Breakthrough bleeding between your periods can be a very normal thing. You may also refer to it as “spotting” and it can have many different causes. Most women claim they have had spotting at least one time if not more.

For the most part, breakthrough bleeding is nothing to worry about if you can explain why it happened. If the cause cannot be explained, it could be a sign that something isn’t right with your body and you should contact your physician. This article will help you understand it better and how to manage it.

What Is Breakthrough Bleeding?

Breakthrough bleeding refers to spotting in between periods. It normally occurs during the middle of the cycle and common in women who use birth control pills that do not contain enough estrogen. However, it can occur with any form of birth control. Bleeding while on the pill is normally just light “spotting,” but can be heavier at times like a period. After your body adjusts to birth control, it usually goes away on its own.

When breakthrough bleeding cannot be explained, it is called metrorrhagia. Abnormal breakthrough bleeding is usually heavier than spotting and does not let up. This type of bleeding is not normal and needs to be evaluated.

What Causes Breakthrough Bleeding?

There can be many reasons for breakthrough bleeding, but the most common cause is over thickening of the lining of the uterus. It is usually harmless and often causes periods that are longer than normal. The period may stop for a few days and then start up again.

Another cause is spotting during ovulation. This is due to a small release of blood from the ovary when the follicle breaks free. This too is harmless, normal, and nothing to worry about. If the egg is fertilized after ovulation, there may also be some spotting as it implants itself into the uterine lining.

This issue may be due to your own natural hormonal cycles. Your body releases a certain amount of estrogen on a daily basis, along with FSH, LH, and Progesterone. If something gets thrown off with your natural hormonal cycles, you may experience breakthrough bleeding.

One reason your natural hormonal cycle gets thrown off is the use of birth control pills. You make your own estrogen and when you add more or don’t get enough estrogen then mid-cycle bleeding can occur. This is very normal with the first few months after starting the pill and usually goes away as the body adjusts.

Lastly, if you suffer from absent menstrual periods (amenorrhea) then breakthrough bleeding can happen. This is due to an abnormality in the lining of the uterus where it fails to build up properly during the cycle. You may miss your period and then bleed in the middle of the cycle rather than during your monthly period.

Here are some other common reasons:

  • Forgetting one or two birth control pills during a cycle
  • Smoking can lower your estrogen level and cause breakthrough bleeding
  • Low-dose contraceptives may contain too little hormones and cause bleeding
  • Sexually transmitted disease can cause spotting
  • Reproductive system cancers can cause bleeding between periods
  • Polycystic ovarian syndrome (chronic ovarian cysts)
  • Anti-depressant, Anti-seizure, and Steroid medications can all cause irregular bleeding

How to Deal with Breakthrough Bleeding

If you find that you have bleeding between your periods and you are not on birth control, see your doctor for an evaluation to make sure it isn’t a sign of something serious. If you have spotting on the pill, it almost always clears up in a few months after your body adjusts. If it does not you may need to talk to your doctor about stronger birth control pills.

One important thing to remember is to take your pills at the same time every day. If the level of hormone drops in your body even after a few hours, breakthrough bleeding can occur. Take all of your pills in the pack, even the ones that contain no hormone at the end of the month. This will help you remember to take your pills every day.

Here are some other important tips to prevent breakthrough bleeding:

  • Take your pills every day. If you consistently forget to take your pills and you get breakthrough bleeding, you raise the risk of getting pregnant on the pill.
  • Journal bleeding. Keep track of your periods on a calendar and note any days that you have breakthrough bleeding. This can help you identify any issues.
  • Talk to your doctor about a “pill-break.” If the breakthrough bleeding does not let up, your doctor may have you stop your pills for a few days to allow a normal period. Then have you start again consistently for another 21 days.
  • Quit smoking. It is important for your health and to prevent breakthrough bleeding to stop smoking.

If you suffer bleeding between periods and are not on the pill, your doctor may suggest taking the pill to regulate your periods better. If you are on the pill with breakthrough bleeding, discuss other methods of birth control with your doctor.

Medical Treatments for Breakthrough Bleeding

You are unable to control breakthrough bleeding on your own, you need to see your doctor for help. There are some medical treatments that can stop heavy bleeding between periods or help regulate your cycles better. These include:

  • Medications.Doctors will usually attempt to regulate any heavy mid-cycle bleeding with medications first. They includebirth control pills that contain both estrogen and progesterone, inserting an IUD (intrauterine device), plain estrogen, or a new drug known as Lysteda.
  • Surgical procedures.If bleeding is unable to be controlled with medications, surgery may be needed. These procedures may render you permanently infertile. They includeHysterectomy (removing the uterus and/or both ovaries), endometrial ablation where the lining of the uterus is cauterized and rendered permanently inactive.