Do you get your period on the pill? All about birth control bleeding
Everything you need to know about contraceptives & breakthrough bleeding
TL/DR: Knowing the facts about birth control bleeding is so important for choosing your contraceptive method. Three of the more common birth control methods are the pill, IUD, and vaginal ring — and each has its own effect on how you bleed.
From the pill to the IUD to the vaginal ring, birth control options have definitely changed since that cheesy ‘80s video you watched in your high school sex-ed course (just me?).
With so many birth control (BC) options available, it can be hard to keep the details straight, especially when it comes to the question most of us have on our minds when choosing BC: How will this impact my period? Do you even get your period on the pill?
The short answer is this: You may or may not continue to get your period on birth control, and it all depends on how your body interacts with the specific kind of contraceptive you choose. Let’s discuss.
Menstruation vs. breakthrough bleeding vs. withdrawal bleeding: What’s the difference?
There are so many terms used to describe how we bleed, so we thought it could be good to start out with a few basic definitions – because (spoiler alert) your period when you’re not on birth control is actually a whole different thing than the bleeding that happens when you are on (most forms of) birth control.
The process of discharging blood and other materials from the lining of the uterus at intervals of about one lunar month from puberty until menopause, except during pregnancy. (aka your period) is the act of Another term for menstrual flow (commonly known as your period)., the cyclical bleeding that happens with shedding of the uterine lining.1 This occurs when fertilization does not, which means that progesterone levels stay low and allows for the endometrium (your uterine lining) to slough off. Your period will usually last for 3 – 7 days and occurs on a roughly monthly time cycle. For more on this, check out our first Re: Your Cycle article.
Withdrawal bleeding is a type of bleeding that happens when your body is no longer being influenced by external hormonal stimulation, and the resulting withdrawal from those hormones allows the uterine lining to shed to produce your period.2 However, withdrawal bleeding isn’t technically the “same thing” as your period since it happens as the result of the hormonal medication (and lack thereof) influencing your body, and not your natural hormonal fluctuations.
To think of it in practical terms, withdrawal bleeding is what happens during the placebo portion of your pill pack, or during the week when you remove your vaginal ring.
Breakthrough bleeding is when bleeding happens in between normal menstrual periods.3 Although it can be annoying and frustrating (hello, unexpected stains), it doesn’t generally mean that there’s something abnormal happening down there. Certain factors can increase the likelihood of breakthrough bleeding – including some types of birth control.
For example, breakthrough bleeding is more common when you first begin taking oral hormonal BC: around 30-50 percent of people experience it during the first 3 to 6 months of being on a new combined (usually, a combo of synthetic estrogen and progesterone) pill.4 It usually decreases as your body becomes accustomed to the hormones over the first year, but a small percentage of people may still have some level of breakthrough bleeding.
The general thought in the contraceptive community is that low-estrogen forms of BC are more commonly associated with breakthrough bleeding, although this can be different for every person.
Other factors that are associated with breakthrough bleeding? Smoking, taking meds that interact with BC, and digestive woes like diarrhea and vomiting that affect absorption of the pill. Also, skipping or missing pills – seems like an obvious one, but any missed or delayed pill will also increase the likelihood of breakthrough bleeding.
The contraceptive ring is also associated with an increased rate of breakthrough bleeding, especially in the first couple months of use. Again, this varies person to person.
If you experience breakthrough bleeding, make note of it in your phone or cycle tracking app of choice. Write down the quantity and appearance, from spotting to a full-on bleed, how many hours or days it lasted, and where in your cycle it happened (hint: Look at your BC packaging to find the specific day if you’re having a period on birth control during the active pills).
You should always feel comfortable bringing up abnormal uterine bleeding to your healthcare provider. The more details you have, the better.
How different types of birth control impact your period
This is by no means an exhaustive list, but some of the common types of birth control that we’ll talk about here include the pill, the IUD, the patch, and the ring. Calling it “the pill” is really a misnomer, as there isn’t just one type of pill available.
In fact, there are hundreds of varieties: ones that are estrogen-dominant vs. progestin-dominant, ones that have the same dose per day or change throughout the month, ones that come in a light purple package or a blue one (okay, that last bit isn’t important but still a difference!). And with each of these comes a change in how it does or does not affect your period.
Types of birth control that (might) stop your period
Some types of birth control may be able to lighten your period, and these types are often prescribed for those with health conditions like endometriosis or PCOS, or even plain old menorrhagia. These include most forms of combined oral contraceptives (e.g., combined progestin-estrogen pills), the hormonal IUD, and other options like the patch, shot, implant, and ring.5 Depending on the dosage and your body’s own reaction to the contraceptive, these options may also stop your period altogether.
Some individuals may be motivated to find a form of BC that stops their period altogether due to the demands of their profession, for instance, or severe menstrual pain. Remember that everyone’s body interacts with birth control differently: Talking to your OB-GYN is the best way to figure out which method is best for your unique needs.
Stopping/lightening your period with the pill or ring:
There are several specific formulations of the pill, in particular, that are designed to stop your period. These are termed “continuous use” contraceptive pills. They work by “skipping” the normal placebo week that is in your pack, which means that you have a consistent inflow of estrogen/progestin that prevents the withdrawal bleeding mentioned above. This is equivalent to not removing the vaginal ring during the fourth week of your cycle.
Stopping/lightening your period with an IUD:
There are two categories of IUDs approved for use in the United States: hormonal and non-hormonal. Hormonal IUDs (brand names include Kyleena, Liletta, Mirena, Skyla) are pretty variable in terms of their impact on your cycle – and how much your period changes – for about the first 6 months. Things generally even out around the 6-month mark.
Most people who have hormonal IUDs placed will end up having lighter and shorter periods over time, although this of course will vary from person to person. For certain individuals, hormonal IUDs result in no period whatsoever (after the initial adjustment phase). Certain types of hormonal IUDs for some people may also result in not even having a period, although this is a discussion to have with your provider.
Keep in mind that the non-hormonal, copper IUD (more on that below) will not result in a lighter period and, in most cases, does the opposite. Finally, it’s important to note that all IUDs require a visit with a medical provider for insertion and removal. This makes them a great long-term contraceptive – but it’s something to consider if you think you may want to become pregnant in the near term.
Other options: The shot, implant, or patch:
There are also several other BC options that are less frequently talked about in the mainstream: the depo-provera shot, the implant, and the patch. All three work differently and have varying pros and cons depending on your unique needs. These options, in general, will cause lighter periods and may even result in no period for some. Talk to your provider to learn more.
Heavy bleeding on birth control
Some BC options might do the opposite of what we discussed above – and may actually result in heavier menstrual bleeding. If you had a super light period to begin with, this may be no big deal (and may not outweigh the benefits these forms of BC could offer).
The most famous of this category is the non-hormonal copper IUD, the brand name of which is Paragard®. This contraceptive works by creating an environment that is so toxic to sperm (insert Jane Lynch Glee meme here) that the odds of fertilization are less than 1 percent.6
So, it’s a trade-off: the copper IUD is considered one of the most effective forms of contraception, and it’s low-effort (insert it once and it lasts for up to 10 years)… but the other side of the coin is a potentially heavy menstrual flow that may come with some other symptoms like bad cramping.
When to worry about heavy bleeding or breakthrough bleeding on birth control
The first couple of months of any new form of BC can result in changes to your menstrual cycle, like heavy menstrual bleeding or breakthrough bleeding. Most of this should balance out within about six months or sooner. Also, it’s important to remember that the copper IUD, in particular, is associated with heavier menstrual bleeding, so for most people this will be par for the course.
However, if you’re past that six month mark, not on the copper IUD, and still experiencing heavy bleeding on birth control, let your doctor or healthcare provider know ASAP. Heavy bleeding, FYI, is defined as using more than one pad or tampon an hour on average, bleeding that totals 80mL/5.4 tablespoons or more, and/or bleeding that lasts longer than 7 consecutive days.7
Your provider will be able to do a deep dive to make sure there isn’t something more serious going on – or, at the very least, switch you to a method that works better for you.
Birth control bleeding is different for everyone
Not to sound like a broken record, but it’s SO important to keep in mind that your own body is unlike anyone else’s, and this means that your menstrual cycle – and your reaction to different forms of birth control – will vary depending on your baseline hormonal levels, comorbidities (e.g. other health conditions), and other factors.
This means that, although we have population-level data on many if not all of the contraceptive options available, this information represents a bird’s-eye view. So, not all of it is necessarily applicable to YOU as an individual. For this reason, it’s important to communicate with your healthcare provider about your needs prior to beginning any contraceptive regimen.
Ask yourself these questions:
- Are you more concerned about efficacy or ease of use?
- Do you prefer hormonal or non-hormonal methods?
- Are you interested in potentially becoming pregnant in the short term, or within a couple of years?
- Do you have any pre-existing reproductive or pelvic conditions?
- What cycle-related symptoms (like acne, severe cramps, or headaches) are you experiencing currently that you would like to address?
The more *detailed* information you give your provider, the better chance you’ll have at finding your ideal BC option, ASAP.
Each method will have its pros and cons and it’s ups and downs with use. And your body will take a little bit of time to adjust, so don’t expect perfection during week one, or even month one. However, by having a clear understanding about your priorities and how you see contraception fitting into your lifestyle, you can support your provider in presenting options that will align with these needs.
Bleeding will also be a component of this conversation. Some folks prefer a lighter period or no period at all, others will prioritize a non-hormonal option above others despite any effects on bleeding, and still others like the regularity of having a period (or withdrawal bleeding) every month. Your preference is your preference, and you deserve to have this validated by a healthcare provider with the options we have at our disposal.