Your period on the pill, explained: What is withdrawal bleeding?

Withdrawal bleeds. Spotting. Breakthrough bleeding. Periods…?

With all this bloody lingo it’s no wonder that most of us are completely confounded by our bleeding (or lack of) when we’re on the pill. 

There seems to be (like many birth control and menstrual-related conundrums) lots of contradictory advice out there about whether we should, or shouldn’t be bleeding when we’re taking hormonal birth control.

So, let’s get this pill-period palava sorted—when are those scarlett streaks a cause for concern, and what the bloody hell is a withdrawal bleed?

Period 101

Before we dive into the details of all that withdrawal what-now? First, we need to get some period perspective and remind ourselves of what’s going on during our natural menstrual cycles—whenever we aren’t taking any form of hormonal birth control.  

During our normal menstrual cycles the lining of our wombs (or endometrium if you wanna get real fancy) builds up over the course of the month—getting ready for a fertilised egg to get nice and cozy up in there(4). 

But, if there’s no sperm meet egg moment, then our female sex hormones will plummet to really low levels—giving our endometrium the green light (nope, not this time) and the lining of our wombs shed(1). 

Cue, period.

Periods on the pill

Although it might look (and feel) a lottt like a regular period—on the pill, your period isn’t really a period at all. It’s actually what’s known as a withdrawal bleed(3). 

Simply, we get a  withdrawal bleed when we stop taking (or withdraw from) hormones—like during a pill break or when a pill pack contains a number of sugar or placebo pills that don’t contain any hormones, or when we stop taking the pill altogether(3,5). 

When we have any of these hormone-free breaks, our levels of our female sex hormones suddenly plummet. This dramatic drop triggers the shedding of our uterus lining (our good ol’e endometrium) and excess blood and mucus are released(1).

Withdrawal bleeding vs a normal period?

So far that sounds an awful lot like a normal period, no? We hear ya. 

But actually, when using hormonal birth control, our womb lining is prevented from building up to the same extent that it normally would during the latter half of our (1)(see above graph). 

This is because, on the pill, ovulation is usually suppressed(1,6), avoiding all of the hormonal hullabaloo that happens after it. Essentially, if no egg is released—no thickened uterus lining is required. 

So rather than being a complete endometrial exodus, like with our ‘natural’ periods, a withdrawal bleed is usually much lighter and shorter than the real deal (sold)(1).

Withdrawal bleeding vs breakthrough bleeding?

Simply, withdrawal bleeding is a planned bleed. Breakthrough bleeding is really any other bleeding that happens outside of your pill break, or hormone-free break (when you’re sugar pill poppin’)(1,3). 

To add some more jargon to the mix, breakthrough bleeding is also sometimes referred to as spotting—but contrary to its misleading name, this can be anything from solitary spots in your new white Calvin Klein’s, to a total tampon-soaking situation(3). 

Breakthrough bleeding or spotting is common when using pills on a continuous regimen (when you don’t have a hormone-free break), and very common if you’ve started a new birth control pill within the last 3 months (often being a common ‘settling in symptom’ when starting a new pill)(2,3). 

Although heavy spotting can be alarming, usually it’s nothing to worry about. But, if you’ve been experiencing continuous unplanned bleeding, or are regularly experiencing heavy spotting after being on a birth control pill for over 3 months—consider getting it checked out. 

When we aren’t using hormonal birth control, breakthrough bleeding and spotting are also used in reference to any unexpected bleeding outside of our normal periods. It’s totally normal to experience some light brownish bleeding or discharge at the start and end of your period—this is just dried blood that’s taken a bit longer to get gone. However, if you experience any brown discharge outside of your period, this could indicate some issues, so it’s best to get it checked out by a medical professional. 

Also, if you are post-menopausal and experiencing any bleeding—definitely consult your doctor. 

To bleed, or not to bleed?

Interestingly, there are actually no real health benefits to having a withdrawal bleed(7). It is perfectly safe to not have a withdrawal bleed (no, months worth of blood will not build up inside of you and be unable to escape).

You can safely take some pill types back-to- back (what’s known as a continuous regimen) or shorten your pill-break and bleed by increasing the number of active hormone pills in your pack (with a tailored regimen)(7,8) . 

(Not so) fun fact: Historically, the 7-day pill break was introduced to ‘mimic’ a natural menstrual cycle—partially, to appease the pope (yep, really). And like the roots of most modern day misogyny, it kinda stuck around. 

Whether you don’t mind your withdrawal bleeds and want to keep them—or similarly, if you feel it’s time to wave goodbye to your withdrawal—remember, the choice is yours and you can do whatever feels right for you and your body.

Bloody FAQ’s

How long does withdrawal bleeding last?

The length of your withdrawal bleed will depend on your pill regimen, and how long your scheduled hormone-free break or pill break is. For example, on a standard regimen, you will usually take 21 days of active hormone pills and a 7-day pill break. 

But, there are many types of tailored regimens with different lengths of active hormone pills and breaks, and what’s best for you will depend on your body, your baseline hormone levels, your goals, and your opinions. There’s no ‘one size fits all’ regimen, period.

Does the mini pill stop periods?

Technically, all pills stop periods because a withdrawal bleed is not the same as a natural period(1,2). But yes, mini pills or progestin-only pills (POPs) can only be taken with a continuous regimen—meaning pill packs are taken back to back, so you will forgo a monthly bleed. You will however get a withdrawal bleed when you stop taking the mini-pill(3), and spotting is common as a ‘settling in symptom’ during the first 3 months.

When do you get your period on birth control pills?

You will get a withdrawal bleed (not period) either during your hormone-free break, pill break or whenever you stop taking your pill altogether(3). Unfortunately, withdrawal bleeds can’t be avoided—you can postpone or control when you get them with your pill regimen, but you will get a bleed when you stop taking hormones(3). You can think of them as our body's natural ‘withdrawal’ symptom from the hormones in birth control pills.

How long after stopping taking the pill will I get a period?

Generally, you will get a withdrawal bleed the day after you stop taking your pill (whether that be for a break or altogether)(3). If you stop taking your pill altogether, usually you’ll get your first natural period back again the following month—but it might take a few months for your normal period to get back in sync again and it’s common during this time to experience spotting(9).

What are the best birth control pills to regulate periods?

All Combined Oral Contraceptives (COCs) will regulate your bleeding, which is why they are commonly prescribed for those of us who experience very heavy periods (menorrhagia) or other menstrual malfunctions(9).

Written by

Annalisa Hayes (she/her)

Copywriter at Tuune, Annalisa has worked for various pioneering health-tech startups and healthcare companies with purpose-led missions. Driven by empowering people to take control of their health, she helps make the science behind hormones accessible for our community, so they can make clued-up choices about their healthcare.

Medically reviewed by

Dr. Alejandra Elder Ontiveros, MD, PHD (she/her)

Ale is a PhysicianScientist with a doctoral degree in Development Biology and Embryology and is currently a Postdoctoral Scholar at UCSF. Ale believes that the union of academia and business can lead to transformative discoveries for women’s health.

Scientifically researched by

Hannah Durrant (she/her)

Hannah is a Biomedical Content Writer at Tuune, with a BSc in Biomedical Sciences from University College London. She is passionate about bringing together the scientific community and the general public by disseminating modern science via digestible, engaging and thought-provoking content.