What Is Breakthrough Bleeding?

Breakthrough bleeding is menstrual bleeding that happens outside the normal time frame of a menstrual period.
Medical evaluation may be necessary if breakthrough bleeding is heavy.
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  • Written By: Madeleine A.
  • Edited By: W. Everett
  • Last Modified Date: 20 December 2014
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Typically, breakthrough bleeding refers to the spotting or bleeding that happens when the body is adjusting itself to hormonal dosages from the use of contraceptives. In addition, breakthrough bleeding is menstrual bleeding that happens outside the normal time frame of a menstrual period, and the pattern is influenced by the method of the birth control itself. Generally, breakthrough bleeding can occur at different stages of using birth control, such as at the start of the regime, or when attempting to switch brands. Most of the time, however, the bleeding ceases on its own, and usually only lasts for one or two cycles. For most, the bleeding is only a light spotting, however, it can be heavy.

Not all women who use hormonal contraception experience breakthrough bleeding, but it is more frequently seen in smokers. The hormones that are responsible for breakthrough bleeding are progesterone and estrogen, either taken alone or taken as a combination. Although contraceptive hormones are frequently taken in the oral form, breakthrough bleeding can occur when the hormones are used in other forms. Different forms of hormonal contraception are subcutaneous implantation of a birth control device, injection, and patches, In addition, devices can be placed directly into the vagina, such as a vaginal ring contraceptive device.


While breakthrough bleeding is usually the result of the body regulating itself in response to the absorption of estrogen and progesterone, there are other causes of breakthrough bleeding as well. Even in the absence of hormonal methods of birth control, natural levels of circulating hormones can fluctuate, causing bleeding. In addition, a decline in thyroid function can also cause this occurrence, as can dietary changes and fluctuations in weight. Sometimes, medications such as anticoagulants can be responsible for abnormal uterine bleeding because they interfere with platelet aggregation, which causes the blood to become thinner.

Generally, treatment for abnormal uterine bleeding depends upon the cause. If bleeding is related to birth control, the physician may adjust the hormonal amounts given, or switch the patient to a different contraceptive method altogether. The physician may also recommend that the patient quit smoking, in attempt to reduce or eliminate bleeding in between periods.

Typically, if the abnormal bleeding or spotting worsens or is accompanied by pain, vaginal discharge, or weakness, it may indicate a more serious medical condition. Usually, in this case, it may be recommended that the patient undergo further medical evaluation. Doctors will want to rule out infection, abnormal thyroid function, or even a gynecological malignancy.


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