Why you may be spotting on birth control

Key takeaways: 

• ‘Spotting’ is a light amount of irregular bleeding that can occur between periods
• This is usually experienced in the first few months of starting a new birth control method, and should subside over time 
• If you continue spotting several months after switching to a new birth control method, experience spotting after sex, or your spotting becomes more heavier, it’s important to schedule a check-in with an in-person healthcare provider 

Birth control pills can sometimes cause abnormal vaginal bleeding or ‘spotting.’ Spotting is bleeding that is lighter than a period, and happens when you’re not expecting your period. The birth control methods that can lead to spotting are usually the ones that contain very little or no estrogen. 

Estrogen-free, progestin-only methods include progestin-only birth control pills (sometimes called mini-pills or POPs), the birth control shot, the birth control implant, and the hormonal IUD.

Estrogen helps to stabilize the lining of the uterus (the endometrium). When there isn’t as much estrogen around, the endometrium can shed a little bit at a time, causing spotting. Spotting is more likely to happen if you have just started using a particular birth control method, while your body is adjusting. If your spotting is minimal, it may be a good idea to try to ride it out for three months before stopping or switching methods.

Forgetting to take a birth control pill can also cause spotting, and you may also experience irregular bleeding if you have skipped periods by skipping the placebo week in your birth control pack, or are taking extended cycle birth control pills like Jaimiess®. 

What causes spotting on birth control?

Spotting is one of the most common side effects people experience when starting a new hormonal birth control method, especially during the first few months of use. While it can be inconvenient or even concerning, spotting is usually harmless and temporary.

One of the most common reasons for spotting is starting a low-estrogen or progestin-only method, such as:

• The mini-pill (progestin-only pills)
• The birth control implant (Nexplanon®)
• The hormonal IUD (like Mirena®)
• The birth control shot (Depo-Provera®)

These methods don’t contain much (or any) estrogen, which plays an important role in stabilizing the uterine lining. Without it, the lining may shed in small amounts throughout your cycle, leading to unexpected light bleeding.

Other common causes of spotting include:

• Starting a new method: Your body needs time to adjust. Spotting during the first two or three months is very common.
• Missed or late pills: Inconsistently taking the pill—even by a few hours—can disrupt hormone levels and lead to spotting.
• Extended-cycle or continuous birth control: If you’re skipping placebo weeks or taking an extended-cycle pill like Jaimiess®, it can take time for your body to adapt to the lack of a scheduled bleed.
• Switching methods: Transitioning between birth control types can also trigger spotting as your hormone levels rebalance.

While occasional spotting isn’t usually a cause for concern, it’s important to stay consistent with your method and give your body time to adjust. If spotting continues past the three-month mark or becomes heavy or bothersome, it’s worth checking in with a provider.

When is spotting considered normal?

Spotting is often a normal part of starting a new birth control method, especially within the first one to three months. During this adjustment period, your body is getting used to new hormone levels, which can temporarily disrupt the regular shedding of your uterine lining.

It’s helpful to know that spotting is not the same as a period. Spotting is light bleeding that can happen at any point in your cycle. It’s usually lighter in flow and shorter in duration than your typical menstrual cycle, and it doesn’t follow your usual menstrual schedule. You might notice it as pink or brown blood when wiping or small amounts on a panty liner.

Spotting is considered normal if:

• You’ve recently started or switched birth control
• You’re using a low-estrogen or progestin-only method
• You’re on an extended-cycle or continuous-use pill regimen
• You occasionally miss a pill or take one late

If the spotting is very light and goes away within a few days, it’s likely nothing to worry about. But if it continues beyond three months, becomes heavier, or is accompanied by pain or other symptoms, it’s a good idea to reach out to a healthcare provider.

At Nurx, we’re here to help you understand what’s normal—and what’s not—so you can feel confident in your birth control plan.

Solutions to manage spotting

Spotting can be frustrating, especially when you’re adjusting to a new method. The good news? In most cases, it’s temporary, and there are effective ways to manage it.

Give it time

Spotting is especially common during the first 2–3 months of starting or switching birth control. Your body is adapting to new hormone levels, particularly if you’re using a low-estrogen or progestin-only method like the mini pill, implant, shot, or hormonal IUD. If the spotting is light and not accompanied by other symptoms, it’s usually okay to wait it out.

Take your birth control pills consistently

If you’re taking birth control pills, one of the best ways to minimize spotting is by taking it at the same time every day. Inconsistent timing—or missing doses—can lead to hormone fluctuations that trigger breakthrough bleeding.

Be mindful when skipping periods

Some people choose to skip the placebo week on combination pills to avoid having a period. This can cause spotting, especially at first. Over time, many find that their body adjusts. If you’re skipping periods regularly, it helps to do so with a pill designed for continuous use, or speak to a provider about how to do it safely.

Consider a different method

If spotting continues after a few months, it might be worth switching to a birth control method with slightly higher estrogen. Estrogen helps stabilize the uterine lining, which can reduce or stop spotting altogether.

When to see a healthcare provider

Spotting while using birth control is common—especially in the first few months as your body adjusts—but in some cases, it can be a sign of something more. Here’s when it’s worth checking in with a provider:

Spotting after months of stable use

If you’ve been taking the pill continuously (and correctly) for a while and suddenly notice spotting, it may be your body responding to something new, like stress, an illness, or another medication. Still, unexpected bleeding after a long period of stability in hormonal contraception is worth mentioning to a provider, especially if it persists.

Spotting after sex

Light bleeding after sex could be caused by friction, but it might also point to cervical irritation or infection. If it happens frequently or is accompanied by pain or unusual discharge, schedule an in-person check-in with your healthcare provider.

When spotting becomes heavier or lasts too long

Spotting that becomes heavier, continues for more than a week, or feels more like a full period may indicate that your current method isn’t the right fit, or that something else is going on.

Other causes to be aware of

• Infection: Spotting paired with pelvic pain, itching, or discharge could signal an infection that needs treatment.
• Pregnancy: While unlikely with consistent birth control use, spotting can sometimes be an early sign of pregnancy, especially if you’ve been inconsistent with your birth control method.
• Stress: High stress can affect your hormones and throw off your cycle, even while on birth control.

If you’re unsure why you’re spotting—or think it’s time to explore a different method—Nurx is here to help. 

Take the guesswork out of spotting

Spotting on birth control is common—especially when starting a new method or using options with lower estrogen—but that doesn’t mean it’s not frustrating. While most spotting is temporary and nothing to worry about, ongoing or unexpected bleeding can be a sign that your body needs a different approach.

The good news? You don’t have to figure it out alone. Whether you’re adjusting to a new method, curious about switching, or simply want to feel more confident in your birth control plan, Nurx makes it simple to get expert support from the comfort of home.

Our licensed medical team is here to help you find the birth control that fits your body, your lifestyle, and your goals—no waiting room required. Start your online consultation with Nurx today.

Frequently Asked Questions (FAQ):

How do you fix spotting on birth control?

Spotting often improves on its own after a few months, especially when starting a new method. Staying consistent with your pill schedule, avoiding placebo weeks if you’re skipping periods, or switching to a method with more estrogen can help. If spotting persists, check in with a healthcare provider to explore your options.

Why have I suddenly started spotting on the pill?

Sudden spotting on the pill can happen if you’ve missed a dose, taken your pill late, or changed brands. It can also occur due to stress, illness, or interactions with other medications. If your spotting continues or seems unusual, it’s a good idea to speak with a medical provider.

What color is breakthrough bleeding on the pill?

Breakthrough bleeding is usually light pink, brown, or rust-colored, lighter than a regular period. It may look like spotting or light discharge and typically isn’t a cause for concern, especially in the first few months of pill use.

The information provided is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon this content for medical advice. If you have any questions or concerns, please talk to a medical professional.

Services not offered in every state. Medications prescribed only if clinically appropriate, based on completion of required consultation. Individual results may vary.

Not all options discussed in the blog are available through Nurx. Please see Nurx.com for details.

Jaimiess® (levonorgestrel 0.15mg/ ethinyl estradiol 0.03mg and ethinyl estradiol 0.1mg), Rx only, is an oral contraceptive used to prevent pregnancy. This drug may cause side effects, including headaches, irregular and/or heavy uterine bleeding, dysmenorrhea, nausea and/or vomiting and back pain. Important drug safety and benefits information on [Jaimiess® can be found here.  You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch  or call 1-800-FDA-1088.”

Mirena® is not available via Nurx. Learn more at www.mirena-us.com. Depo-SubQ Provera® 104 may be prescribed by a Nurx-affiliated provider, but is not fulfilled through a Nurx pharmacy. All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx.

Depo-SubQ Provera 104® (medroxyprogesterone acetate injectable suspension, 104mg/0.65mL for subcutaneous use), Rx only, is used as contraception to prevent pregnancy. This drug may cause side effects, including dysfunctional uterine bleeding (irregular, increase, decrease, spotting), headache, and weight gain. If you would like to learn more, see full prescribing information, here. You are encouraged to report negative side effects to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Nexplanon® is not offered through Nurx. Learn more at nexplanon.com. All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx.

Nexplanon® is a highly effective birth control implant, but it should not be used if you’re pregnant, have a history of blood clots, liver disease, breast cancer, or unexplained vaginal bleeding. After insertion, you should be able to feel the implant—if not, use backup birth control and contact your provider. The most common side effect is changes in your bleeding pattern, but other possible effects include headaches, weight gain, mood changes, and acne. Rare but serious risks include blood clots and ectopic pregnancy. NEXPLANON does not protect against HIV or other STDs.