Irregular bleeding can be concerning, especially when you're on a hormonal birth control pill. Let's go through some steps to figure out why you may be bleeding.
Birth Control Pills
OCPs, or Oral hormonal contraceptives (aka the Pill), come in many different forms. We're going to concentrate on the Combination Pill. These have synthetic progestin and enthinyl estradiol. They stop ovulation from happening and thicken your cervical mucus so sperm have a harder time entering the uterus (1). Because most birth control pills contain 35 mcg or less of estradiol, breakthrough bleeding is fairly common. It's all about the balance of estradiol and progestin and how your body metabolizes it- which can vary from woman to woman.
Withdrawal Bleeding
Bleeding while you're consistently taking the Pill is not your period. During the placebo week of your pills, you may bleed because the little endometrial lining you may have is super fragile and sheds with a quick shift of hormones (2). There isn't really a physiological need to bleed while on the Pill. They were simply designed with placebo pills so the withdrawal bleeding mimicked a period and they would be more widely accepted by society and religious groups.
So why am I bleeding if I'm taking the active pills and not placebo?
- You don't consistency take your birth control pills
- If this is the case, consider taking a pregnancy test if you have also been sexually active and aren't using an alternative form of protection
- You've been using this particular birth control pill for three months or less
- Your body just needs time to adjust
- You're a smoker
- Studies demonstrated that cigarette smoking can lower estrogen levels, impacting your hormonal balance
- You may have an underlying STD
- STDs like chlamydia and gonorrhea can cause irregular bleeding. Get tested!
- You may need a different dose of estrogen or progestin in your birth control pill
- Talk to your gynecologist about continuous irregular bleeding
Resources:
1.https://www.aafp.org/afp/2002/0515/p2073.html
2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621397/