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Dr.M.D.Mazumdar, Doctor
Category: OB GYN
Satisfied Customers: 9033
Experience:  MD (Obst&Gynecology)
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I take Levlen ED as my birth control pill. I always take it

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I take Levlen ED as my birth control pill. I always take it before I go to bed around the same time every night however I went away 15 days ago & forgot to take my packet of pills so I missed one active tablet on a Wednesday night. I was able to get a new prescription the next morning so I took the missed tablet Thursday lunchtime then took my Thursday tablet as normal that night (took two tablets in one day) Because the Friday was my last active tablet before my sugar pills, I skipped the 7 sugar pills & started a new packet on the active pills as the leaflet said to skip the sugar pills so you have 7 days of active pills after the missed one.
Yesterday I had a bit of spotting (brownish color) & today I've had a bit more spotting all day similar to yesterday but now its more like a light period bleed. Just enough to stain my underwear to the point where I have now put in a liner for some protection. What could cause this spotting & break through bleeding? Could it be because I have skipped the sugar tablets & did not have my period/withdrawal bleed like normal? I am still on active tablets- only half way through my current pill packet. I have never had any withdrawal bleeding previously since I've been on the pill & the only spotting I ever get is sometimes a day or so after my period finishes but not all the time. I should also note that I have never skipped the sugar pills before until now since being on the pill.
Is there reason to worry about whether my birth control pill has failed? My partner & I don't always use a condom when having sex however have not had any issues in the past so far (touch wood) The only times we had sex around when I missed my active pill was 6 days prior & 8 days afterwards (we don't see each other alot due to work commitments!)
Welcome and thank you for your question. I am Dr.Mazumdar and I hope I'm able to help you with your medical problem today.
The bleeding you are having now is a breakthrough bleed caused by the missed pill. When you missed your pill, the hormonal level went down failing to support the endometrium. Some of the endometrial cells started to slough, leading to the bleeding.
Your taking the pill the next day ( this is the standard advice when a pill is missed) will protect you from pregnancy but endometrial sloughing which which has already occurred will lead on to bleeding. The endometrial cells which did not slough may continue to get support from the new pack and it is very likely that your bleeding will clear up spontaneously. Sometimes, in some cases however, it may lead on to a full slough and a period.
Since you have started a new pack and since you had sex after 8 days on the new pack, you are protected from getting pregnant.
This bleed is not related to your missing t sugar pills and not getting a period. Missing the sugar pill and going on to the active pills will protect you from pregnancy and does not cause withdrawal bleeds.
I hope this helps.
Dr.M.D.Mazumdar and other OB GYN Specialists are ready to help you
Customer: replied 4 years ago.

Thank you Dr Mazumdar for your reply.

Is that normal to experience break through bleeding due to a missed pill this long after missing the pill (15 days)? I half expected to get some kind of break through bleeding or some side effect straight after I missed the pill so it was a bit of a shock when it happened today & yesterday- had me a bit worried as it hasn't happened before.

And could the break through bleeding that I'm experiencing now potentially affect my normal withdrawal bleed that I should get when the sugar pills come around?

Breakthrough bleeding usually occur about 3-4 days after a missed period. getting it this late (15 days) is not very common but can happen. A hormonal imbalance due to the missed pill, rather the missed pill itself can lead to a later breakthrough bleeding.
No, the later bleeding which will occur when you are on your sugar pills will not be affected as that will depend on the pack of pills that you are presently on. It should occur after 3-4 days of the last active pill.
I hope this helps.
Customer: replied 4 years ago.

So should I be concerned about this current breakthough bleed? I am on my third day of spotting however it is much less then yesterday- just a bit of brown colored spotting so far. I have had a few mild cramps on & off the last few days which very much resemble my normal period cramps but not as bad. I don't have access to a good local GP as I am in a remote location so have to wait weeks to be able to visit a doctor that I will get any sense out of so sorry for all the questions!

I rang a women's help line & spoke to them also & they said giving what I told them that it may be because my body is not used to having an extended period on the active BCP (ie skipping the inactive pills) pills even though alot of people do it all the time without any problems... ???

If it has been caused by a hormonal imbalance, what what cause it to suddenly become unstable? I haven't missed any pills before prior to this recent occasion & I always take them every night before I go to bed which is normally around the same time. I am sometimes guilty of taking them a bit later then usual such as at 11pm instead of 9-9:30pm if I'm out & don't get back in until later. That is the only inconsistency I can think of though. I do take Thyroxine medication though as I have an auto-immune underactive thyroid condition. I have regular blood tests to check those levels & they are always fine & I haven't changed that or any other medication recently either.

Thank you for your feedback!

Being on active BC pills for an extended time will not cause a breakthrough bleed. Some BC pills pills like Seasonique contain active pills which are actually meant to be taken for 3 months straight without any sugar pills.
Breakthrough bleeding is due to the body not being used to extended pills. It occurs due to a decreased level of hormones in the blood. Your missing the pill caused sauce a decrease. This decrease may either cause a bleed within 3-4 days or may set off a hormonal imbalance which will cause a bleed a few days later.
Delaying taking the pill for 1-2 hours will not cause hormonal imbalance.
In your case, it is due to the missed pill. Continuing to take the pills now will help the hormonal levels to be regularized.
I hope this helps. Please click on a positive rating to credit me for the answers.