Is breakthrough bleeding more common with extended-cycle birth control pills, such as Seasonale and others?
Answer From Tatnai Burnett, M.D.
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. //www.uptodate.com/contents/search. Accessed Nov. 18, 2019.
- Jolessa (prescribing information). Teva Pharmaceuticals USA; 2018. //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
See also
- Birth control pill FAQ
- Can birth control pills cause birth defects?
- Choosing a birth control pill
- Delaying your period with hormonal birth control
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Q: Is it natural to have prolonged periods after just starting birth control? I started taking the pill when I started my period and it still persists. 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