Is Spotting Normal Between Periods While on the Mini Pill?

"I am on the mini pill and am spotting between periods. Will it ever improve? Is this normal?"

Yes, spotting between periods when you are on a progestin-only mini pill can sometimes be normal, especially if you have just started this new method within the last couple months.

This happens for some women as their bodies adjust to the new hormones in their body. Bleeding between periods, or “breakthrough bleeding,” can happen as the hormones in your body are fluctuating and inconsistent as your body adjusts to your new method. It can also happen if your body has trouble adjusting to a progestin-only pill, not having the estrogen that typically sustains your uterine lining.

Causes of Breakthrough Bleeding on the Mini Pill

During your typical menstrual cycle, the hormones estrogen and progesterone help build and sustain your uterine lining to prepare the body for pregnancy. If pregnancy does not occur, hormone levels drop, causing your uterus to shed its lining (your period).

If you are starting the progestin-only mini pill or switching from another form of birth control, your body can get confused by newly fluctuating hormone levels and begin shedding it uterine lining prematurely. This is why spotting or “breakthrough bleeding” can occur on and off between periods.

For most women, it takes only a few months to adjust to the mini pill, and then their cycles become more regular again.

Note that if your irregular bleeding is accompanied by symptoms such as itching, foul-smelling discharge, colored discharge, or pain during urination or sexual intercourse, it could mean you have an infection. In this case, it's important to see a doctor right away. 

Additional Possible Side Effects of the Mini Pill

Beyond irregular bleeding, the mini pill may cause other side effects you should know about. Those include:

• Acne
• Breast tenderness
• Changes in your bleeding pattern—your periods may become less regular or stop
• Increased or decreased sex drive
• Mood changes, including feelings of anxiety or depression
• Headache or migraine
• Nausea or vomiting
• Ovarian cysts—these are usually harmless when they occur

Know that the progestin-only mini pill is safe for most people and has a lower risk of serious complications compared to combined hormone birth control pills.

Estrogen-Free Mini Pill Alternatives

If you have been on the mini pill for several months and are still experiencing irregular spotting or bleeding between periods, you may want to explore other estrogen-free birth control options. The good news is, there are actually quite a few, and all are extremely effective:

An IUD: All IUDs are estrogen free, last for 5-10 years, and are over 99% effective. They are inserted by your doctor during an office visit.

The Nexplanon implant: This implant is inserted into your arm. It contains progestin only and is over 99% effective.

The Depo Shot (Depo-Provera): This is an injection you get once every three months that contains progestin only and is 94% effective with typical use.

Above all, your health and peace of mind matter. If you have concerns about breakthrough bleeding, mini pill side effects, or your birth control in general, schedule an in-person or telehealth appointment with one of our healthcare providers today. Our team is here to help you find the best contraceptive options for your needs.

Also ask your telehealth provider about mailing birth control pills, emergency contraception, and condoms directly to your home!