Breakout Bleeding – What is it? why does it happen?

Breakthrough  bleeding , also known as spotting, is light bleeding that occurs in the middle of the cycle, comes unexpectedly and is one of the causes of dissatisfaction with contraceptives . It can occur with the use of pills as well as with the use of vaginal rings, IUDs or implants. Spotting bleeding comes in small amounts and lasts for fewer days. It occurs in the first few months of starting contraceptive use and gradually decreases. The most important thing is to know that this is a common effect and does not mean a failure of the method, that is, there is no increased risk of becoming pregnant for this reason.

It is not yet known for sure why breakthrough bleeding occurs . The main hypothesis is that when the uterus is exposed to hormones, the inner layer of the uterus becomes thinner, exposing the blood vessels, thus promoting bleeding.

How many days lasts?

Spotting lasts for fewer days than a woman’s usual menstrual period, which ranges from 2 to 7 days. It can occur in women who use contraceptives  or in early pregnancy (in the first 3 months of pregnancy).

Spot bleeding is usually a different color than menstrual blood . The frequency of breakthrough bleeding is higher in the first few months of contraceptive use . With correct use, leakage is not associated with contraceptive effectiveness .

For women who smoke, it is recommended to stop smoking. In some cases, it is necessary to use other medications to stop the bleeding. So look for your gynecologist to guide the best choice.

Can you get pregnant?

Spotting is common for women using  hormonal birth control . By making regular use of contraceptive , without fail, it will have its effective effect even with these leaks. Breakthrough bleeding is the minimal loss of blood that can occur over the course of the menstrual cycle. This bleeding is different from menstruation bleeding  because it has a less vivid blood color, it is not prolonged, usually lasts a few days or even just 1 day, it is noticed in stained panties and sometimes the woman does not feel the need to use a tampon.

The risk of pregnancy in those who use contraceptives  is reduced, around 1%. That is, those who make regular use of the medication, even with breakthrough bleeding , have a low risk of becoming pregnant. If you have any questions, consult your family doctor, gynecologist or general practitioner for an evaluation.


Here are the main causes of spotting:

1. Sexual relations:

As the flow of blood in the vagina and cervix increases during pregnancy , some small vessels can rupture during intercourse, causing spotting.

2. Touch exam:

Also due to increased blood in the vagina and cervix , invasive tests such as Transvaginal US and digital examination can cause a small breakthrough bleeding. It’s usually nothing serious.

3. Assisted reproduction:

Women undergoing IVF may experience small spotting  early in pregnancy , and one of the causes may be the failure of one of the implanted embryos to develop.

4. Anticoagulant drugs:

Women at risk of miscarriage can be treated with some drugs that favor small spotting , such as heparin and aspirin.

5. Fibroids:

Fibroids are benign tumors that present inside the uterus and polyps are lumps that are born in the uterus or cervix . If implantation of the fetus occurs close to either of these two cases, bleeding may occur.

6. Vaginal infection:

It is important to have prenatal care as soon as the pregnancy is discovered , precisely to detect infections. If so, they can cause breakthrough bleeding .

7. Nidation:

As we explained earlier, the implantation of the embryo can cause small breakthrough bleeding  that are even confused with menstruation .

8. Early labor:

From 37 weeks onwards, breakthrough bleeding can signify the start of labor. The woman should observe carefully and seek medical attention if bleeding occurs, even in small amounts.

9. Intra-uterine hematoma:

There is a possibility of a bag of blood forming in the uterus becoming a spotting bleed . When this happens, the pregnancy is risky and should be monitored by the obstetrician even more often. Rest is recommended in these cases.

10. Threat of miscarriage:

If the bleeding is bright red and comes with dull cramping and severe pain, this could be a sign of a miscarriage . It is necessary to see your doctor as soon as possible.

It’s dangerous?

You should see your doctor if you have unexplained spotting between your periods. While it may be nothing to worry about or go away on its own, it could also be a sign of something more serious. Try to record exactly when your spot occurs and any other symptoms you have so you can share this information with your doctor. You should see your doctor right away if spotting is accompanied by:

  • Fever;
  • dizziness ;
  • Easy bruises;
  • Abdominal pain;
  • heavy bleeding;
  • pelvic pain.

It’s also especially important to make an appointment with your doctor if you’ve been through menopause and have experienced breakthrough bleeding . Your doctor may perform a pelvic exam, order blood tests, or recommend imaging tests to find out what is causing your symptoms.

Difference between menstruation and spotting:

To identify this difference between menstruation  and spotting, it is necessary to analyze and observe the day on which this bleeding is occurring, as well as the appearance of this flow. If your cycle is regular or you use oral contraceptives, menstruation  has a correct day to come over. Spotting bleeding occurs any day of the cycle.

Also, it is important to note the consistency, appearance, and color of the blood as spotting tends to be somewhat different from menstruation . This is because spotting bleeds , which occur throughout the cycle, usually have a less vivid color and a much smaller volume than menstruation . Spotting also does n’t last long and usually lasts between 1 or 2 days, unlike menstruation .

Although breakthrough bleeding can be considered common when it is not recurrent, the alert is always for cases of pregnancy that deserve extra attention in these situations .


Since it can have the most varied causes, the treatment indication can also vary greatly according to the diagnosis given by the doctor. Therefore, only a specialist and properly trained doctor can indicate the best treatment for each case, as well as the correct dosage of each medication or the duration of the treatment.

After this is done, it is very important that the patient always correctly follows the instructions and guidelines given by the doctor and never self-medication or interruption of treatment on her own.

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