Bright red breakthrough bleeding while taking the pill

The blood may look bright because it has left the uterus recently. Colour does not measure severity or show whether contraception is working. Bleeding is more likely after starting or changing a pill, taking pills late, missing doses, vomiting, diarrhoea, or using a medicine that affects the pill.

Hormonal contraception keeps the womb lining thin, and the lining can shed unpredictably while the body adjusts or when hormone levels fluctuate. This can range from spotting to bleeding resembling a period. It does not necessarily mean the pill has failed.

Bleeding can have another source. Chlamydia can present with bleeding between periods or after sex, while endometrial polyps can present with irregular bleeding. Pregnancy-related bleeding, cervical changes, and other gynaecological conditions may also need consideration based on symptoms and examination.

Continue taking the pill according to its leaflet unless a clinician advises otherwise. Check the instructions for late or missed pills because advice differs by pill type and place in the pack. A pharmacist or contraception clinic can tell you whether backup contraception or emergency contraception is needed.

Take a pregnancy test if pills were missed, absorption may have been reduced, or pregnancy is otherwise possible. Arrange a review if bleeding continues, repeatedly returns, begins after stable pill use, or occurs after sex. Bring the pill name and a list of medicines or supplements; the clinician may consider infection testing, pregnancy testing, examination, or a different formulation.

Seek urgent assessment for heavy bleeding that rapidly soaks through period protection, fainting, severe dizziness, breathlessness, or severe abdominal or pelvic pain. If pregnancy is possible, bleeding with one-sided pelvic pain, shoulder-tip pain, collapse, or marked light-headedness requires emergency care because an ectopic pregnancy must be excluded.

Prompt review is also appropriate when bleeding comes with fever, worsening pelvic pain, or unusual foul-smelling discharge. These features can accompany infection and should not be managed by altering the pill without clinical advice.

Ask whether your pill-taking pattern could explain the bleeding, whether contraceptive protection has changed, and when to test for pregnancy. Discuss infection testing if relevant, medicines that may interact with the pill, and whether changing the dose, hormone type, or contraceptive method would suit your priorities.