Withdrawal Bleeding

What is withdrawal bleeding?

Withdrawal bleeding is the period you get while you’re on hormonal birth control. It happens when you’re switching to a new pill pack, ring or patch, or when you’re switching birth control brands or types. When you stop taking hormonal birth control or make changes to your typical schedule, it changes the hormone levels in your body. This change triggers bleeding.

Withdrawal bleeding may look and feel like a menstrual period, but it’s different. It’s often milder and lighter than a typical period. You can still have cramps, headaches and other symptoms of PMS (premenstrual syndrome) during withdrawal bleeding, too. It lasts about as long as a normal period — about four to seven days.

When does withdrawal bleeding start?

Withdrawal bleeding is most often the “break” that’s built into your hormonal birth control schedule. When it occurs varies depending on what type of birth control you take:

• Combination birth control pills (28-day): The last week (fourth week or placebo pill week) of your pill pack. This is built into your dosing schedule, so you’ll have a withdrawal bleed.
• Vaginal ring or birth control patch: The week between inserting a new ring or placing a new patch is your break week. You’ll have withdrawal bleeding during this time.
• Extended birth control pills (91-day): These pills can cause a withdrawal bleed every three months.
• 21-day birth control pill: Withdrawal bleeding happens in the fourth week (the one-week break between pill packs).

You don’t experience withdrawal bleeding with long-lasting or continuous hormonal birth control like injections, implants and IUDs. The bleeding that happens when you begin these forms of birth control is called breakthrough bleeding. This usually improves within a few months.

It’s also worth noting that you can experience a withdrawal bleed any time you change your hormonal birth control or if you skip/miss doses.

If you’re unsure if your vaginal bleeding is normal or safe, it’s always best to talk to your healthcare provider.

What causes withdrawal bleeding?

Changes in hormone levels cause a withdrawal bleed. Your hormone levels change when you take a break from hormonal contraception — this includes scheduled breaks like between pill packs, missing doses or switching to a new birth control. It looks a lot like a normal period, but it’s different.

During a natural menstrual cycle, hormones thicken your uterine lining. Then, you shed that entire lining during menstruation. But when you’re taking hormonal birth control, your uterine lining doesn’t thicken. This is why withdrawal bleeding isn’t as heavy in flow as a typical period — there’s lining to shed. Additionally, the shift in hormones isn’t as severe, which is why your PMS symptoms may be milder, too.

Is withdrawal bleeding normal?

Yes, it’s normal and safe. It’s a side effect of “withdrawing” hormones from your body when you take hormonal birth control.

Does withdrawal bleeding cause cramps?

Yes, you may feel typical period symptoms like cramps during a withdrawal bleed.

How is withdrawal bleeding treated?

There’s no treatment for withdrawal bleeding because it’s a normal effect of hormonal birth control medication. Just like a typical period, you can use sanitary pads or tampons to catch the blood.

But if your withdrawal bleeding is unpredictable or lasts longer than a week, it’s worth contacting your healthcare provider.

Can you get pregnant after withdrawal bleeding?

It depends. If you stop birth control entirely and experience withdrawal bleeding, it’s possible to get pregnant if you don’t immediately change to a new birth control method. If withdrawal bleeding is from the scheduled dosing break, it should still prevent pregnancy (if it was taken correctly).

When in doubt, use a backup method of contraception (like a condom) if you stop using or taking birth control, even if it’s for a day or two.

If you don’t wish to get pregnant, always talk to your healthcare provider when you want to change your birth control.

When should I call my provider about withdrawal bleeding?

Withdrawal bleeding is usually not a cause for worry. But if you’re bleeding for longer than a week or if you’re bleeding when you shouldn’t be bleeding (like in the middle of a pill pack), contact your healthcare provider.

You should also contact your healthcare provider any time you have questions about your current birth control method or when you wish to change birth control. They can help ensure you remain protected against pregnancy.

How long after a withdrawal bleed will I ovulate?

It depends. If you’re taking birth control and a withdrawal bleed happens due to a scheduled “break,” you won’t ovulate. But, if a withdrawal bleed happens because you’re ending birth control, you could ovulate in two weeks. The exact timing isn’t predictable, so if you don’t want to become pregnant, use another form of birth control and talk to your healthcare provider.

Is withdrawal bleeding necessary?

Not really. There isn’t a medical reason you need to have a withdrawal bleed. Birth control manufacturers designed the medication to mimic your natural menstrual cycle. That’s the only reason it happens. Skipping a withdrawal bleed is usually safe, but you should always talk to your healthcare provider if you plan to skip your withdrawal bleed.