Sexual Health Birth Control Withdrawal Bleeding From Birth Control This is different than a menstrual period By Dawn Stacey, PhD, LMHC Updated on October 20, 2022 Medically reviewed by Anita Sadaty, MD Print Table of Contents View All Table of Contents Causes Timing Medical Need Skipping It Frequently Asked Questions 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 ring. It is normal and expected, but is not your period. Withdrawal bleeding is usually briefer and lighter. Withdrawal bleeding 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. Laura Porter / Verywell 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. Your Menstrual Cycle 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 or vaginal ring Week 4 (the week off before placing a patch 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. Frequently Asked Questions What does it mean if withdrawal bleeding does not occur during the the placebo pill week? Lack of withdrawal bleeding during the placebo pill week could mean nothing, but it could also be a sign of pregnancy. If you are expecting to have withdrawal bleeding and it does not come, take a pregnancy test just in case. How long does withdrawal bleeding usually last? Withdrawal bleeding should last a few days to a week. If you experience prolonged bleeding, consult with your healthcare provider. 5 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. InformedHealth.org. How does the menstrual cycle work? Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). Hatcher RA, Kowal D. Birth Control. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990. InformedHealth.org. Contraception: Hormonal contraceptives. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). Dhont M. History of oral contraception. Eur J Contracept Reprod Health Care. 2010;15 Suppl 2:S12-8. doi:10.3109/13625187.2010.513071 Edelman A, Micks E, Gallo MF, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev. 2014;(7):CD004695. doi:10.1002/14651858.CD004695.pub3 Additional Reading Edelman A, Micks E, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev. 2014;7(CD004695.). doi:10.1002/14651858.CD004695.pub3. Isley MM, Edelman, A. Extended and continuous OC dosing regimens. Contemporary Ob/Gyn. 2008;53(7):50-54. Kaunitz AM. Patient Education: Hormonal Methods of Birth Control (Beyond the Basics). In: Eckler K, Martin KA (Ed.) 2017. Pletzer BA, Kerschbaum HH. 50 years of hormonal contraception-time to find out, what it does to our brain. Front Neurosci. 2014;8:256. doi:10.3389/fnins.2014.00256 Thiyagarajan DK, Basit H, Jeanmonod R. Physiology, Menstrual Cycle. In: StatPearls. By Dawn Stacey, PhD, LMHC Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookies Settings Accept All Cookies