Hello, I have gone through your query and understood the concern. To detect the cause of the breakthrough bleed and manage it, you need further evaluation. A complete hormone profile including thyroid profile, serum Prolactin, insulin resistance and a sonogram to know the status of the pelvic organs, routine blood counts, coagulation profile, renal and hepatic function tests are needed. Management depends on the result. Please maintain a healthy weight and regular exercise. Stress , sudden weight change, infection, cysts, polyps and erosions are some other causes. Maintenance of proper nourishment, styptics to control the bleeding and replacement of hormone deficiencies, if any, is the mainstay of the treatment. The hormone contraception has to be stopped if there is no response and other ways adopted. Hope you find this information useful. Wish you good health.