Withdrawal bleeding from birth control: What you need to know

If you’re on birth control (or are considering starting), you’re already familiar with your menstrual period. But the “period” you get while you’re on some forms of hormonal birth control isn’t actually a period, it’s called withdrawal bleeding.

The term refers to when you experience a withdrawal of hormones from your birth control, which causes your uterine lining to shed.¹ But even though withdrawal bleeding might look and feel like a period, that’s where the similarities end.² To make things even more confusing, withdrawal bleeding is not medically necessary, and doesn’t add any major health benefits nor risks.

Some people opt to delay withdrawal bleeding by extending the amount of time they use birth control before taking a break.³ Others are sometimes able to skip it entirely by taking birth control continuously or using a continuous method like an IUD (though not everyone loses their period).⁴ For almost every type of hormonal birth control, there are different options for controlling the timing of withdrawal bleeding. So how do you choose?

Here’s everything you need to know about withdrawal bleeding, when it happens and why, and what you can do about it.

What is withdrawal bleeding?

Withdrawal bleeding occurs if you use a type of hormonal birth control that includes a break between your regular doses of hormones. This drop in hormones causes your body to shed the mucus and lining of the uterus, which is why withdrawal bleeding looks like a period.² As a result, withdrawal bleeding can happen if you take a scheduled break between regular doses of any type of hormonal birth control, such as between monthly pill packs, or when you stop taking one type of birth control when switching to another.⁵ Like with a period, you may also experience bloating, cramps, and other premenstrual symptoms as your body reacts to the drop in hormones.⁶

Which types of birth control cause withdrawal bleeding?

Only hormonal birth controls can cause withdrawal bleeding. These include combined oral contraceptives like the pill, which involves a standard 28-day cycle: 21 days of hormones and 7 days of taking a placebo or no pill at all.² Other variations exist, like 24/4⁷ and 26/2⁸ regimens, and often involve less bleeding. The patch⁹ and the vaginal ring¹⁰ also involve 3 weeks of hormones, followed by a one week break.

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Anytime you take birth control continuously without a break, like if you take the Depo-Provera injection, use a hormonal IUD, or take extended-use birth control pills, you won’t experience withdrawal bleeding. With these contraceptives, you are more likely to get some unscheduled bleeding, called breakthrough bleeding, though. Breakthrough bleeding can decrease over time as your body adjusts to the birth control, but that doesn’t happen for everyone.³

You also won’t experience withdrawal bleeding from the copper IUD because it isn’t a hormonal contraceptive – you get a regular period.¹¹

How is withdrawal bleeding different from a period?

The hormones from your birth control prevent your endometrium from thickening during your cycle and can also prevent you from ovulating. This means that there’s less build-up to get rid of, and so bleeding is usually lighter and shorter than a regular period.²

Because birth control regulates your hormones, premenstrual symptoms are often less severe than during a regular period, too.¹² This is why many people choose to take birth control to help with their PMS or PMDD.

When does withdrawal bleeding happen and how long does it last?

How and when withdrawal bleeding occurs varies from person to person and can change depending on how you react to different types of hormonal birth control. One study found that it’s common to have less or shorter withdrawal bleeding and less severe premenstrual symptoms using 24/4 and 26/2 birth control regimens than 21/7 options.¹³

You’re likely to start having withdrawal bleeding during the first few days of your break week and have it last 4-6 days.⁶ If you take the pill and forget a day or two, you might also have some slight withdrawal bleeding due to the temporary drop in hormones. And if you stop birth control entirely, you won’t be protected from pregnancy, but you might experience withdrawal bleeding before your regular cycle kicks in again.¹⁴ So, whenever you take a break from hormonal birth control, whether it’s temporary or long-term, experiencing withdrawal bleeding is totally normal.

How long withdrawal bleeding lasts can also decrease the longer you’re on birth control. In a study that compared new and current users of 21/7 day regimen birth control pills, people who just started taking birth control had slightly more bleeding in their 2nd cycle compared to those already taking birth control at the start of the study.⁶ But by the third cycle, bleeding flow in new users decreased and was similar between both groups. By nine months, women taking continuous birth control had less spotting overall than those on the 21/7 day regimen.

Keeping track of the duration of your withdrawal bleeding can be a helpful tool for monitoring changes to your health.

Keeping track of the duration of your withdrawal bleeding can be a helpful tool for monitoring changes to your health. With time, you can figure out whether your monthly bleeding is decreasing over time and whether this is a regular pattern for you. If bleeding is heavy or interferes with your daily life, you should talk to your doctor about possibly switching to a different type of birth control.

What is the purpose of withdrawal bleeding?

Medically, there is no purpose for withdrawal bleeding! Birth control pill regimens were originally designed to mimic a natural cycle — although many people do not naturally experience a 28 day cycle — with the “period” included to reassure them that their birth control was working to prevent pregnancy.² Since withdrawal bleeding doesn’t occur if you become pregnant (more on that later), a scheduled break in administered hormones was a useful check before the invention of rapid home pregnancy tests.

But today we know birth control pills are highly effective at preventing pregnancies. And since hormonal birth control prevents ovulation and build-up of the uterine lining, there’s no biological need for an off week. So why do so many birth control pills still come with placebos?

Well, there are some benefits of withdrawal bleeding. One is just peace of mind. Because you won’t see any withdrawal bleeding if you’re pregnant, some people find that having a monthly check-in can be a big relief.³ But if you think you skipped any birth control doses or haven’t been taking it as prescribed,¹⁵ and there’s a chance you might be pregnant, it’s a good idea to take a pregnancy test or consult with your doctor if you miss your withdrawal bleeding “period.”

If you’ve been taking your birth control consistently and correctly, and miss a withdrawal bleed, it’s highly unlikely that you’re pregnant. But if you’re concerned, you may want to take a pregnancy test for reassurance, especially during their first year of taking birth control.^16,3

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Another benefit from taking a break (and allowing the withdrawal bleed to happen) is that it can help stave off breakthrough bleeding in your next cycle.^17-18 You can talk to your doctor about figuring out the right way to schedule a break from your hormones that both treats unpleasant side effects from birth control while ensuring it remains effective.¹⁹

And if you’re worried about whether keeping withdrawal bleeding in your schedule comes with any health risks, the answer is a resounding no. You can still have sex during your placebo week just as you would at any other point in your cycle. Since you don’t ovulate on hormonal birth control, you’re still protected from pregnancy even during a break in taking hormones.²⁰

Long story short, since withdrawal bleeding doesn’t come with any health benefits or risks, you’re free to choose the birth control regimen that works best for your body and lifestyle.

What if I want to delay or stop bleeding altogether?

If you’re interested in having fewer periods, there’s good news. It’s safe and there are several options available for how to do it.

Continuous birth control involves taking active hormones all year long with no breaks.¹⁴ This means there’s no scheduled withdrawal bleeding, but many people experience breakthrough bleeding that usually gets better over time.²¹ Continuous birth control options include replacing each weekly vaginal ring or patch without taking a week off, taking birth control pills continuously, or using hormonal IUDs or the Depo-Provera injection.

Extended birth control entails taking your regular birth control for longer than 21 days, but involves taking breaks throughout the year. Similar to your options for continuous use birth control, you can replace your regular weekly vaginal ring or patch immediately for consecutive weeks, or take birth control pills for more than a month in a row.

There are several pills available that have standardized regimens and involve taking different combinations of hormones for 3 or 4 months, in which you’ll experience withdrawal bleeding four times a year.¹⁴ Other options include taking pills that have the same dose of hormones every day and simply skipping the week off by starting the next pack right away.

What are the benefits of skipping withdrawal bleeding?

Fewer periods often means less discomfort, fewer out-of-pocket expenses on period supplies, and greater control over your life, especially if you have irregular cycles.²

In a 2003 study that compared 32 women given either 28-day (21/7) cycle or continuous use of ethinyl estradiol/levonorgestrel birth control, continuous users reported significantly less bloating and fewer menstrual cramps.²²

Being able to manage your cycle can also allow you to plan ahead for events when withdrawal bleeding might be inconvenient, like a wedding, running a marathon, or a beach vacation.

Taking control of your cycle

If you take hormonal birth control, you’ll likely experience withdrawal bleeding whenever you take a break from hormones, whether that’s at the end of a 28- or 91-day cycle. Your birth control protects you during this time as long as you take it as prescribed, and it can help you know that you’re not pregnant.

But if you’re interested in changing the duration of withdrawal bleeding or if bleeding seems excessive, there are many options you can try while still preventing pregnancy. Depending on your preference, you can reschedule withdrawal bleeding or skip it altogether, no matter if it’s for a one-time event or because you’re looking for a more permanent change.

Your doctor may not bring up these options right away, especially if they’re more familiar with the standard 21/7 day birth control cycle1, so be sure to ask questions during your doctor’s visit to find the right type of birth control that works for you.