How long does spotting last after starting birth control

Is breakthrough bleeding more common with extended-cycle birth control pills, such as Seasonale and others?

Answer From Tatnai Burnett, M.D.

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Is breakthrough bleeding more common with extended-cycle birth control pills, such as Seasonale and others?
From Mayo Clinic to your inbox
Is spotting longer than 7 days on birth control normal?
How can I stop spotting immediately on birth control?
Why am I spotting for so long on birth control?

Spotting or bleeding between periods (breakthrough bleeding) can occur with any birth control pill, especially during the first few months of use. However, breakthrough bleeding is more likely with continuous and extended-cycle regimens than with the traditional 28-day schedule. Breakthrough bleeding can also occur when taking normal 28-day birth control pills in a continuous manner.

What causes breakthrough bleeding with oral contraceptives isn't always clear. It may simply take time for your body to adjust to the hormones in the pill or for your uterus to transition to a thinner lining (endometrium).

You're more likely to experience breakthrough bleeding if you:

Miss a pill
Start a new medication, such as certain antibiotics, or take supplements, such as St. John's wort, that may interfere with the contraceptive
Become ill with vomiting or diarrhea, which may impair absorption of the medication

Unpredictable bleeding resulting from the use of continuous or extended-cycle birth control pills usually decreases with time. In the meantime:

Continue taking the medication as directed. Breakthrough bleeding isn't a sign that the pill isn't working. If you stop taking it, you risk unplanned pregnancy.
Track breakthrough bleeding in a calendar or diary. Typically, careful tracking offers reassurance that breakthrough bleeding is decreasing.
Ask your health care provider about taking a short pill-free break. If you've taken active pills for at least 21 days, your provider may suggest that you stop for three days to allow bleeding that resembles a period and then take the pill again for at least 21 days.
If you smoke, ask your health care provider to help you quit. Women who smoke are more likely to experience breakthrough bleeding than are women who don't smoke.

If breakthrough bleeding becomes heavy or lasts more than seven days in a row, contact your provider. There may be another possible cause for the bleeding, such as an infection. Depending on the circumstances, your provider may recommend an alternative method of contraception.

With

Tatnai Burnett, M.D.

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Dec. 24, 2021

Edelman A, et al. Evaluation and management of unscheduled bleeding in women using contraception. https://www.uptodate.com/contents/search. Accessed Nov. 18, 2019.
Jolessa (prescribing information). Teva Pharmaceuticals USA; 2018. https://www.tevagenerics.com/product/jolessa-levonorgestrel-ethinyl-estradiol-tablets. Accessed Jan. 28, 2020.
AskMayoExpert. Contraception. Mayo Clinic; 2019.
Nappi RE, et al. Cycle control with an extended-regimen oral contraceptive combining levonorgestrel and ethinyl estradiol that includes continuous low-dose ethinyl estradiol instead of the traditional hormone-free interval. International Journal of Women's Health. 2017; doi:10.2147/IJWH.S142078.

See more Expert Answers

A: Irregular bleeding is the most common side effect of birth control pills. It is especially common during the first three months as your body adjusts to the hormones in the medication. However, other things (like sexually transmitted infections) can cause prolonged bleeding too. If the bleeding is especially heavy (more than a normal period), persists throughout the whole month or occurs only with intercourse – especially if you’ve stopped using condoms – you should see your women’s health care provider to make sure nothing more serious is going on.

The most common cause of irregular bleeding is missed pills, so make sure you are taking the pill every day, and at the same time every day.

Birth control pills can cause a lot of other side effects, especially bloating, nausea and breast tenderness. Most side effects resolve after a few months, but the clinicians in our Women’s Services Department usually recommend that you check in with your health care provider after your first 3 months on the pill to make sure everything is going OK. If you have any questions or concerns about birth control, they’re happy to answer them for you.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Is spotting longer than 7 days on birth control normal?

How can I stop spotting immediately on birth control?

How to stop breakthrough bleeding on the pill immediately? The best way to resolve breakthrough bleeding is to go off of the pill for a week. This will reset your uterus. Then, resume taking birth control, and the bleeding should go away.

Why am I spotting for so long on birth control?

Spotting is an extremely common side effect for people taking birth control pills. These episodes are also known as “breakthrough bleeding” and can occur when pills aren't taken at the same time every day, as your body gets used to a new pill, or in a variety of other situations.