combined estrogen-progesterone and progesterone-only. Some people take a third option, which is the continuous or extended-release pill.

About 27.5% of all contraceptive users in the United States take the combined pill.

According to The American College of Obstetricians and Gynecologists, about 4 in 10 women who use progestin-only pills keep ovulating.

A 2016 review cites research that suggests about 40% of people taking the progesterone-only pill will experience breakthrough bleeding at some point.

In addition, it states that unscheduled bleeding occurs in 30–50% of people during the first 3–6 months of starting to use a combined oral contraceptive, decreasing among 10–30% of these by the third month of use.

The bleeding should decrease and stop after this unless there is another cause.

Possible causes

While bleeding changes and spotting with the birth control pill often get better, it is not clear that they resolve for every person taking the medication.

Doctors do not fully understand why spotting occurs on birth control pills. One possible reason is that an increase in progestin leads to changes in the lining of the uterus, called the endometrium.

Progestin may thin the endometrial lining, which can cause some bleeding initially. A thinner lining helps prevent pregnancy, as a fertilized egg cannot implant as effectively.

Other potential causes of spotting while on the pill include:

  • Forgetting to take a pill: Spotting may occur if a person forgets to take their pill for a day or more.
  • Taking a new medication: Some drugs interfere with the effectiveness of birth control pills. This includes a few antibiotics, such as rifampin. Although most antibiotics should not have this effect, a person with a new prescription for an antibiotic or another medication will need to check whether it may affect their birth control pills.
  • Infection: Yeast infections or sexually transmitted infections (STIs) can lead to irritation and inflammation of the uterus or cervix.
  • Vomiting or diarrhea: The body may not have had time to absorb the hormones in the pill before losing it when a person vomits or experiences diarrhea.
  • Pregnancy: The pill is not 100% effective in preventing pregnancy. Therefore, it is possible that a person could experience implantation bleeding or spotting as a result of the implantation of a fertilized egg in the uterus.

If a person has taken birth control pills for more than a few months and still experiences spotting, this may indicate an underlying condition.

Some underlying conditions that can cause spotting include:

Other contributing factors may include:

  • smoking
  • not taking birth control pills consistently or according to a doctor’s instructions
  • use of a continuous dose or extended-release pill
  • taking emergency contraception

However, most of the time, spotting occurs because the levels of hormones in birth control pills are not high enough to prevent occasional bleeding. The body may require more estrogen, which thickens the uterine lining and may reduce the likelihood of bleeding and spotting.

Alternatively, the body may not respond as effectively to the synthetic progestin in the pills, allowing spotting to occur.

Neither of these issues is necessarily cause for concern. However, both could indicate that an individual may benefit from trying another pill type.

People can adopt habits that can maximize a pill’s effectiveness and help prevent spotting, such as:

  • taking the pill at the same time every day to help maintain consistent hormone levels in the body
  • continuing to take birth control pills regularly even if there is some spotting, as a person’s body may take up to 6 months to adjust to the medication fully
  • checking any other medications to ensure they do not interfere with the effectiveness of the birth control pill

If it has been longer than 6 months and spotting still occurs, switching to a different type of pill may help.

Spotting may be light enough that a person does not have to wear a pad or tampon. However, some people may wish to wear a thin panty liner to avoid staining clothing. Using a tampon for a light or regular flow can also help.

According to the American College of Obstetricians and Gynecologists, spotting can happen with any hormonal contraception, including:

However, spotting is most common when a person uses:

  • low dose birth control pills
  • a birth control implant
  • hormonal IUDs

A doctor can help if the spotting is connected to birth control use. They can also help identify other possible causes of unexpected bleeding.

While some people take birth control pills for decades without any problems, others experience adverse side effects.

A person should call a healthcare professional if they experience any of the following:

If a person is still experiencing spotting after taking the pill for 6 months, a doctor may wish to change their prescription. Several different types and brands of birth control pills are available.

The doctor may prescribe a pill with a higher estrogen dose or one with a different progestin formulation.

Infection signs

People can also look out for possible signs and symptoms of an infection. In addition to spotting, these can include:

If a person has an infection, they will likely require treatment, such as antibiotics.

Birth control pills use progestin, which is an artificial form of the hormone progesterone. It works to prevent pregnancy in a few ways:

  • by stopping ovulation, which is when the ovary releases an egg
  • by thickening the mucus of the cervix, making it harder for sperm to enter the uterus
  • by thinning the lining of the uterus

Estrogen also interrupts the work of hormones that prepare the body for pregnancy.

Those who take the combined birth control pill experience effects from both progesterone and estrogen.

Common side effects of birth control pills

Some people experience side effects from estrogen-progesterone or progesterone-only birth control pills. Some of these include:

These effects generally decrease within 3 months of being on a birth control pill. If they do not, a doctor can prescribe a different type of birth control.

Below are answers to some common questions about spotting on birth control.

Can spotting while on birth control indicate pregnancy?

Spotting is an early sign of pregnancy but can have other causes. Therefore, there is no reason to assume spotting while on birth control means a person is pregnant.

Does spotting mean the pill is not working?

Spotting does not mean that birth control is not working as it should. Spotting is possible with any kind of hormonal birth control. Several risk factors make spotting more likely, such as using an ultra low dose birth control pill, smoking, or inconsistent dosing.

What color is spotting on birth control?

Although some people experience heavier bleeding, spotting on birth control is just a small amount. It can appear as red as regular menstrual blood, or it could appear as a brown smudge.

How long does spotting last on birth control?

Spotting on birth control should settle within 6 months. If spotting lasts any longer than this, a person may wish to talk with a doctor about changing their birth control.

Spotting on the pill is likely to occur in the first 6 months of starting hormonal birth control. If it occurs after this time or there are symptoms of infection, it is best to speak with a doctor for further evaluation.

They may prescribe a different type of pill or recommend nonhormonal birth control methods instead.