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Withdrawal Bleeding

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Are you using any hormonal birth control? Here is what you have to know about hormonal contraception and withdrawal bleeding.

Medically reviewed by

Dr. Natasha Bansal

Published At March 31, 2022
Reviewed AtApril 13, 2024

Introduction:

Every new menstrual cycle begins with a period, and this bleeding is triggered by certain hormones that cause the uterine lining to shed when implantation of a fertilized egg has not happened. And when the woman is on hormonal birth control, there can be spotting or light bleeding different from that of the regular menstrual period. This withdrawal bleeding happens when there is a change in the hormone levels.

What Is Withdrawal Bleeding?

Withdrawal bleeding refers to the bleeding that women experience while using hormonal birth control methods such as pills, patches, or vaginal rings. It may seem like menstrual bleeding, but it is not actually the same as a period. It is different from the menstrual period.

Usually, monthly courses of hormonal birth control are given for three weeks or for 21 days with a break for one week. During this break, the women can experience bleeding. This bleeding may resemble menstruation bleeding.

Women may also experience withdrawal bleeding when they discontinue or switch the methods of hormonal birth control. After they discontinue a certain contraceptive medication, it may take several months for the periods to regularize after discontinuation.

What Does Withdrawal Bleeding Look Like?

Withdrawal bleeding is not the same as a regular menstrual period. It is generally lighter and shorter. Some women experience menstruation-like symptoms while taking hormonal birth controls. Some of which include:

  • Breast tenderness.

  • Abdominal bloating.

  • Mood swings.

  • Weight gain.

  • Digestive problems like constipation or diarrhea.

  • A mixture of blood and mucus passes through the vagina during the break.

Are Clots Normal During the Withdrawal Bleeding?

Generally, clots are seen when the bleeding is heavier. In the case of withdrawal bleeding, if the person takes several birth control packs back-to-back with breaks, this can make the withdrawal bleeding to be heavier with more clots than usual.

Why Does Withdrawal Bleeding Happen?

In a normal menstrual cycle, when the woman is not using any hormonal birth controls, the fluctuating hormone levels cause thickening of the uterine lining, preparing the uterus for a possible pregnancy. And if the pregnancy does not occur, this uterine lining or the endometrium sheds along with the blood.

In women who are on hormone birth control, the hormone levels do not fluctuate throughout the 28-day period, and the uterine lining does not thicken and also does not shed. This is because the hormones in birth control prevent that from happening. And so, when the hormones are cut off during the break period, some blood mixed with mucus is shed out through the vagina.

Similarly, like a regular menstrual period, withdrawal bleeding is also caused due to drop in the hormone levels in the body. This drop in hormone levels triggers the release of some blood and mucus from the lining of the uterus out through the vagina.

How Long Does Withdrawal Bleeding Last?

The time period for withdrawal bleeding differs from person to person. And if the person is taking the medications as instructed, the bleeding should stop within a few days.

What Are the Birth Control Methods That Cause Withdrawal Bleeding?

There are a few birth control methods that have the potential to cause withdrawal bleeding. Here are a few:

  • Pills.

  • Vaginal rings.

  • Patches.

  • Injections.

Birth Control Pills:

The birth control pills come in different doses of hormones and as 21-day, 28-day, or 90-day packs with a break usually prescribed between these doses. These contraceptive pills cause withdrawal bleeding during the break week if taken as instructed.

Vaginal Rings:

Vaginal rings are also a 21-day estrogen and progestin vaginal ring. It is instructed to be worn for 21 days and causes withdrawal bleeding when removed.

Patches:

Patches contain estrogen and progestin. These are to be applied on the chest, abdomen, buttocks, or upper arm every week for three weeks, and the fourth week is left free before the cycle starts. So during this break week, withdrawal bleeding occurs.

Injections:

Injections that contain progestin are advised to be taken once every three months. These injections do not cause any withdrawal bleeding when taken as prescribed.

Birth Control methods causing withdrawal bleeding

Does Ovulation Occur Even With Contraceptive Methods?

No, ovulation does not occur if the contraceptive method is used consistently and correctly. During the normal cycle, when the contraceptive method is not used, the body’s reproductive hormones fluctuate and prepare the body to release eggs, whereas on taking the contraceptive pill, the hormones in the pills prevent the ovaries from preparing and releasing eggs. Hence ovulation does not occur.

What Kind of Bleeding Is Considered Normal While on Contraception?

  • Spotting for the first few months on taking birth control.

  • Withdrawal bleeding that is lighter and shorter than the actual menstrual bleeding.

  • Having little or no withdrawal bleeding during the placebo week after taking birth control correctly.

What Does It Typically Mean When There Is No Withdrawal Bleeding During the Placebo Pill Week?

If withdrawal bleeding does not occur, it does not mean anything, but it could also be a sign of pregnancy. So, in that case, if you are not planning for pregnancy and if you do not have withdrawal bleeding, it is wise to take a pregnancy test.

Is It Safe to Have Sex During the Withdrawal Bleeding?

It is safe to have sex during the withdrawal bleeding if you have taken the hormonal birth control method as advised. If in case, the person uses patches, rings, or 21-day pills pack properly, the person is protected from unplanned pregnancy even during the break week. If in the case the person has missed any doses, it is always better to use a backup birth control method during the break week. Under the direction of a healthcare provider, women can purchase birth control pills.

When Can the Regular Periods Be Expected After Stopping the Birth Control Method?

After discontinuing the birth control method, women will have withdrawal bleeding for two to four weeks. After the withdrawal bleeding, the natural regular menstrual period should resume the following month. The period in the following month will be heavier and longer than usual. And it may take several months for the period to regularize and become a monthly occurrence after the discontinuation of the birth control.

Conclusion:

Spotting or light bleeding is fairly normal when being on hormonal birth control. This bleeding should not last longer than a couple of days. Having prolonged withdrawal bleeding or heavy bleeding that starts to interfere with everyday life may require medical attention.

Frequently Asked Questions

1.

What Is the Duration of Withdrawal Bleeding?

The duration of withdrawal bleeding varies from one person to another. It typically lasts for a few days, similar to a regular period. It is generally expected to last from two to seven days. If the medications are taken as instructed, the bleeding will stop within a few days.

2.

Is Withdrawal Bleeding a Period?

Withdrawal bleeding is not the same as a regular menstrual period but resembles a period. It happens when a woman is on hormonal therapy or birth control methods such as pills, patches, or vaginal rings. It is a response to the withdrawal of hormones and is often lighter and shorter in duration than a typical menstrual period.

3.

Is Withdrawal Bleeding an Indication of Pregnancy?

Withdrawal bleeding indicates that the woman is not pregnant. It occurs if a person is using hormonal birth control like birth control pills, patches, or hormonal IUDs and takes a break from those hormones during the placebo or hormone-free interval. It is a response to hormonal changes and is generally not related to pregnancy.

4.

How to Differentiate Withdrawal Bleeding From a Period?

Withdrawal bleeding does not resemble a regular menstrual period as it is lighter and shorter. Some females can experience period-like symptoms while taking hormonal birth control. Symptoms include:
- Abdominal bloating.
- Breast tenderness.
- Mood swings.
- Weight gain.
- Digestive problems such as diarrhea or constipation.
- A mixture of blood and mucus passes through the vagina during the break.

5.

What Is the Color of Withdrawal Bleeding?

The color of withdrawal bleeding is generally pinkish or light red as the hormonal contraceptives cause thinning of the uterine lining to prevent pregnancy; less fluid is released in a withdrawal bleed.

6.

How Does Withdrawal Bleeding Appear?

Withdrawal bleeding is lighter and shorter, unlike a period. It appears as light to moderate spotting or bleeding and varies in color, often being darker or lighter than usual period. It lasts for two to seven days and occurs during the hormone-free week of the contraceptive regimen.

7.

Does Withdrawal Bleeding Lead To Pregnancy?

No. Withdrawal bleeding is generally an indication of not being pregnant. It is a response to the drop in hormonal levels during the break period. If withdrawal bleeding does not happen during the break period, it is advised to get a pregnancy test.

8.

Is It Safe to Have Unprotected Sex During Withdrawal Bleeding?

Having sex is safe during withdrawal bleeding if the woman takes the contraceptives regularly as instructed. The person is protected from unplanned pregnancy if they are using patches, pills, or rings, even during the break period.

9.

Is Pregnancy Safe After Withdrawal Bleeding?

If a person is taking hormonal contraceptives, they should wait until two or three menstrual periods are over before getting pregnant because getting pregnant right away is challenging to estimate the due date and ovulation cycle.

10.

Does Withdrawal Bleeding Represent the Action of the Drug?

Withdrawal bleeding does not mean that the contraceptives are working; it is just a side-effect of the contraceptives, which is lighter, shorter, expected, and normal. During the hormone-free week, hormone levels drop, mimicking the hormonal fluctuations that occur naturally in the menstrual cycle. This drop in hormone levels triggers the shedding of the uterine lining, leading to withdrawal bleeding.

11.

How Heavy Is the Bleeding During Withdrawal Bleeding?

Withdrawal bleeding has a lighter flow and lasts for a few days. It is not a period but can present like a period and period-like symptoms. The bleeding flow varies from person to person and depends on the type of hormonal contraceptive being used. Some individuals can have light spotting while others can have slightly heavier bleeding but not as a regular period. 
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Dr. Natasha Bansal
Dr. Natasha Bansal

Obstetrics and Gynecology

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