Why you never have a real period on the pill
Periods are just one of the amazing functions of the female body. And while we're all probably familiar with what a period is, you might not know quite so much about a withdrawal bleed (AKA a period you have while taking hormonal contraception). So, whether you've had a withdrawal bleed before, or you're considering starting on birth control, here's everything a doctor wants you to know about withdrawal bleeding.
What is withdrawal bleeding?
A withdrawal bleed is essentially the period that you have while you're on hormonal birth control. But how does it work? Here are the basics:
"Many types of contraception work by altering your body’s hormones, preventing your ovaries from releasing an egg each month," explains Dr Samantha Wild, a GP and Primary Care Physician at Bupa Health Clinics. A lot of these hormonal birth controls, like the pill, patches and vaginal rings, work on a 21-day cycle, giving you a week off taking hormones which is when you have the withdrawal bleed. And there's a purpose to this intermittent bleeding. "A 'withdrawal bleed' happens as a result of this drop in hormones when you have the week off, and the body releases some of the blood and mucus from the lining of the uterus," Dr Wild explains.
Why is a period on the pill not a 'real' period?
For all intents and purposes, you might think a withdrawal bleed is the same as a period - it looks the same, anyway. But it's not. "Withdrawal bleeding isn’t the same as a regular period. This is because the hormones from the contraception affect your endometrium – the lining of your uterus – preventing it from thickening, so there’s less discharge," notes the doctor.
"Similarly, the hormones also prevent you from ovulating, meaning there is no egg for your body to get rid of. As such, withdrawal bleeds are typically lighter and have less pronounced symptoms to a standard period, Dr Wild adds.
Which types of contraception can you have a withdrawal bleed with?
It's not just the pill that can cause withdrawal bleeding. Other kinds of hormonal contraception usually contain the same hormones and have the same effect - they're just inputted into the body in a different way.
"Contraceptive patches work in the same way as the pill and contain the same hormones, oestrogen and progestogen, and the same goes for the contraceptive vaginal ring which is inserted in the vagina," Dr Wild explains. "But pills, patches and vaginal rings are the only types of contraception which may cause withdrawal bleeding. You won’t experience one when using the coil," she advises.
This is because, on the copper coil (IUD), you still get your normal monthly period. "The IUD doesn’t contain any hormones. Your regular period may be heavier, longer or more painful, especially in the first 3-6 months after it is put in," says the doctor. "The Intrauterine System (IUS) won’t cause a withdrawal bleed either. This is a small plastic T-shaped device that releases the hormone progestogen into the womb to stop you getting pregnant. It can make your periods lighter, shorter or stop altogether. These aren’t withdrawal bleeds though, as the progestogen is provided constantly so there’s no break in the cycle." So there you have it.
In terms of the implant, Mr Ahmad Sayasneh, Consultant Gynaecologist at The Princess Grace Hospital, Part of HCA Healthcare UK details how it may have an effect, but that it's different for everyone. (FYI, the implant is a small rod that is inserted under the skin of the arm that releases progestin.)
"It is possible for individuals to experience irregular bleeding or spotting with the implant, while others may have infrequent or no periods," he says.
As for 8-Injectables, such as Depo-Provera - a form of contraception that can be administered through an injection - Dr Sayasneh outlines that many individuals may experience irregular bleeding or spotting, particularly during the initial months, but that it's different to a withdrawal bleed. "Some individuals may experience irregular or absent menstrual cycles over a period of time," he adds.
What is important - says Dr Sayasneh - is that everyone's experience with contraception can be different, and it is normal for bleeding patterns to fluctuate over time. If you have any concerns about your bleeding pattern while using a specific contraceptive method, he recommends consulting with a healthcare professional. "They can provide personalised guidance and discuss alternative options, if necessary."
How long does a withdrawal bleed last for?
As with 'normal' periods, withdrawal bleeds vary from person to person, and everyone's cycle is different. However, they will usually average at just under a week. "Withdrawal bleeding happens when you are having one week with no hormones," explains Dr Wild, "but the bleed will usually last for less than a week as it can take a couple of days to start after the hormones have stopped going into your system."
Can you still suffer from PMS around the time of your withdrawal bleed?
"You might still experience some symptoms similar to those you get around your 'normal' menstruation, but they are usually less severe," says Dr Wild. So, hopefully, even if you've still got cramps they won't be as tough as usual.
Plus, hormonal contraception like the pill is actually often prescribed as a treatment for PMS because the symptoms are milder, Dr Wild adds, so if you're struggling with PMS then switching to hormonal contraception with a withdrawal bleed could actually be a good option. But, of course, speak to your doctor first.
Should you have a pill break to allow a withdrawal bleed every month, or can you go a few months without one?
Although pill packets are usually designed to give you a break (and therefore a withdrawal bleed) once a month, you actually don't need to take one. "It's not medically necessary to have a withdrawal bleed every month," Dr Wild explains. "Early pill regimes were designed like this to mimic a natural menstrual cycle, but it's safe to take them for longer before having a break."
Dr Sayasneh affirms this, noting: "The main reason for withdrawal bleeding in these contraceptive methods is to offer users peace of mind by confirming that they are not pregnant. This method helps simulate a typical menstrual cycle, providing individuals with the comfort of having predictable monthly bleeding."
Taking pill packets back to back without having a break will mean your withdrawal bleeds become less frequent. And if you do still experience symptoms during your withdrawal bleeds, then you most likely won't have any of these symptoms while taking packets without a break.
However, Dr Sayasneh addresses that it's also important to note that the lack of withdrawal bleeding or experiencing irregular bleeding does not indicate that the contraceptive method is ineffective in preventing pregnancy. "The effectiveness of hormonal contraceptives depends on consistent daily or long-term use, as directed by a healthcare professional, rather than the occurrence of withdrawal bleeding," he says.
What's the difference between withdrawal bleeding and breakthrough bleeding?
Like both doctors have said, withdrawal bleeding is the 'period' you get when taking birth control. Which makes it a different thing entirely from breakthrough bleeding. But how? According to Dr Sayasneh, the causes of the latter include "hormone fluctuations, missed pills or irregular use of hormonal contraceptives, drug interactions, or using a contraceptive method that may not fully suppress the uterine lining."
In summary, he details that withdrawal bleeding is a regular, predictable bleed that mimics menstruation during the hormone-free interval in certain hormonal contraceptives. While breakthrough bleeding is unscheduled and irregular during hormonal contraceptive use.
Is it possible to experience withdrawal bleeding after stopping birth control?
"Yes, you can have withdrawal bleeding if you stop taking birth control," explains Dr Sayasneh. "When you stop using some hormonal forms of birth control, like combination birth control pills, contraceptive patches, or contraceptive rings, your hormone levels drop quickly. This can cause withdrawal bleeding."
After you stop using hormonal birth control, it may take a while for your menstrual cycle to return to its natural pattern, he outlines. The doctor also adds that some people may have irregular periods or periods that come later than usual for a few months.
Is a withdrawal bleed still a sign you're not pregnant?
The short answer is yes. "A withdrawal bleed is still a sign that you're not pregnant," says Dr Wild. And on the flip side, "if you don't bleed when you expect to then you should do a pregnancy test if there is a chance that you could be pregnant."
However, some people don't have withdrawal bleeds, adds Dr Wild, and if you're not having a pill break then you won't have one either - so you won't be able to use bleeding/not bleeding as an indication. Other first signs of pregnancy include "breast tenderness, nausea or fatigue," says Dr Wild, but if you suspect you could be pregnant then still take a test.
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