Hello Casey, I am Dr Nilajkumar a consultant gynecologist and I will be helping you in your queries. Missing three pills means that you may no longer be protected by pills and need to use another method. So chances of pregnancy are there. The spotting may be due to implantation bleed or due to irregular intake of pills or due to any other unrelated cause like a fibroid or erosion of cervix. Confirmation may be done with a home pregnancy test done if there is a missed period preferably one week after missed period. If the periods begin after some days, no need to do anything, watch the next cycle. If there are no periods and urine preg test is negative, you must see a gynec if the symptoms persist. I hope that the answer helped you in making a decision. Thanks for using HCM. Have a good day. Dr Nilajkumar Bagde Consultant Obstetrics and Gynecology