How Birth Control Affects Your Period

If you are on birth control you may wonder, “how does my birth control affect my period?” and – like with most things physiological – the answer isn’t quite as simple as it first appears. In most cases, hormonal birth control frequently stops your period from arriving each month, and you instead get a ‘withdrawal bleed’. This differentiation can appear confusing at first: doctors and nurses often assure women that going on birth control will help make their period ‘regular’, but birth control pills can’t make your period regular.

This is because pills work by preventing ovulation (a key step in getting your period at the end of your menstrual cycle). To make matters more confusing, if you are on the patch, the implant, or the copper IUD, your experience will vary, because different birth control forms work by different mechanisms: on some forms of birth control, you are able to keep your menstrual period, while also protecting yourself against pregnancy, while on others you may not get your period.

To give you a clear idea of how your birth control is affecting your period, in this article, we’ll talk about:

• The different types of birth control and how they affect your period
• How birth control works  
• The difference between a regular period and a withdrawal bleed
• What forms of birth control allow you to ovulate (and thus keep your period) each month.

Let’s dive in!

The different types of birth control and how they affect your period

Oftentimes, when we refer to birth control in popular culture and everyday conversations, we’re often referring to the combined oral contraceptive pill.

It’s important to note though, that this form of birth control is different from the mini-pill, the implant, IUDs, and barrier methods of birth control, such as the diaphragm, male-condoms, and vaginal sponges. Technically, though, all of the above forms of birth control are in fact birth control. The key difference is how they work to prevent pregnancy. For simplicity’s sake to explain how each has the capacity to affect your period, we will be separating the forms of birth control into two categories: hormonal and non-hormonal.

How does hormonal birth control work?

There are types of birth control that allow you to keep your period each month, but hormonal birth control is not one of them.

Hormonal birth control works by preventing ovulation. The hormones in these birth control methods contain synthetic versions of your body’s natural hormones: specifically, they control man-made forms of estrogen (in the US, the most common synthetic form of estrogen is ethynilestradiol) and/or progesterone (progestin). The combined pill will have both forms, but it’s worth noting that the mini-pill and the hormonal IUD   are progestin only.   Progestin only methods can be  as effective as the combined pill, but the lack of estrogen can make breakthrough bleeding (more on this later!) a common side effect.  

Since ovulation is triggered by a peak in estrogen, combined hormonal birth control prevents ovulation by maintaining more consistent hormone levels. Without a peak in estrogen, the ovary doesn’t get the signal to release an egg. This means your ovaries do not release a mature egg, which in turn does not travel down your fallopian tubes, ready to be fertilized. In keeping with preventing ovulation, hormonal birth control also discourages your vagina from secreting “stretchy, ferticle” mucus, which is a hospitable environment for sperm.

How does non-hormonal birth control work

Each form of non-hormonal birth control works a little differently, but for the most part, they rely on some form of barrier or substance that either directly prevents sperm from reaching an egg, or provide an especially inhospitable environment meant to kill sperm in the vagina.

Since non-hormonal forms of birth control work by being inserted into the body for a certain length of time, and then removed – barring the copper IUD – they do not have the ability to affect your period.

We will go into more detail about the non-hormonal birth control options, their efficacy, and how they work to prevent pregnancy later in the article.

What is a “withdrawal bleed”?

Okay, so now we’ve covered how hormonal birth control works, we know that it works by preventing ovulation. This means, inherently, that you do not get a monthly period while on combined hormonal birth control.

So what is that 3 to 5 day bleed that users experience every month on birth control pills? And is the light spotting or bleeding that can occur throughout the month also a withdrawal bleed?

Let’s tackle each of those questions in turn.

The bleed that is scheduled when you are on hormonal birth control pills is a withdrawal bleed. This occurs during the days when you take sugar pills (usually 4 to 7 days in length). Some women, who want to skip this withdrawal period altogether, can continue taking the hormonal pills as normal, and this has no effect on their protection from pregnancy. In fact, there is no requirement to experience the withdrawal period each month: this simulation of a normal period was programmed into the packaging by drug companies back in the 1960s to make hormonal birth control seem more marketable to users. Put another way: users went from having a period frequently, to having a withdrawal period frequently, as opposed to never having a monthly bleed, which might have seemed more jarring.

The reason it’s called a withdrawal bleed? Quite literally, it is your body’s reaction to not receiving the levels of hormones it has become accustomed to for the rest of the month. Remember: your hormones, off of birth control, can be charted in terms of ebb and flow, which triggers the follicular phase, ovulation, the luteal phase, menstruation, and repeat. On hormonal birth control, your progesterone and estrogen levels are kept consistent throughout the entire month to prevent ovulation, so when they drop suddenly during the sugar pill phase of the pack, your body sheds your uterine lining but this withdrawal bleed is a lot lighter than your natural period, because hormonal birth control suppressed this lining from thickening.

Now let’s talk about the light spotting that’s cited as a drawback of the mini-pill and some IUDs. Simply put, the odd spotting or light bleeding that occurs during the month is called breakthrough bleeding.

This is a not uncommon result of synthetic progestin without estrogen. As we touched on earlier, the combined pill has both estrogen and progestin in it, which means that breakthrough bleeding isn’t as common: the progestin is responsible for preventing ovulation and thickening the mucus to prevent sperm from reaching your cervix, but the estrogen is responsible for making bleeding predictable. Without it, “progestin-only methods [of birth control] can cause changes in menstrual bleeding”. Essentially, then, estrogen helps keep the withdrawal period confined to the sugar-pill window. It’s important to note that if your breakthrough bleeding is more than the odd spotting, you should definitely speak to your doctor: you should not be bleeding for days on end and you should not be made uncomfortable. If that is the case, it may be time to explore other options.

Should you find a birth control option that doesn’t affect your period?

The answer to this question will differ depending on the person, but ultimately we would argue that if you:

• Have struggled to ovulate frequently, and you want to work toward ovulating regularly
• Don’t like the way hormonal birth control changes your menstruation cycle, or you have reacted badly to hormonal birth control in the past
• Think that non-hormonal methods would work better for your lifestyle and preferences

Then potentially pursuing non-hormonal birth control methods may be better for you. Hormonal birth control is amazing in that it has allowed women to have more control over if they have children, at what time point, and under what circumstances, but it is not carte blanche the right choice for everyone. It comes with very real side effects, spanning both the physical, emotional, and psychological (increased anxiety, weight gain, bloating, and migraines top the most common side effects list), which should not be underrated. We urge you to do more research to understand what birth control option is right for you, keep a diary of your mood and wellbeing when going on and off any birth control, and work with a trusted physician to discuss all your options. This is your body and your wellbeing: do not be rushed or pushed into anything else than what feels right for you.

On the other hand, if you:

• Suffer from heavy periods
• Want to skip periods altogether
• Have had positive experiences with hormonal birth control

Then hormonal birth control may be the right option for you. If you have consulted with a physician to discuss the underlying reasons behind long, painful periods (this is definitely worth doing, to make sure that everything is as it should be), or you know that it is the best choice to have the option to skip your period each month: it may be worth doing more research to figure out if the IUD, pill, patch, injection, or implant is right for you. Different pills and forms have different hormone compositions and forms of synthetic hormones – they also have different levels of investment (IUDs are inserted for years and you do not have to worry about them, for their lifespan, while pills require a daily commitment to remembering for 99%+ efficacy). All these factors are critical to keep in mind as you explore your options.

We would also like to make a note that hormones are extremely powerful, and so choosing a hormonal birth control option based on potential benefits, like better skin, might be worth thinking twice about. For instance, a dermatologist and your physician can work with you to understand the underlying causes of things like hormonal acne and work toward a treatment plan that resolves the root problem. Hormonal birth control, by its very function, will not fix any root problems –  it can only hope to put a bandaid over the issue.  

Whether hormonal birth control is right for you or not should also be a question of how important ovulation and having a natural period is to you, as well as the best option to prevent pregnancy that suits your lifestyle: this is only a question you can answer, so definitely meet with your healthcare provider and consult with trusted resources and friends to discuss the best options for you.

Birth control options that do not affect your period

For those that know – for any reason – that they want to ovulate, have their natural period, or simply avoid synthetic hormones while being protected against pregnancy, we have put together a list of non-hormonal birth control options that do not interfere with your period:

• Male and female condoms
• When used correctly, this form of birth control has a high efficacy rate (98% for male condoms, and 95% for female condoms), no side effects, and is completely hormone free. A big bonus here? They also protect you against STDs.
• Copper IUD
• This form of birth control lasts 10 years, and does not prevent ovulation.
• This allows you to get your period each month, although the drawback is that it can make periods heavier. Women on this form of birth control report that heaviness typically goes down over time, but it’s worth noting that your periods with the copper IUD  may always be more painful or heavy than without the IUD.
• Spermicide and vaginal sponges
• Unfortunately, this method does not have the highest efficacy rate, and is best used in conjunction with the withdrawal method or the family-planning method (also not as effective as condoms, hormonal birth control, or any of the IUDs).
• Spermicide comes in different formats (foams, films, etc), and are estimated to hold 82% efficacy when used perfectly. It is placed inside the vagina before sex, and blocks the cervix, helping stop sperm from joining the egg.
• Family planning method (FPM) and the withdrawal method
• Family planning means – daily – closely watching your period, body temperature, cervical fluid, ovulation symptoms, and typically using a family planning app to estimate when you are fertile (and avoiding sexual contact during certain days before and shortly after ovulation). Planned Parenthood reports this method holds a 76% pregnancy prevention rate, so it is worth having another method of birth control (such as condoms) to have peace of mind with this method.
• The withdrawal method (73% efficacy) means your partner pulls out before ejaculation. Clearly, this requires a lot of trust, and does not protect you against STDs. It can be a useful method, just like the FPM, when used in conjunction with a barrier method.

Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.

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