Withdrawal Bleeding From Birth Control

This is different than a menstrual period

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Withdrawal bleeding is the monthly bleeding women experience while using a hormonal birth control method, such as the pill, the patch, or the vaginal ring. While it can feel like menstrual bleeding, withdrawal bleeding is not actually the same thing as a period.

If you use hormonal birth control for contraception, here's what you should know about withdrawal bleeding, from when it occurs to if it's OK to take steps to skip it.

Causes

Withdrawal bleeding is similar to menstrual bleeding in that it, in most cases, comes once a month and requires a trip to the drugstore or medicine cabinet for sanitary products. Beyond that, withdrawal bleeding and a menstrual period have few similarities.

During a natural menstrual cycle of a woman who is not using hormonal birth control, fluctuating hormone levels cause the uterine lining to thicken to prepare the uterus for a possible pregnancy. If a pregnancy doesn't occur, this uterine lining, or endometrium, along with blood, is shed.

For those who use hormonal birth control, hormone levels do not fluctuate throughout a 28-day period, which means that the uterine lining does not thicken—and doesn't need to be shed. Instead, by halting the addition of hormones to your system during the fourth week of use, hormonal birth control methods are designed to soften your uterine lining just enough to cause some bleeding.

This bleeding is your withdrawal bleeding, which tends to be shorter and lighter than a regular period and does not contain uterine lining.

When It Occurs

When you will bleed depends on the method of contraception you use.

Method When Withdrawal Bleeding Occurs
Combination birth control pills (28-day pill pack) Week 4 (placebo week)
Patch of vaginal ring Week 4, the week off before placing a path or ring
Extended cycle birth control pills (91-day, like Seasonique) Every three months
Progestin-only birth control pills During week 1 of your next pack (if you start taking your pills on the first day of your menstrual period)
21-day birth control pills (e.g., Loestrin 1/20) Week 4 (placebo week)

Placebo and break weeks mean that your body is not being exposed to hormones it is during other times of contraception use, which is what allows for withdrawal bleeding.

Is Withdrawal Bleeding Necessary?

Unlike menstrual bleeding, there is no medical reason for withdrawal bleeding. It was a choice of the designers of oral contraceptives in order to mimic a woman's natural menstrual cycle.

When you use hormonal birth control, you are, in essence, overriding your natural menstrual cycle. In a way, these methods trick your body into thinking it is already pregnant—so that a new pregnancy doesn't occur.

When the birth control pill was first developed in the 1950s, developers felt that women may not like the idea of not having a monthly period, especially since women usually relied on their regular period as reassurance that they were not pregnant. They also believed that since the pill mimicked a woman's natural cycle, there would perhaps be less religious objection to pill use.

Is It OK to Skip Withdrawal Bleeding?

Whether it's to avoid uncomfortable period symptoms, treat symptoms of conditions like endometriosis, or for various personal lifestyle factors, waiting longer than the standard 21 days between periods has become a common practice. This is accomplished by starting a new package of birth control pills, inserting a new vaginal ring, or applying a new patch after 21 days, rather than taking placebo pills for seven days or taking a week off from wearing a patch or ring.

Studies have found that continuous use of hormonal birth control for longer than 28 days is just as safe and effective as 21 days and may help relieve period symptoms including headaches, bloating, menstrual pain, and tiredness.

Talk with your healthcare provider to ensure you are skipping withdrawal bleeding in a way that is healthy and won't make your birth control less effective at preventing pregnancy.

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Article Sources

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