When to expect a time after breakthrough bleeding

Everything you need to know about breakthrough bleeding

Breakthrough bleeding refers to vaginal bleeding or spots that occur between menstrual periods or during pregnancy.

The blood is usually either light red or dark red-brown, similar to the blood at the beginning or the end of a period. However, depending on the cause, it may resemble normal menstrual blood.

Breakthrough bleeding is common in women using the pill or another form of birth control, such as an intrauterine device (IUD). However, many medical conditions can also cause irregular vaginal bleeding. If you are not sure of the cause, you should consult a doctor.

In this article, we examine some of the most common causes of breakthrough bleeding, as well as management strategies and when to seek professional advice.


The following factors can cause breakthrough bleeding in women who are not pregnant:

  • hormonal contraception
  • IUDs
  • Infections
  • Fibroids

Hormonal contraception

Women who use hormonal birth control often experience breakthrough bleeding, especially if they have recently switched contraceptive methods. Breakthrough bleeding can take several months as the body adapts to the new form of birth control.

Breakthrough bleeding is also common in women who abuse birth control pills to skip their periods.

Monthly packs usually contain 3 weeks of hormonal pills and an additional week of placebo pills. During this last week, a period occurs because the person is not on contraceptive hormones.

Some women want to skip their periods. You can take hormonal pills for 3 weeks and then start hormonal pills immediately for another 3 weeks. Most doctors believe this is safe for up to 3 months at a time.

Other hormonal contraceptives, some of which contain ethinylestradiol and levonorgestrel, increase the amount of time between periods. For example, a person taking this drug may have a period every 3 months. This method of birth control is also likely to cause breakthrough bleeding.

Women taking hormonal contraceptives are more likely to have breakthrough bleeding if they:

  • miss a pill or take one at a different time
  • are sick, especially if they have vomiting or diarrhea
  • start new drugs


IUDs are popular forms of birth control. No daily pill is required and a device can work for several years.

Hormonal IUDs release a contraceptive called progestin, while copper IUDs prevent pregnancy without the use of hormones. Both types cause changes in the menstrual cycle, and any such disorder can lead to breakthrough bleeding.

This bleeding is especially common in the first 3 months after the IUD is inserted.


The following infections and conditions can cause breakthrough bleeding:

  • sexually transmitted infections (STIs), such as chlamydia or gonorrhea
  • Vaginitis
  • pelvic inflammatory disease

Infection can cause additional symptoms. These can include:

  • cloudy urine
  • Pelvic pain
  • unusual smell
  • abnormal discharge
  • Burning sensation in the pelvis
  • Painful intercourse
  • heavy periods

Most of all, the problems require medical intervention.


Endometriosis occurs when tissue similar to the lining of the uterus grows elsewhere in the pelvic area. This tissue can develop in the ovaries or fallopian tubes, or around the bladder or intestines.

Endometriosis causes a number of symptoms, including:

  • severe pain during menstruation
  • Pelvic pain, if not menstruating
  • Pain during sex
  • Nausea during a period
  • Constipation or diarrhea during a period
  • Bleeding or spotting between periods

This pain can be so severe that a person cannot engage in regular activities.

Endometriosis can also make it difficult to get pregnant.


Uterine fibroids are abnormal growths that form in or around the uterus. There are many causes including genetics and hormones.

Some people with uterine fibroids have no symptoms. Others experience breakthrough bleeding. Additional symptoms include:

  • Pelvic pressure and pain
  • heavy periods
  • frequent urination
  • constipation
  • Back pain
  • Leg pain
  • incomplete emptying

Fibroids can be very small or large enough to deform the uterus.

Breakthrough Bleeding During Pregnancy

Up to 30 percent of people who were pregnant experienced breakthrough bleeding in the early stages.

This can mean:

  • a sensitive cervix
  • Implantation bleeding
  • subchorionic hematoma
  • a miscarriage or ectopic pregnancy

Whenever vaginal bleeding occurs during pregnancy, consult a doctor.

Sensitive cervix

The cervix is ​​at the base of the uterus. It becomes softer and more sensitive during pregnancy. Sexual intercourse and vaginal exams are more likely to cause irritation.

If bleeding from the cervix is ​​unrelated to sexual intercourse or an examination, it could be a sign of cervical insufficiency. This happens when the cervix begins to open before the baby is fully developed, which increases the risk of premature birth.

Implantation bleeding

This happens when the fertilized egg is first implanted in the uterus.

Implantation bleeding typically occurs 6-12 days after conception and a few days before the first missed period.

This bleeding is often so small that no tampon or pad is needed. Many people with implantation bleeding are still unaware that they are pregnant.

Subchorionic hematoma

This happens when the placenta separates from the original implantation site. The resulting bleeding can be light or heavy.

Subchlorionic hematomas are often harmless, but a doctor should evaluate bleeding during pregnancy.

Miscarriage and ectopic pregnancy

Even heavy bleeding doesn't always lead to a miscarriage. According to the American Pregnancy Association, about 50 percent of women who experience bleeding in the first trimester of pregnancy have not failed.

A miscarriage occurs when a pregnancy stops on its own within the first 20 weeks. After 20 weeks this is called stillbirth. As many as 25 percent of pregnancies result in miscarriages.

Ectopic pregnancies are much less common and occur when an embryo is implanted in a fallopian tube instead of the uterus.

Bleeding from a miscarriage or ectopic pregnancy can be severe and accompanied by abdominal cramps.

Ectopic pregnancies can be very dangerous if not treated right away. If a person suspects they may have an ectopic pregnancy, they should seek immediate medical care.

When to see a doctor

Breakthrough bleeding may not be a cause for concern. It is often a birth control side effect or cervical spine irritation. Minor causes of breakthrough bleeding usually resolve without medical intervention.

However, consult a doctor if other symptoms accompany breakthrough bleeding. Problems like STIs or fibroids can lead to complications if left untreated.

If you experience unexplained vaginal bleeding during pregnancy, see a doctor. In some cases, bleeding can simply indicate a tender cervix, although it can indicate a more serious problem.


Treatment for breakthrough bleeding usually depends on the cause. Mini pads or tampons provide all of the management required.

In the event of infection, a doctor will prescribe antibiotics or other medication. If birth control is causing the bleeding, a doctor may recommend a different brand or method.

A doctor will recommend medication and, occasionally, surgery to treat fibroids and endometriosis.

Often times, cervical irritation does not require treatment. If a person has a subchorionic hematoma, they will likely be monitored by a doctor and may recommend bed rest.

If the bleeding is the result of a miscarriage, a doctor will perform a procedure called dilation and curettage to remove tissue.

An ectopic pregnancy may require surgery.


While breakthrough bleeding is usually not a cause for concern, talk to a doctor if bleeding occurs during pregnancy.

If a person bleeds between periods, their birth control method may be responsible. Or they have an infection. Consult a doctor if this bleeding is common, severe, or otherwise causing discomfort.