When taking birth control, some individuals may experience bleeding more frequently than expected, leading to concerns about having a “period twice a month.” This is often not a true menstrual period but rather breakthrough bleeding or irregular spotting, a common occurrence for many using hormonal contraception. This article explains the reasons for such bleeding patterns and when to seek medical advice.
How Birth Control Affects Bleeding Patterns
Hormonal birth control methods, such as pills, patches, or rings, introduce synthetic versions of hormones like estrogen and progestin into the body. These hormones primarily prevent ovulation, meaning an egg is not released from the ovary each month. This suppression of ovulation prevents pregnancy.
The hormones also influence the uterine lining, making it thinner and less receptive to a fertilized egg. They thicken cervical mucus, creating a barrier to sperm. For many combination birth control methods, a “withdrawal bleed” occurs during the placebo week or hormone-free interval. This resembles a period but is a response to a temporary drop in hormone levels, not a natural cycle. Irregular bleeding outside this expected withdrawal bleed is known as breakthrough bleeding.
Common Reasons for Irregular Bleeding
Experiencing bleeding more than once a month while on birth control can stem from several factors, often related to the body’s adjustment or how the contraception is used.
Initial Adjustment Period
One frequent cause is the initial adjustment period, especially during the first three to six months of starting a new hormonal birth control method. During this time, the body adapts to new hormone levels, which can result in unpredictable bleeding as the uterine lining stabilizes.
Inconsistent Use
Inconsistent use of birth control can lead to irregular bleeding. Missing pills, taking them at different times, or not adhering to the prescribed schedule can cause hormone level fluctuations. These inconsistencies can destabilize the uterine lining and trigger unscheduled bleeding. Maintaining a consistent daily routine is important for both efficacy and bleeding control.
Type of Birth Control
The specific type of birth control method chosen can influence bleeding patterns. Progestin-only methods, such as the mini-pill, hormonal IUDs, implants, or injections, often cause more unpredictable bleeding or spotting compared to combination methods. While some users of progestin-only methods may experience no bleeding, others might have frequent or prolonged spotting. Combination birth control pills, containing both estrogen and progestin, generally offer more predictable bleeding patterns, but breakthrough bleeding can still occur.
Other Factors
Certain medications can interact with hormonal birth control, reducing its effectiveness and causing irregular bleeding. Examples include some antibiotics, antifungals, and antiepileptic drugs. These interactions alter how the body processes the hormones. Lifestyle factors like significant stress, drastic weight changes, or certain illnesses may also contribute to bleeding changes.
When to Consult a Healthcare Provider
While irregular bleeding on birth control is often harmless, certain signs warrant a discussion with a healthcare provider. Evaluation is needed if bleeding is excessively heavy, soaking through more than one pad or tampon per hour for several consecutive hours, or accompanied by severe abdominal pain. Persistent bleeding beyond the initial adjustment period (typically 3-6 months) also warrants consultation.
Other concerning symptoms include bleeding after sexual intercourse, a foul-smelling vaginal discharge, fever, or any signs suggesting pregnancy. These symptoms could indicate an underlying medical condition requiring attention. A healthcare provider can help determine if the irregular bleeding is simply a common side effect or points to another issue.
Discussing bleeding patterns with a doctor is also helpful if the irregularity significantly impacts quality of life or causes distress. They can assess the situation, rule out other causes, and suggest adjusting the birth control method or dosage. Exploring different contraceptive options may help manage or resolve persistent irregular bleeding.