Spotting on Contraception (Breakthrough Bleeding): Why It Happens & What’s Normal
- Samantha Pieterse
- Aug 28
- 8 min read
Almost every woman who’s used contraception has had that inconvenient surprise, bleeding or spotting at the wrong time. You expect your period to arrive on schedule, but instead, you notice light bleeding in between. Naturally, the first thought is worry: Is my pill failing? Did my IUD move? Am I supposed to be bleeding like this?
This kind of unexpected bleeding is known as breakthrough bleeding, but most women simply call it spotting. It’s one of the most common side effects across nearly all contraceptive methods. In most cases, it’s not a sign that your contraception isn’t working. It usually comes down to your body adjusting to hormonal changes, alterations in your uterine lining, or the way your chosen method is used.
While it’s usually harmless, spotting can still be frustrating and unpredictable. That’s why it helps to understand why it happens, which contraceptives are most likely to cause it, and when it’s a signal to check in. Knowing the difference gives you peace of mind.
Why Spotting (Breakthrough Bleeding) Happens
Breakthrough bleeding is the medical name for spotting or light bleeding that pops up when you’re not expecting it. It can be messy and worrying, especially when you’ve chosen contraception to avoid surprises. But, so you know, in most cases, it’s not dangerous.
The exact reasons depend on the contraceptive you’re using, but there are a few common culprits:
Hormone fluctuations
Most contraceptives rely on steady hormone levels to control ovulation and your cycle. When those levels shift, especially in the first few months of starting a method, your body may “protest” with irregular bleeding.
Endometrial changes
Many contraceptives thin the lining of the womb (endometrium). This lining becomes less stable, which means little bits can shed at random, causing light bleeding.
Missed doses or late injections
Pills, patches, rings, and injections are most effective when used exactly as prescribed. A missed pill, a late patch change, or an overdue injection allows hormone levels to dip, and spotting is often the first sign.
Other health factors
Sometimes the cause has nothing to do with contraception. Infections, thyroid disorders, pregnancy, and uterine growths like fibroids or polyps can also cause unexpected bleeding. These are less common but worth ruling out if the bleeding is unusual or persistent.
With that foundation in mind, let’s look at what causes breakthrough bleeding with different contraceptive methods and when it might be worth booking a check-up.
Spotting on the Pill or Mini Pill
The combined pill and the mini pill (progesterone-only pill) are two of the most commonly used contraceptives in South Africa. Both are effective, but both can also cause breakthrough bleeding, especially in the early months.
Combined Pill (Estrogen + Progesterone):
Spotting is very common during the first 3–6 months as your body adjusts to its new hormonal rhythm.
Missed pills are one of the biggest triggers. Even being a few hours late on certain brands can throw things off.
Illnesses such as vomiting or diarrhoea, or interactions with certain antibiotics, can also reduce absorption and lead to unexpected bleeding.
For most women, this bleeding improves with consistent use.
Mini Pill (Progesterone-Only Pill):
Because it doesn’t block ovulation as strongly as the combined pill, irregular spotting is more common.
Timing matters. The mini pill needs to be taken at the same time every day. Even a delay of a few hours can lower hormone levels enough to cause spotting.
Some women find they have unpredictable bleeding throughout the first year of use, though it often settles later.
💬 Book a consult if the bleeding is heavy, lasts longer than 6 months, or if you’re concerned about pregnancy. A quick check-in can help rule out other causes and make sure your contraceptive is still the best fit for you.
Spotting with Mirena® and Kyleena® (Hormonal IUDs)
The Mirena® and Kyleena® are hormonal intrauterine devices (IUDs) that release a small, steady dose of progesterone directly into the uterus. They’re over 99% effective at preventing pregnancy, but one of the most common side effects is spotting or breakthrough bleeding, especially in the beginning.
What to Expect:
In the first 3–6 months, irregular bleeding and spotting are very common. Some women notice frequent light bleeding, while others experience heavier, unpredictable cycles.
As time passes, periods typically become lighter, shorter, or less painful. For many women, bleeding stops altogether, which is one of the reasons these IUDs are so popular.
The spotting is not usually dangerous. It’s your uterus adjusting to the local effect of progesterone, which thins the uterine lining and makes it less stable.
When to Check In:
If spotting is accompanied by severe pain, heavy bleeding, or unusual discharge, it could mean the IUD has shifted or there’s an infection.
If bleeding suddenly changes months or years after insertion, it’s worth booking a check-up to rule out other causes.
💬 At Mums & Bums, we can help you decide if your bleeding is part of the normal adjustment phase, or if it’s something that needs a closer look.
Spotting with the Copper T (Non-Hormonal IUD)
The Copper T IUD is a highly effective, hormone-free contraceptive that works by releasing copper ions, which create an environment that prevents sperm from fertilising an egg. Because it doesn’t use hormones, it avoids many side effects linked to hormonal methods, but it can still affect your bleeding patterns.
What to Expect:
The Copper T often causes periods to be heavier, longer, and more crampy, especially in the first few months after insertion.
Breakthrough bleeding and spotting between periods are less common than with hormonal methods, but they can still happen as your body adjusts.
Over time, many women find their cycles settle, though some continue to experience heavier periods throughout use.
When to Check In:
If your bleeding is very heavy, unusually painful, or doesn’t improve after a few cycles, it’s worth getting checked.
In some cases, excessive bleeding may mean the IUD has shifted position or is irritating the uterine lining.
💬 Always consult if you’re worried your Copper T is causing more than just the expected adjustment. A quick exam can confirm whether it’s sitting correctly.
Spotting with the Two-Month & Three-Month Injections (Nur-Isterate or Depo-Provera®)
The contraceptive injection is a popular choice in South Africa because it’s discreet, long-lasting, and doesn’t require daily pills. The two main options are Nur-Isterate® (every 2 months) and Depo-Provera® (every 3 months). Both are highly effective, but the most common side effect is irregular spotting or breakthrough bleeding.
What to Expect:
Spotting or irregular bleeding is the most common side effect, especially during the first several months. Some women have light bleeding on and off for weeks at a time.
Over time, the uterus lining becomes very thin. For many women, this means that after about a year of use, periods stop altogether, which can be a welcome change.
If you miss your injection window (even by just a few days), hormone levels drop, and breakthrough bleeding often follows.
When to Check In:
If the bleeding is very heavy, persistent, or accompanied by pain or other unusual symptoms, it’s a good idea to seek medical attention.
Sometimes adding a short course of the combined pill can help settle the bleeding, but this should be done under medical guidance.
Spotting with Implanon® (Contraceptive Implant)
The Implanon® implant is a small, matchstick-sized rod inserted under the skin of your upper arm. It steadily releases progesterone and is over 99% effective for up to 3 years. While it’s one of the most reliable and low-maintenance methods, the most common side effect is irregular spotting or breakthrough bleeding.
What to Expect:
Irregular bleeding is extremely common in the first 6–12 months. Some women have very light, unpredictable spotting, while others may experience heavier or prolonged bleeding.
A smaller group of women have the opposite experience, little to no bleeding at all. It really depends on how your body responds to the progesterone.
After the first year, many women find their bleeding pattern becomes more stable, though irregularity can persist in some cases.
When to Check In:
If spotting is very heavy, prolonged, or disruptive to your daily life, it’s worth speaking to us.
Sometimes, a short course of another hormonal contraceptive (like the combined pill) can help settle persistent bleeding.
If bleeding changes suddenly after you’ve had the implant for a long time, it’s also a good reason to get checked.
💬 At Mums & Bums, we’ll guide you through what’s normal and help you decide whether you need to consider another option or not.
Spotting with the Contraceptive Patch
The contraceptive patch works much like the combined pill. It delivers estrogen and progesterone through the skin to prevent ovulation. It’s worn on the skin and changed weekly, making it a convenient option for women who prefer not to take a pill daily. Just like other hormonal methods, though, spotting or breakthrough bleeding can happen.
What to Expect:
Spotting is most common in the first 2–3 months as your body adjusts to the new hormone levels.
If the patch isn’t changed on time, or if it comes loose for too long, hormone levels can dip, which often leads to unexpected bleeding.
Some women find their cycles become lighter and more predictable after the adjustment phase, while others continue to notice the occasional breakthrough bleed.
When to Check In:
If spotting continues for more than a few months, is very heavy, or is accompanied by pain or unusual discharge, it’s worth seeing a nurse.
Unexplained changes in bleeding after you’ve been stable on the patch for a while should also be checked.
Spotting with the Vaginal Ring (NuvaRing®)
The vaginal ring, often known by the brand name NuvaRing®, is a small flexible ring that sits inside the vagina and releases estrogen and progesterone, much like the combined pill and the patch. It’s replaced monthly, making it a low-maintenance option. Just like other hormonal methods, spotting or breakthrough bleeding can happen, especially early on.
What to Expect:
Spotting and irregular bleeding are very common in the first few months of use while your body adjusts to the hormones.
If the ring is removed too early, left out for too long, or not replaced on schedule, hormone levels can dip and trigger breakthrough bleeding.
For most women, cycles become regular and lighter once their body adapts.
When to Check In:
If spotting continues for more than a few months or suddenly changes after a long period of stability, it’s worth getting checked.
Heavy bleeding, pain, or unusual discharge should always be evaluated to rule out infection or another underlying cause.
When Spotting on Contraception Might Not Be Normal
Most spotting on contraception is harmless and linked to your body adjusting. However, sometimes irregular bleeding indicates a more serious underlying issue. Causes that aren’t directly related to your contraceptive include:
Hormonal Imbalances: Thyroid issues or conditions like polycystic ovarian syndrome (PCOS) can affect your cycle.
Infections: Pelvic infections, including STIs, can irritate the uterus and cervix and cause bleeding.
Pregnancy: While rare on contraception, unexpected bleeding can be an early sign of pregnancy, including ectopic pregnancy.
Growths in the Uterus: Fibroids or polyps can cause irregular, heavy, or prolonged bleeding.
Cervical Changes: bleeding after sex or persistent spotting can sometimes be linked to changes in the cervix that need further assessment.
These causes are less common, but they highlight why it’s important not to ignore new or unusual bleeding patterns.
When to See a Nurse or Doctor for Spotting
Breakthrough bleeding is usually just annoying, not dangerous. But book a consult if:
The bleeding is very heavy or lasts more than a week.
You have pain, fever, or unusual discharge (could be an infection).
You’ve missed doses or are worried about pregnancy.
The bleeding started suddenly after months of stability.
💬 We can help you sort out whether your bleeding is simply part of the adjustment period or if it needs further investigation. Sometimes, reassurance is enough, and sometimes a quick check-up or a change in method can make all the difference.
Final Thoughts: Spotting on Contraception Doesn’t Have to Be a Mystery
Spotting or breakthrough bleeding on contraception can be frustrating, but for most women, it’s a normal, temporary part of using birth control. Each method comes with its own pattern, and understanding what to expect can save you unnecessary worry.
The important thing is knowing the difference between bleeding that’s just your body adjusting and bleeding that needs a closer look. If it’s heavy, persistent, painful, or comes with other unusual symptoms, it’s time to check in with a professional.
At Mums & Bums in Centurion
We support women through every stage of contraception, from choosing the right method to managing side effects like spotting to switching if something isn’t working for you. Whether you need reassurance or a change in plan, we’re here to guide you with safe, reliable care.
➡️ Book your contraception consult at Mums & Bums Centurion today and get peace of mind about your health.
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