Bleeding on the Pill

Can you have a period while on the pill?

The answer, in short, is yes and no. Did that not clarify things for you? Oh, sorry. I should start off by saying that the subject of bleeding while on the pill has been confusing for women since the invention of the birth control pill and its FDA approval in 1960.

It was only years after the release of the pill to the market that one of the original developers of it, Dr. John Rock, created a new regimen for taking the pill that involved taking a “break” from it for about one week to allow for bleeding to occur. This eventually was replaced with the idea of having one week of placebo (inactive) pills for a women to take at the end of the cycle, so that she maintained the habit of taking a pill every day.

Besides maintaining the habit, why take a placebo? It became apparent that women and doctors were uncomfortable with the idea of a woman no longer menstruating. So the solution was to take the inactive pills to allow for a period-like bleed. This bleeding is also referred to as a withdrawal bleed or a hormonal bleed. Typically, it is lighter than a woman’s normal period.

What causes a withdrawal bleed?

The bleeding associated with the pill or any other hormonal contraception is actually not a period, but a bleed from the withdrawal of hormones. When taking the pill, a woman’s hormones are suppressed and at lower levels in the body. So by taking away the artificial hormones provided in the pill, some endometrial lining will be sloughed off. While it psychologically may make women feel better about taking the pill, it actually serves no particular physiological function.

What other types of bleeding can you have on the pill?

Implantation Bleeding:

While the pill is meant to be a form of contraception to avoid pregnancy, it does not always successfully do this. So in this case, when a woman conceives while on the birth control pill, she may still see implantation bleeding. This is bleeding that occurs a few days after ovulation and conception as that new life implants into the uterine lining. It can look like the typical pill bleeding, though, which can be confusing for women to help them identify early on that they did actually conceive.

Breakthrough Bleeding:

This is actually very similar to withdrawal bleeding on the pill, as it is the body’s response to changing hormone levels. However, as withdrawal bleeding occurs from a withdrawal of hormones, the breakthrough bleeding is from the increase in hormones; this typically occurs in the first few months on the pill as a woman’s body tries to adapt to the artificial hormones.

Can a woman have withdrawal bleeding without being on the pill?

Yes, the pill is not the only cause of withdrawal bleeding. Some women with hormonal imbalances may see unusual bleeding during their regular cycle. This typically presents itself as bleeding in the middle of the cycle as Estrogen rises when the body prepares for ovulation and drops right around the time of ovulation. While this may happen during an unmedicated cycle for a woman, that doesn’t mean it is normal, and it likely still warrants a follow up with a medical provider to determine the cause and possible treatments of this bleeding.

Why does bleeding on the pill matter?

While there are historical reasons for introducing a pill bleed during the month, we know it isn’t actually serving the same purpose as menstruation. And while most medical professionals agree that this bleeding on the pill does not serve a critical physiological function, there are varying opinions about if having a real period is actually essential to a woman’s health.

Some doctors say that it is antiquated to think a woman needs to have a period each cycle, and so they prescribe contraception to potentially suppress the cycle. Others argue that there is not enough research on the effect of breast health, bone health, and other systems affected by those normal cyclical hormones to say that it is inconsequential to stop a woman from menstruating.


How can I track bleeding?

As with most matters of fertility, I would argue that knowledge is power, so it is a good idea to begin tracking your cycle to learn more about what is going on inside your body. There are some options requiring a greater investment of time like working with a professional to track your fertility through a fertility-awareness based method. Then there are options to track your bleeding and other indications of fertility with simple apps designed to be intuitive and accessible. Either way, any unusual bleeding that you see should be brought up with a healthcare provider to determine if it is something that warrants treatment.

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