Continuous Birth Control Pill Use

Taking an active, hormone containing, pill every day is designed to stop all bleeding after an initial period of irregular bleeding. This handout explains how and gives tips to decrease the irregular bleeding.

Why do the spacer pills cause the uterus to bleed?

"The Period Pills," "spacer," "or "sugar" pills contain no active or hormone medication. The reason you bleed when you take spacer pills is because your hormone levels drop. You bleed because you did not take a progestin hormone or "real" birth control pill. The lining of the uterus needs stable hormone levels to prevent bleeding. The best way to prevent any bleeding or spotting is to have constant levels of the estrogen and the progesterone hormones, because these hormones support and keep the blood lining of the uterus stabilized.

What do birth control pills do to the uterus?

Birth control pills work to shrink the blood lining of the uterus. Over time the lining is so thin, the chances of unexpected bleeding and spotting become very low. It is very, very unlikely something is building up inside your uterus when you are on the pill. As a matter of fact, the risk of endometrial cancer decreases by 80% in women using the birth control pill for five years.

Irregular Bleeding is common at first

Break-through bleeding, or bleeding when you are not scheduled to bleed, is very common in the first 6 months of continuous birth control pill use. Your body is getting used to the constant level of hormones. Spotting is when the amount of blood is so tiny that no pad or tampon is needed. The longer you take the continuous pills the less bleeding and spotting will happen. You do not need to stop the pill to have a period because bleeding happens, instead try to figure out what caused the bleeding and keep taking the daily pill if you want to have no bleeding. Stopping the pill only begins the whole process again.

How can you help prevent a drop in the pill hormones and stop bleeding/spotting?

The most important thing is to take your pill as close as possible to the same time every day. Estrogen in the body begins to wear off, especially if you take your pill over 4 hours late.

Other suggestions if spotting continues:

All these suggestions and ideas listed below are to help you make it through the first six months of continuous pill use. Most women will have significantly less bleeding or spotting after six months. Keep a menstrual diary so you can learn what triggers a bleeding episode for you. Remember all women are individuals. You can learn about how you metabolize your pill and what works with your body.

If you have any questions about any of these suggestions, please call your clinic. Often your provider can help and may even need to do an exam to find out why you are bleeding, because there may be an infection or change in health that is causing the bleeding. You can also email Dr. Miller at for suggestions. Please call your clinic before you stop the birth control pill.