Active confusion about inactive pills: Off weeks and withdrawal bleeding

Anatomy of a Birth Control Regiment

Most combined hormonal birth control birth controls operate on a 4-week cycle. That's three weeks of synthetic versions of the hormones estrogen and progesterone, then one week off.

In your first three weeks, the steady intake of estrogen and progesterone prevents the fluctuation in hormone levels that causes ovulation (and with it, your ability to become pregnant that month)

In your "off time", your hormones drop from taking inactive birth control pills (placebo pills)*, not taking pills, or not wearing the ring or patch. Because of that, your endometrial lining sheds, just like it does during your period. This is called withdrawal bleeding. 

*Inactive pills, or placebo pills, contain no hormones. Some brand’s inactive pills contain iron or other nutrients to help with withdrawal bleeding symptoms. Others are sugar pills.

Need a refresher on what's going down during your menstrual cycle? 

But, can I get pregnant? 

As long as you have been using your combined hormonal birth control correctly during the active time, you do not need to use any backup forms of protection to prevent pregnancy during your inactive or break time.

Since your birth control prevents ovulation, you cannot become pregnant at any point during the month. If you have missed pills or had a problem with the changing of a patch or ring, be sure to use protection until you have had 7 days of active hormones to ensure ovulation does not occur. 

It is very important to start your next pack, ring, or patch on time to make sure ovulation does not occur in the 6 days after placebo week, given that sperm can survive up to 5 days in the body. 

Withdrawal bleeding is not a period (period.)

Withdrawal bleeding is the period part of hormonal birth control. While it’s almost indistinguishable from your “real period,” it’s technically not the same thing! 

Periods occur in the natural hormonal cycle when the endometrial lining, which has grown in preparation for a potential fertilized egg, sheds due to a drop in hormone levels from the dissolution of the corpus luteum which used to hold the egg.

Because hormonal birth controls prevent ovulation, the endometrium does not build up in the same way, and the drop in hormones is created directly by you. 

Here's more on withdrawal bleeding from the experts at Healthline!

Withdrawing from Withdrawal Bleeding aka Continuous Use

Early hormonal birth control methods were made to closely mimic the natural cycle of the body. The regular monthly period was an important part of this.

Studies show, however, that it is not a medical necessity. There are no intrinsic medical risks or benefits to withdrawal bleeding.

Some use the monthly withdrawal bleeding as reassurance that they are not pregnant. Others find that the ability to go without a period allows greater freedom in their lives. 

Wondering why we even have inactive pills? Here's some history.

Using hormonal birth control without placebos or breaks, is called continuous use. It has been used in some cases to treat conditions like migraines, endometriosis, or anemia. It can be done with the pill, the patch, or the ring.

In some cases, especially if pills are missed or taken at incorrect times or there is an issue with the changing or application of the patch or ring, breakthrough bleeding and spotting can be more significant than it is when having regular withdrawal bleeds. 

Making Big Birth Control Moves

Placebo pills, break weeks, and withdrawal bleeding are some of the most customizable aspects of hormonal birth control regiments, and understanding them can help you to make the right decisions for you.

While breaks and placebo pills help you keep in routine and give you an extra confirmation that you aren’t pregnant with withdrawal bleeding, they are not the same thing as menstruation. With all the options out there, you can really make your birth control work for you.

If you want to make changes to your birth control regiment, be sure to talk to your healthcare provider first.