Withdrawal Bleeding From Birth Control

Withdrawal bleeding is vaginal bleeding that happens during the one-week break from hormones that is built into the dosing schedule for some hormonal birth control, be it a pill, patch, or vaginal ring. It is normal and expected, but it is not your period.

Withdrawal bleeding is usually briefer and lighter. It usually begins two to three days after you stop taking hormones and can last four to six days. It is not necessary from a health perspective.

This article explains more about when withdrawal bleeding occurs, why it happens if it's not actually needed, and what it may mean if you don't experience it.

What Are the Causes of Withdrawal Bleeding?

Withdrawal bleeding is similar to menstrual bleeding in that it, in most cases, comes once a month and requires the use of sanitary products like tampons or pads. Beyond that, withdrawal bleeding and a menstrual period have few similarities.

During a natural menstrual cycle of a person 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.

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 the 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 during the 1950s, developers felt that people may not like the idea of not having a monthly period, especially since people usually relied on their regular period as reassurance that they were not pregnant.

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 traditional use when comparing risks like blood clots. It 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.

Sex During Withdrawal Bleeding

If you want to have sex during withdrawal bleeding (or during your period), there's no evidence that it's harmful. Your birth control should continue to work as planned because the bleeding is a part of the hormonal cycle established by your birth control.

Keep in mind that spotting or bleeding can have other causes, though. These can include sexually transmitted infections (STI).

Can You Have Withdrawal Bleeding After Stopping Birth Control?

When you stop taking hormonal birth control, it can take some time for your body to return to a new and consistent menstrual cycle. These normal cycles should return within a few months.

Withdrawal bleeding may start as soon as you stop taking birth control, just as it does during the part of the month when you take placebo birth control pills (for those using oral contraceptives) and have your period.

Withdrawal bleeding should last a few days to a week. If you experience prolonged bleeding, talk to your healthcare provider.

Summary

Withdrawal bleeding occurs during the one-week break from contraception (placebo week) when you use hormonal birth control products. It is similar to your period but not the same thing.

Withdrawal bleeding is different from breakthrough bleeding, which describes unexpected uterine bleeding apart from your period. Talk to your healthcare provider if you have concerns about your birth control use, pregnancy, or withdrawal bleeding.