What can be done about breakthrough bleeding?

Breakthrough bleeding usually decreases with time, but there are some things you can do in the meantime:

• Stay on schedule. Missing a pill, forgetting to replace your vaginal ring or scheduling a DMPA injection late makes breakthrough bleeding more likely.
• Track breakthrough bleeding in a calendar or diary. Typically, careful tracking offers reassurance that breakthrough bleeding is decreasing.
• Go back to taking your birth control as typically prescribed. You'll likely have less breakthrough bleeding if you don't try delaying your period by skipping inactive weeks.
• If you smoke, ask your doctor to help you quit. Women who smoke are more likely to experience breakthrough bleeding than are women who don't smoke.

If you use estrogen-progestin birth control pills or the vaginal ring, taking occasional hormone-free days may help manage unscheduled bleeding. As long as you have been taking active hormones for at least 21 to 30 days, you can stop taking the pill or remove the ring whenever breakthrough bleeding becomes a problem. After three or four hormone-free days, restart your pills or reinsert the ring. Over time, the episodes of breakthrough bleeding should space out and eventually stop.

Breakthrough bleeding isn't a sign that your birth control isn't working. Be sure to keep taking your birth control — even if you experience bleeding — to lower your risk of unplanned pregnancy. If breakthrough bleeding becomes heavy or lasts more than seven days in a row, contact your doctor.