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What Causes Spotting, Abdominal Pain While On Oral Contraceptives?

Posted on Wed, 11 Feb 2015

Question: Hello my girlfriend is taking the birth control pill and has not missed a day, taking it perfectly at the same time each day, shes also not taking any extra medication that could reduce the effectiveness of the pill. Also, she did not vomit or had diaharrea. We also did not have any problems for the past year or so (since when she started taking the pill). This cycle, we decided to have unprotected sex, and i ejaculed inside her since a long time ago (we have done that in the past, but i decided not to, to prevent) we had sex 4 days ago and there's left something like 10 pills to the end of the cycle, but she told me she had some spotting at the previous night and some unconfortable abdominal pain (nothing too serious, just sensitive and unconfortable as she described) on that day. The spotting stopped a couple hours later, but today, during the day, she had again the spotting, she said it looks like a menstruation, but its not since there's still about 10 pills to go... She has been for more than a year on the pill and never got this side effect, i heard it is common in the first 3 months, but i don't know what it is when it happens an extended time later, what is happening? Is she pregnant? Is it common? is it something i should worry about? I dont trust the internet a lot that's why i need an expert call.

Answered by Dr. Manisha Jain (11 minutes later)

Brief Answer:
nothing active needs to be done

Detailed Answer:
Hello sir, it is common in chronic pill users and is synonymous with mid cycle ovular bleeding.
No active intervention needed and just ask her to take it lightly.
In case this happens for a longer period in upcoming cycles then she will need to take pills with higher estrogen content for 3 months and then resume taking older pill pack.
Nothing to worry in this cycle, in case this spotting stops in a day or two.
Take care

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Manisha Jain (50 minutes later)

Thank you! So i should not worry about pregnancy? I heard that its common to bleed when the egg is fertalized 3,4 days after and thats why i was so scared...But she has been on birth control for months and took it perfecly so i dont think its likely . I wouldnt say she had "spotting" the way she described was more like a "breakthrough bleeding", she had it twice, and when i heard its common only in the first months i had another reason to be scared because its the first time this happens in more than a year taking birth control. Enlighten me please, so i dont panic

Answered by Dr. Manisha Jain (13 hours later)

Brief Answer:
no risk of pregnancy

Detailed Answer:
In my opinion there is nothing to panic.
This bleeding will stop in a day or two as I have told you and is of no clinical implication on birth control.
Just relax and wait for her periods.
It is all a play of hormones which and more common in low dose pills.
Also to help you from relieving anxiety there is a well known fact that pregnancy is unlikely after 6 months of leaving oral pills because of the fact that both uterus and ovaries are out of phase with implantation.
So stay calm and relax now.
Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Manisha Jain (3 hours later)

Thanks for clarifying... Just one more question... regarding her unconfortable feeling in the pelvic area (probably in the uterus?), is there any connection to the bleeding and the pill? or is an isolated problem? this strange feeling started to show after we had the unprotected sex and i ejaculated inside.. but as you said, cant be anything serious, but i dont know, its strange that things that never or rarely happened in the past started to happen now...
And regarding the pill, that you said she might start taking estrogen, does it mean the current pill started losing its effects? its efficacy? that her body got used to it and its not working anymore? or does the birth control still works as it used before?

Thank you!

Answered by Dr. Manisha Jain (20 hours later)

Brief Answer:
low estrogen content of pills causes it

Detailed Answer:
I understand your questions and the concerns behind the same.
This is all due to endometrial thinning and is due to the low content of estrogen in pills used these days which provide contraception and also are free from the side effects of estrogen.
But at times that low estrogen is not able to fulfill the demand of body to develop enough endometrial thickness which can cause mid cycle bleeding (when demand for estrogen is very high) as in your case.
So just keep taking pills like before, most probably there will be no problem in the long run.
All the very best.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Manisha Jain (16 minutes later)

I see... I heard about something called mid cycle ovulation pain in the internet, which i think is the release of the mature egg ( you might understand it better ) and the side effects are really similar to what my girl is having, how likely it is? Is it possible to get this while on the pill? As well is it possible to get pregnant? Although what you said in the answers make really sense.

Last thing, when can she do a pregnancy test ? Theres still about a week to go on the cycle

Answered by Dr. Manisha Jain (9 minutes later)

Brief Answer:
pregnancy test on day of expected periods

Detailed Answer:
Yes it is possible to ovulate while still on pill but the chances are only theoretical and usually seen in women with poor compliance or in those with diarrhea or vomiting which nullify the effect of pills by decreasing the level of hormones in blood.
The symptoms she is get getting is due to mid cycle surge of hormones which may or may not be related to ovulation.
Chances of pregnancy are negligible but still if you want to be double sure do it on the day of her expected periods.
In case you have any questions in future you can contact me directly on http://bit.ly/drmanishajain

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Manisha Jain (6 minutes later)

Thank you doctor for all your information and help, sorry about the numerous questions, but you know, pregnancy is something that a lot of people dont want too soon in their lives. I wanted to clarify everything in my head and certainly you did! Thanks, and yes i will contact you if i need it. take care

Answered by Dr. Manisha Jain (1 minute later)

Brief Answer:
welcome

Detailed Answer:
You are most welcome.
Take care.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar