The Pill Bleed is Not a REAL Bleed or Period.
In the introduction episode of my new podcast, Thrive. Even with a period. I mentioned how I want to help women thrive with a ‘real’ period. But what did I mean by the word ‘real’?
Well, many doctors tell their female patients that the bleed they get on the combined oral contraceptive pill (AKA ‘the pill’) is their natural real period. This is simply not true – the pill stops regular ovulation (which is the main event of a real period). It suppresses natural hormone production that is needed to create a ‘real period’ in favour of stopping a woman from getting pregnant.
(This blog can be listened to as a podcast episode – the player to listen is above this. My podcast gives women the education around menstrual cycle health that most do not get – to help them thrive with a real period, and that aims to make women’s health care better globally because everything is discussed here – nothing is off the table or too taboo. Be sure to subscribe to this podcast to never miss an episode and to share this episode with someone who might be interested or inspired by today’s topic.)
The Pill Bleed is a Withdrawal Bleed.
Instead, what ends up happening when you get a bleed whilst taking the pill is you get a withdrawal bleed – this is the correct terminology.
So, a withdrawal bleed on the pill is when you take the active pills with synthetic hormones for 21 days straight, and then for 7 days a woman would take the ‘sugar pills’ – there are no hormones in these tablets – it is this ‘drop’ in synthetic hormones over the 7 sugar pill days that triggers the release of some blood and mucus from the lining of the uterus and out of the vagina – very similar to what happens when you get a real period when not taking birth control but not at all the same.
The hormones given in the pill are designed to stop a woman from getting pregnant, but it can also be harder to fall pregnant naturally when you stop the pill or other forms of contraception that cause a withdrawal bleed also because your natural menstrual cycle has been suppressed and needs time to recalibrate and ultimately get back to producing its own natural hormones (oestrogen and progesterone) that were drastically reduced when taking the pill.
There are some birth control tablets out there also that are taken continuously and, therefore, can stop the withdrawal bleeding from happening at all.
On The Pill, It Is Hard To Track Ovulation
This is why it is very hard to track when you can conceive whilst taking the pill – if you were to look at the natural hormones oestrogen and progesterone being made by the body at this time, they would be very low on a test, and to fall pregnant, we use these hormones as a guide. These same hormones are then given synthetically in the pill, but it is important to know they are not the same structurally. Only true natural oestrogen and progesterone help the body have a ‘real period’ and therefore keep a woman ovulating.
Ovulation is actually the main event of the period and is needed to keep a woman healthy all month long – falling pregnant is just one natural side effect but definitely not the main reason to encourage a woman to keep ovulating naturally.
This is not to say you can’t fall pregnant at all on the pill; a woman is still fertile, but if taken correctly, the pill is 91-99% effective depending on what type you use and if you take it regularly as intended.
Forms Of Birth Control That Cause a Withdrawal Bleed
Other forms of birth control can also cause a withdrawal bleed which includes:
- Injections (including Depo-Provera and Nexplanon, which is an implant)
- Intrauterine devices (AKA IUDs – including the hormonal IUDs and the copper IUDs)
- The pill, including the mini pill
- Patches
- And Vaginal rings
Breakthrough Bleeding vs Withdrawal Bleeding
Something else that is important to remember is that withdrawal bleeding is not the same as breakthrough bleeding. Withdrawal bleeding only happens during the time you do not take your birth control – the week you break with the sugar pills. Breakthrough bleeding, however, is bleeding outside of the pill break week. Breakthrough bleeding should always be investigated just in case there is an underlying cause such as having an STI, an inflammatory condition or fibroids. There can be other causes I have not mentioned but do always speak to your trusted healthcare provider if you suddenly start experiencing breakthrough bleeding.
Withdrawal Bleeding vs a Real Period
So, just to recap: a real period or menstrual bleed is when a woman is not taking any form of synthetic birth control – the bleeding that occurs then is from a natural and ‘real’ menstrual cycle. The one we were designed to not meddle with, and if we do, then we need to be aware that other issues may arise, which will be covered in another podcast episode.
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