This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Combined oral contraceptive pill (breakthrough bleeding)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

This is a checklist in cases of possible breakthrough bleeding (BTB) occurring in COC takers. BTB bleeding may occur during the first few months after prescribing a new COC. If it persists then a cause must be sought.


  • taking of COC - ? missed pills ? taken at same time
  • medication - ? enzyme inducers
  • history of gastroenteritis ?
  • is there a possibility of pregnancy or disorder associated with pregnancy e.g. trophoblastic tumour ?
  • factors affecting absorption of pill e.g. ileostomy ?
  • history of post-coital bleeding ? CIN ? - will need referral for colposcopy


  • pelvic and speculum examination - swabs and cervical smear if indicated

If all possible causes have been excluded then the COC may be changed. Options include:

  • a user taking a monophasic pill may try a phasic pill
  • an increased level of progestogen
  • a different type of progestogen e.g. consider a 3rd or 4th generation COC
  • in some cases a high dose (50 mcg pill) may be considered

For more detailed guidance then see linked item - unscheduled bleeding whilst women using hormonal contraception

Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.