Bleeding on birth control

Usually expected

Spotting is common in the first three months of the pill, patch, ring, hormonal IUD, implant, or injection. With the implant and injection, irregular bleeding can continue longer.

Things that make it more likely

• Missed or late pills, or a patch or ring used off schedule
• Smoking
• Medications that lower hormone levels, including some seizure medicines, rifampin, and St. John’s wort
• Vomiting or diarrhea that affects pill absorption

When to get it checked

• Bleeding that is still happening after three months on a method
• Bleeding that starts after months of a stable pattern
• Heavy bleeding, pain, fever, or unusual discharge
• Bleeding after sex
• Any chance you are pregnant

Evaluation often includes a pregnancy test and testing for chlamydia and gonorrhea, which commonly cause spotting. There are effective ways to reduce breakthrough bleeding, including adjusting or switching the method. Do not stop a method without a backup plan if you need contraception.