Breakthrough Bleeding: Causes & How to Cope With

Breakthrough bleeding, also known as spotting, refers to abnormal menstrual bleeding that takes place during times other than at menses. Although bleeding between normal periods may be inconvenient and frustrating, it is rarely dangerous.

Vaginal bleeding is caused when the endometrium or inner lining of the uterus sheds into the uterine canal and is passed out through the vagina. There are many triggers for breakthrough bleeding, but nearly all can be attributed to fluctuating hormonal levels. Irregularity in the body’s levels of luteinizing hormone, follicle stimulating hormone, estrogen and progesterone can all lead to irregular bleeding, since these are the hormones responsible for regulating endometrial shedding.

These hormonal fluctuations can be caused by pregnancy, ovulation, oral contraceptives or even stress. Smokers who are taking oral contraceptives tend to be more susceptible to spotting than non-smokers. Typically cessation of abnormal bleeding takes longer in smokers than those who do not smoke. This is likely due to lowered levels of estrogen, which have been associated with smoking. Excess body weight has also been associated with irregular bleeding.

What Are The Causes Of Breakthrough Bleeding

The most common cause of bleeding between periods in the use of oral contraceptives. Initial use of birth control pills or changes in the type or frequency of pills taken commonly result in irregular menstrual bleeding. This is due to thinning or atrophy of the endometrial walls as the body’s natural hormone levels are replaced by the lower hormone levels provided in the contraceptives.

Fibroid tumors which are benign tumors that form specifically on the interior uterine walls can also be a common cause of spotting. The presence of fibroid tumors can be detected by a medical professional. Detection of tumors should be followed by a PAP smear procedure to determine the nature of the tumors and rule out potential malignancies. Non-malignant (fibriod) tumors are most common between the ages of thirty and fifty and will typically recede at menopause.

Is it Normal While I’m Pregnant?

In short, yes it can be completely normal for some to have breakthrough bleeding while pregnant.

The key to determining if your bleeding is ok, in your particular case, is to look at it. The amount of bleeding that occurs can range from a little as a few drops, to a much heavier flow resembling a menstrual period. The color of blood can also vary from a yellow straw-like color to reddish to brown. Bright red bleeding that is enough to fill a pad or is accompanied by cramps or any other new or unusual symptoms, could be a sign that something more serious is going on and you should see a doctor.

Many women worry about the likelihood of miscarriage when bleeding is first discovered. While bleeding during pregnancy can be a sign of an impending miscarriage, this is not always the case. It is estimated that anywhere from 5-10 percent of women have bleeding during early pregnancy with no known cause, and these women eventually go on to have completely normal and healthy pregnancies.

In the past, the most common solution for bleeding during early pregnancy was bed rest, however the latest research now shows that most bleeding will usually resolve on its own, and that if bleeding does turn out to be caused by a miscarriage, bed rest will unfortunately not prevent it.

Is it Normal When I’m On Birth Control?

There are many reasons why you may be experiencing breakthrough bleeding:

  • When starting birth control for the first time or switching to a new birth control it takes your body a little while to get use to the hormones, so it self corrects until everything gets in sync.
  • Take your birth control incorrectly. We all forget to take our pill from time to time. However if you miss enough doses and your body no longer has the hormones needed, you may throw yourself off balance until you start taking your pills on schedule again.
  • Medications that may interfere with their birth control. Antibiotics or other prescriptions can make your birth control pill less effective, the best way is to speak to your doctor and let him/her know what medications you are taking.

How to Deal With

There are many things that you can do to cope with your bleeding until it resolves:

  • 1. The first important step is to accept what is going on, that it is not harmful, and it will take time to resolve.
  • 2. Make sure you are prepared. While not harmful long term, bleeding will take both a physical and an emotional toll on your body and mind.
  • 3. Make sure you manage the symptoms, have supplies with you at all times and make sure that your use of tampons is within the safe range as long term use can have potential health complications.
  • 4. Control what you can. Taking your birth control pill at different times or missing doses can contribute to the bleeding, so make sure you are taking the pills on schedule.
  • 5. Quit smoking. Smoking can lead to an increase in bleeding and many other health complications.

Things that you should seek professional consultation:

  • If you are taking oral contraceptives and after a few months your bleeding continues you should consult your prescribing physician to look at a potential change in dose or type of pill.
  • If you are or believe you are pregnant and begin to have bleeding seek medical help immediately.
  • If you have pain, nausea, yellow or brown vaginal discharge or vomiting that accompanies your bleeding you should also seek medical attention.

Better To Be Safe Than Sorry With Breakthrough Bleeding

Most women are likely to suffer from irregular bleeding at some time in their lives. Many will not seek a solution to ease their symptoms, particularly if the bleeding is intermittent and ceases within a few months or if the cause is known. Consulting a health care professional is advised when bleeding is either heavy or does not resolve by itself, since this could signal more serious medical issues. Your doctor can advise you on how best to deal with the causes and symptoms of breakthrough bleeding.