<s>[INST] Hello doctor, I just started birth control a few weeks ago, so this is my first week of my period. I had brown discharge a few days before I started the sugar pill. My period started kind of light but is kind of thicker blood. I just had horrible cramps this afternoon, probably the worst ever. I took a nap and when I got up there was a large clot that looked like some sort of tissue. It was slightly smaller than an egg and was pink with dark spots. I am sexually active but my partner always wears a condom and has never finished inside me so there is no possibility of a pregnancy. Is this something I should be concerned about? [/INST] Hi. According to your description, the possibilities are: During the first months of Contraceptive pills, you can have some amount of menstrual irregularity like intermenstrual spotting. It may take a few months for regularization of the flow. And missing the time or pill can lead to spots. Regarding the tissue you mentioned could be endometrial tissue with blood spots. Anyhow better to check with a urine pregnancy test to be on the safe side. If the test gives a negative result, you can continue with your pills. </s>