Breakthrough bleeding on the pill: how to track it

Seeing spotting or light bleeding on a day you didn't expect it while you're on the pill can be confusing: Should I be worried, when should I ask a doctor, how long did it last? Your doctor is the one who can answer those questions, and this article doesn't replace a medical assessment, but bringing them a clear picture is in your hands. Here we explain how to record your bleeding days while you're on the pill and what information you can take to your doctor.

Breakthrough bleeding on the pill

Spotting or bleeding outside your period is usually called breakthrough bleeding. The NHS notes that breakthrough bleeding or changes to your periods are common in the first few months after starting the combined pill. The same source suggests talking to a pharmacist or doctor if side effects are still there after three months and bothering you.

MedlinePlus lists irregular use of hormonal birth control, such as skipping pills or stopping and restarting, among the possible causes of bleeding between periods. That's why it makes sense to note your pill routine alongside your bleeding.

There are different types of birth control pills and different ways of taking them, and bleeding patterns can vary with them. Finding out which type you take, from the box or from your pharmacist, and writing it at the top of your log makes your later notes more meaningful.

Only your doctor can assess what's causing the bleeding. The point of your log isn't to diagnose anything; it's to bring your doctor ready answers to "when, how much and what was it like".

What to note on each bleeding day

Short, regular notes are more useful than long ones written now and then. On each day of bleeding or spotting, you can write down:

1. Date The day the bleeding started and the day it stopped.
2. Amount Your own scale, such as "spotting", "light", "medium" or "heavy". MedlinePlus suggests keeping track of how many pads or tampons you use to understand the amount of bleeding.
3. Colour and appearance A short description in your own words is enough.
4. Anything that came with it If you noticed pain, cramps, tiredness, dizziness or anything else, write it down.
5. Your pill that day Did you take it, miss it or take it late?

You don't need to write down the days with no bleeding; blank days already mean "no bleeding". But if you forgot to log a day, marking it saves you from wondering later, "Was there no bleeding that day, or did I just not write it down?"

Using the same scale every day matters. If "light" means one thing one day and something else the next, your records become hard to compare. We've gathered what you can generally note when tracking your period in what to note when tracking your period.

Log your pill routine too

It's hard to look at your bleeding days separately from your pill routine. Your doctor will most likely ask how long you've been on the pill and whether you take it regularly. You can write this down once and update it when needed:

• Name of the pill: As it appears on the box.
• Start date: When did you start this pill, and did you take a different pill before?
• How you take it: The routine your doctor or pharmacist explained to you, and whether you take breaks.
• Missed or late days: With their dates.
• Other new medicines and supplements: Note these with their dates too.

This log isn't an instruction on how to take your pill. If you've missed a pill, or you want to switch or stop your pill, ask your pharmacist or doctor what to do; don't make changes on your own.

When to see your doctor

Even though the NHS says breakthrough bleeding is common in the first few months, that doesn't mean every bleed should be expected. See your doctor if:

• Breakthrough bleeding continues after the first three months or is bothering you.
• It has started recently after a long stretch of a steady pattern.
• You bleed after sex.
• The bleeding comes with pain, fever, unusual discharge, tiredness or dizziness.
• You think you might be pregnant.

If you have very heavy bleeding, severe stomach pain or feel faint, don't wait: call your country's emergency number. If you notice a general change in your bleeding pattern, what to tell your doctor when your period changes may also help.

Taking your records to your doctor

Before your appointment, it helps to turn a few months of records into something that can be read at a glance. Instead of going through every detail, you can sum up the main points:

• When you started the pill and how many months you've been taking it.
• How many times and on which days you had breakthrough bleeding, and how many days it lasted each time.
• Any overlap you noticed between missed or late pills and your bleeding days.
• Symptoms that came with it and questions you want to ask your doctor.
• The date of your last period and the general pattern of bleeding while on the pill.

After the appointment, add a short note of what your doctor said in the same place: Was a test ordered, was a change suggested, when is the next check-up? That way, if you need to look back in a few months, the whole story is in one place.

You don't need to interpret your records when you show them to your doctor. Saying "I saw this, on this date" is enough; leave the assessment to your doctor. If you're just starting to track your cycle, you'll find a basic routine in how to keep a period calendar.

Keeping bleeding days and medicines together with Oveluni

Oveluni is a personal tracking app where you can keep your medication plans, daily logs and check-ups in one place. Noting your bleeding days, your pill use and the questions that come to mind in the same place makes it easier to quickly find what you need at a doctor's appointment. The Pill and Cycle Assistant tracks your pack, your pill-free days and your own bleeding records together; Oveluni doesn't choose or change your treatment. Oveluni doesn't diagnose and doesn't determine whether you're pregnant; it shows your records exactly as you logged them. For decisions about your bleeding and your pill, your doctor and pharmacist are always there for you. Oveluni is coming soon to the App Store.

Sources

1. NHS: Combined pill side effects and risks
2. MedlinePlus: Vaginal bleeding between periods