Starting period a week early on birth control pills

Breakthrough bleeding is a common concern among women using hormonal birth control. It’s usually a small amount of spotting at a time when you’re not expecting your period, though some women have heavier bleeding. Most often, my patients come in saying they feel fine, but are noticing a little spotting when they use the bathroom. Should they be worried?

I reassure them that breakthrough bleeding rarely signals a health problem. And it doesn’t mean your birth control isn’t effective at preventing pregnancy. But there are ways we can try to fix it.

Here’s what I tell my patients about birth control and breakthrough bleeding.

It can happen with any type of hormonal birth control.

All these methods work by delivering hormones that prevent pregnancy. These methods include

• birth control pills

• the birth control implant, a small plastic rod that’s placed under the skin of the upper arm

• hormonal IUDs (intrauterine devices)

• the birth control shot given by a health care professional

• the vaginal ring that women can place and remove on their own

• the skin patch that contains hormones

But it’s more common with certain types of birth control.

Breakthrough bleeding happens more often with low-dose and ultra-low-dose birth control pills, the implant, and hormonal IUDs.

With IUDs, women often have spotting and irregular bleeding in the first months after placement. This usually gets better in 2 to 6 months. With the implant, though, the bleeding pattern women have in the first 3 months is usually their pattern going forward.

Some women are more likely to experience it.

Breakthrough bleeding happens more often in women who smoke cigarettes and in women who don’t take their birth control pills consistently. Some medications, like emergency contraception pills, also can cause irregular bleeding. Having certain infections, such as chlamydia or gonorrhea, also can increase risk.

It’s also more common when women who use birth control pills or the ring take a continuous dose of hormones to skip their periods altogether. One more factor: Benign (not cancerous) growths such as uterine fibroids can cause irregular bleeding that’s unrelated to birth control.

Some women can improve breakthrough bleeding on their own.

Quitting smoking can help. So can taking birth control pills at the same time each day.

If you’re getting continuous hormones with birth control pills or the ring, try scheduling a period every few months. This gives the uterus a chance to shed any built-up lining. It can help reduce irregular spotting and bleeding.

Your ob-gyn can help.

Although breakthrough bleeding with birth control isn’t physically harmful, it can be really annoying. When a patient says they’re having spotting or irregular bleeding, we first chat about the factors that might be causing the bleeding. Then we may do a physical exam as well.

After we confirm the bleeding is related to birth control, there are usually a number of options. For example, we can switch from an ultra-low-dose birth control pill to a low-dose pill. We also can change the number of placebo (or pill-free) days. Or we can explore other methods of birth control. With IUDs, implants, or the birth control shot, taking ibuprofen can be helpful, or we can add short-term treatment with estrogen pills.

No matter the situation, talk with your ob-gyn if you’re unhappy with your bleeding. We don’t want women to struggle with breakthrough bleeding, and we definitely have options to improve it.

Published: January 2021

Last reviewed: January 2021

Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

Thanks to birth control, I always know when my period is going to start. That is, until it decided to arrive a few days early one month and I still had four active pills left in my pack. We talk about the causes for late periods all the time, but what about early periods? For me, the bleeding was so sudden and unexpected that I went into panic mode. I didn't know what to do: Do I stop taking my pills or carry them over to the next month? What does this mean for next month's period? Most importantly, I didn't understand how my period could be early if I'm on birth control.

As it turns out, unscheduled or "breakthrough bleeding" is one of the more common side effects of hormonal birth control, according to Tatiana Araujo, MD, an ob-gyn in Hollywood, FL. (To quote Ross Geller: "They should put that on the box!" Seriously, it would have helped.)

Dr. Araujo explained that breakthrough bleeding can be brought on by a variety of factors, such as not taking the pill at the same time every day, missing a pill, or switching to a different brand or dosage. Unscheduled bleeding is also fairly common when you first start taking birth control, especially if you have a history of irregular periods. "If someone already has an irregular menstrual cycle to begin with, it may take up to three months of initiation of birth control pills - if taken appropriately and as scheduled and instructed - for their cycle to 'normalize,'" Dr. Araujo said. Additionally, intense exercise, weight fluctuations, and stress can cause unscheduled bleeding.

Should you experience breakthrough bleeding before the week of your placebo pills, you should still finish the pack as you normally would, Elizabeth Garchar, MD, an ob-gyn in Albuquerque, NM, told POPSUGAR. This means pills should not be stopped before instructed, carried over, or mixed with other packs. While the regularity and duration of your period can be controlled by birth control, it's also heavily influenced by other factors. So, there's a possibility your period could arrive early again the following month, or not, Dr. Garchar explained.

In order to better understand what may be triggering the breakthrough bleeding, Dr. Araujo recommends tracking your menstrual cycle and making note of any changes. Perhaps you had a busy month with work, or recently lost a significant amount of weight, or there were a few days where you forgot to take the pill. Writing these things down can be helpful in determining the cause of unscheduled bleeding. If you're concerned or the breakthrough bleeding persists after one month, both doctors recommend reaching out to your ob-gyn.

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