There are various forms of birth control, including patches, pills, and vaginal rings, that work wonders to prevent pregnancy. These methods often use hormones that affect your menstrual cycle and sometimes cause predictable bleeding called breakthrough bleeding.
It is important to know that withdrawal bleeding is different from normal menstruation and is a contraceptive effect. In an interaction with the OnlyMyHealth team, Dr. Deera Samadriya, Consultant Urogynecologist at Jaslok Hospital and Research Centre, Mumbai, shares everything you need to know about withdrawal bleeding so that you can use your contraception with confidence.
Also read: Are your birth control pills causing mood swings? Here’s what you need to know.
What is withdrawal bleeding?
According to Dr. Samadriya, it’s common to have some bleeding or spotting during the week you’re not taking your hormonal pills in a combined hormonal contraceptive (CHC). This is due to the fluctuations in estrogen and progesterone that occur when you take a break from birth control pills. This can happen regardless of how long you’ve been taking the pill, and it can continue into the first few days of your next cycle.
The doctor emphasizes that this withdrawal bleeding is usually predictable and is similar in weight and duration to a normal period. However, withdrawal bleeding is not the same as regular menstrual bleeding.
According to Medical News Today, most monthly hormonal birth control cycles involve taking the drug for three weeks, or 21 days, followed by a week without medication.
Withdrawal bleeding is reportedly very common, with estimates suggesting that about 90 percent of users will experience it when taking a standard combined oral contraceptive pill at a typical dose.
How to distinguish withdrawal bleeding from menstrual bleeding?
A regular menstrual cycle involves the interaction between hormones and other factors that lead to the release of an egg. During a normal menstrual cycle in someone not using hormonal contraception, hormone levels rise and fall, causing the lining of the uterus, also called the endometrium, to thicken in preparation for a possible pregnancy.
If fertilization and implantation do not occur, the inner lining is shed along with blood and tissue, leading to menstruation.
On the other hand, withdrawal bleeding is caused by a drop in hormone levels when a person stops taking hormonal contraception.
Is withdrawal bleeding a sign that birth control is working?
The answer is no. Dr. Samadria states, “Experiencing withdrawal bleeding does not mean that birth control is working effectively. Similarly, the opposite is not true, meaning that the absence of withdrawal bleeding or amenorrhea does not mean that birth control pills are not working effectively.”
Amenorrhea is intentional with continuous and longer CHC regimens. However, amenorrhea can occur unintentionally with 21/7 or 24/4 cyclic dosing schedules. “Especially with the lowest-dose COCs, low levels of ethinylestradiol (relative to much greater growth stimulation) in the absence of withdrawal bleeding,” he adds.
Read also: How do birth control pills cause breast cancer?
Women who are concerned about pregnancy can be reassured that amenorrhea does not mean reduced contraceptive effectiveness if the medication has been taken correctly and consistently. For women who want to be sure of a monthly withdrawal bleed, one option is to increase the estrogen dose in the COC, although this has not been extensively studied and should be discussed with your doctor.
What is breakthrough bleeding?
According to Dr. Samadriya, if withdrawal bleeding is regular and predictable, it has no harmful effects.
However, unscheduled bleeding, also known as breakthrough bleeding, is a common side effect when starting CHCs, affecting around half of users in the first cycle but improving over time.
If patients take the pills correctly, this bleeding does not reduce the contraceptive effect. This can happen regardless of when you start taking the CHC, so there is no advantage in waiting for your period to start.
The doctor also shared that formulations with less ethinyl estradiol (20 mcg) or a 24/4 dosing schedule are more likely to cause unplanned bleeding than those with 30 mcg more and a 21/7 regimen.
He noted that heavy bleeding can also be caused by prolonged thinning of the endometrium or inconsistent pill use, with higher doses of progesterone playing a key role in bleeding from atrophic endometrium.
Conclusion
Withdrawal bleeding is normal and occurs when you take a break from birth control pills, but it’s not like a regular period. The good news is that it’s predictable and nothing to worry about. Whether you have it or not, it doesn’t mean your birth control is working. So, if you’re taking your pills correctly, withdrawal bleeding shouldn’t be a cause for concern. However, it’s important to talk to your doctor if you experience any unscheduled bleeding or symptoms.
