What is Breakthrough Bleeding? | WUKA

Ready to learn all things breakthrough bleeding? WUKA experts discuss what is breakthrough bleeding, when to worry and whether stress and the pill cause the bleeding. 

What is Breakthrough Bleeding?

Breakthrough bleeding is the term often given to bleeding between periods and spotting before period or after your period has finished. There are varying levels of breakthrough bleeding, from heavy bleeding to light spotting, and our very own WUKA experts are here to discuss them all.

What Does Breakthrough Bleeding Look Like?

Bleeding unexpectedly between periods can take you by surprise and it should always be investigated by a medical professional so you can determine the cause. But what does it look like and how do you know when to worry about breakthrough bleeding?

If you’ve ever experienced spotting either before or after your period, you’ll have noticed that the blood is usually dark in colour, sometimes brown. Lots of people report that breakthrough bleeding looks just like this—darker in colour than usual. This is normally because it’s older blood, either at the start or the end of their cycle. 

Breakthrough bleeding is usually quite light and most people tend to be alerted by small amounts of blood when they wipe after using the loo, or on their underwear. It’s not usually a heavy flow, but we’re all different and there can be many reasons why it’s happening too. 

How long does breakthrough bleeding last?

Lots of people experience breakthrough bleeding for a couple of days before their cycle returns to normal. If you’re taking hormonal contraceptives, the bleeding could last a little longer (check out the section on contraceptives below).

As a general rule, persistent (more than 7 days) and regular breakthrough bleeding should always be investigated.

Causes of Breakthrough Bleeding

Sometimes breakthrough bleeding may be closer in colour and consistency to your usual menstrual blood, depending on the cause. Whatever the colour, you should always speak to a doctor if you’re concerned about the possible reasons why you’re bleeding between periods. Here are some of the common causes:

Switching Contraception

Some women find that they experience breakthrough bleeding when they switch contraception. This can be common when switching hormonal birth control pills or to an intrauterine device (IUD). As your body adjusts to the new levels of hormones in the body, some spotting or light bleeding is common, especial when you first start on the new contraception. 

When it comes to the pill, breakthrough bleeding can also occur if you miss a dose or start new medications or supplements while taking it. Illnesses such as vomiting and diarrhoea can also cause bleeding between periods. If you're experiencing breakthrough bleeding, you should use extra protection (like condoms) throughout.

Some hormonal birth control tablets can be taken continuously without a break, meaning you skip your bleed. Lots of people report breakthrough bleeding or spotting when they first start taking the pill in this way, which is completely normal. 

When you switch to an IUD, you may experience changes to your cycle, even if you use the copper IUD (which doesn’t rely on hormones to work). Both the copper IUD and the hormonal IUD can cause breakthrough bleeding but speak to your doctor if it’s particularly heavy or persistent, or if you notice spotting after sex.

The following symptoms should also be reported:

• Abdominal pain
• Heavy bleeding
• Intense leg pain
• Chest pain
• Changes in your vision

Stress

Stress can trigger physical and emotional responses in the body and can have a negative effect in many ways, including disrupting the balance of hormones in the body. And if you’re asking, can stress cause breakthrough bleeding on the pill too—the answer is yes.

Other symptoms of stress include:

• Difficulties sleeping
• Headaches
• Stomach cramps
• Tense muscles
• Low sex drive

If you know that stress is an issue for you, and you’re experiencing breakthrough bleeding, take that as a sign to make some positive lifestyle changes. Regular exercise, meditation and yoga are all great ways to calm the mind and help you relax at the end of a busy day.

STIs

Sexually transmitted infections (STI) can also cause breakthrough bleeding and should never be left untreated. 

Chlamydia affects around 1 in 10 sexually active young people in the UK and is passed on via unprotected sex. However, up to 80% of those infected don’t actually show symptoms, making it hard to diagnose. Those that do have symptoms report changes to vaginal discharge, pain when urinating, pain in the pelvis and pain during sex.

If untreated, Chlamydia can lead to Pelvic Inflammatory Disease (PID), which can cause a whole host of symptoms, including breakthrough bleeding. If you experience pain in the lower abdomen, changes to your vaginal discharge, fever and spotting, make an appointment at a sexual health clinic as soon as you can. 

Preventing STIs is important. The NHS has some good advice here.

Sensitive Cervix

A sensitive cervix, also known as a friable cervix, can also be a case of breakthrough bleeding. Friable refers to tissue that’s prone to inflammation, is easily irritated and bleeds easily. When the cervix is friable one of the main symptoms is bleeding, particularly after sex.

A sensitive cervix can be caused by:

• Infections, such as STIs or Bacterial Vaginosis
• Irritations from latex condoms, spermicides or contraceptive devices such as diaphragms and pessaries
• Pregnancy
• Cervical polyps—these are small, usually begin growths found on the cervix
• Cervical ectopy—a benign condition that is usually caused by hormonal changes, often found in women taking oral contraceptives 
• Cervical intraepithelial (CIN)—a pre-cancerous condition
• Cervical cancer

Treatment for a sensitive cervix varies depending on the cause, so you should always speak to your doctor about what could be causing the breakthrough bleeding for you. Changes to the cells in the cervix are detected during a smear test and this can be easily treated. Getting your smear is so so important, so make sure you get checked every 2-3 years. 

Subchorionic Hematoma

During pregnancy, any vaginal bleeding should be investigated as it’s a clear sign that something could be wrong. Most often, there isn’t any cause for alarm, but in a small number cases, there could be a subchorionic haematoma, which could indicate a problem.

The NHS advises that the most likely causes of this are:

• Implantation bleeding, as the placenta burrows into the lining of the uterus
• Changes to the cervix
• Infection in the vagina

Miscarriage or Ectopic Pregnancy

The most common sign of miscarriage is vaginal bleeding, and this can vary in colour and flow. Some women experience a brown discharge, some report light spotting and others experience heavy, bright red blood or clots. 

Other symptoms of miscarriage include lower abdominal cramps and an absence of your usual pregnancy symptoms. Always seek medical advice if you think you may be miscarrying a pregnancy.

When it comes to ectopic pregnancy, medical attention is required a lot more quickly. This condition is rare, and it happens when the pregnancy develops outside of the womb. Symptoms include:

• Intense and persistent abdominal pain, often more on one side
• Breakthrough bleeding, usually after the pain appears
• Pain in the tip of your shoulder
• Diarrhoea and vomiting
• Feeling faint or passing out

If you suspect an ectopic pregnancy, it’s vital to get medical help straight away. This one requires a swift A&E visit, or if you’re too unwell to travel, the NHS advises to call 999.

Fibroids or Fibrous Masses

Uterine fibroids are non-cancerous masses that grow in or around the uterus. Lots of women are actually unaware that they even have fibroids, and often they’re only diagnosed via a routine examination. For some though, breakthrough bleeding can be an indicator that leads to this diagnosis.

The NHS states that 1 in 3 women with fibroids will suffer from heavy and painful periods and some will also experience spotting or bleeding between periods too. 

Fibroids are easily treated—your doctor will discuss all your options with you.

When to worry about breakthrough bleeding?

Most often, vaginal bleeding is nothing to be too concerned about, but the causes should always be investigated as in some cases there could be an issue that needs medical attention.

If you suspect you have an STI, fibroids, are pregnant or suspect any other medical condition, you should always see your doctor.