Thursday, August 19, 2004

Menstrual Suppression vs. Continuous Use

Good review article on new-ish birth control methods, emergency contraception, and the IUD. Since continuous contraception is mentioned, let's use this opportunity to look at the difference between menstrual suppression (deals with the real menstrual period) and continuous use (deals with the fake period).

Menses (Real period)

Each month, under the influence of hormones, cyclical changes take place in the ovary and the uterus. This is the monthly cycle. For the purpose of our discussion, we can artificially divide this monthly cycle into an ovarian cycle and an uterine one. Since we're talking about the menstrual period, we're only concerned with the uterine cycle; namely the monthly changes undergone by the lining of the uterine cavity (endometrium).

(Functional layer sheds; basal layer doesn't)

In the beginning of the uterine cycle, the lining is thin. It builds-up gradually during the month, reaches a maximal thickness and then, if there's no pregnancy, most of this thickness is shed, in the form of menstrual bleeding. Then the cycle starts anew.

As you can see, the menstrual period (menses, the real period) is just a small part of the uterine cycle. And, contrary to what you might've been told, the period is not so much a sign of the past (your body failed to become pregnant), as it is a sign of the future (your body is ready and able to sustain a pregnancy). How come?

Briefly, on a cellular level, a fertilized egg (egg + sperm) has a couple of unique characteristics: it has foreign genetical material (the sperm's DNA from the male), and, when it implants, it uses techniques similar to those used by tumor cells. [Implantation is the burrowing of the fertilized egg into the lining of the uterus.]

Inside<--invading fertilized egg<--uterine cavity

So, the uterus has to be able to provide a growing, nourishing environment to something it views as a foreign invader. This poses a problem: normally, the body has mechanisms that fight both foreign bodies (think organ transplant rejection), and tumor cells (the body tries to limit the growth of cancer cells). The solution? In anticipation of implantation, the cells in the lining of the uterus start to undergo specialized changes, (decidualization). Decidualization allows the fertilized egg to implant, and at the same time, limits the egg's invasive ability.

As an aside, occasionally this process breaks down, there's no limiting influence on the fertilized egg, and the results can be [WARNING graphic picture/pathological specimen] disastrous; the woman can die (the tissue keeps growing and growing, it invades through the uterus, into the lungs, the brain).

Returning to decidualization, this process solves one set of problems: it allows the uterine tissue to be ready to accommodate the unique needs of the fertilized egg. At the same time, it creates a new problem for the body--it starts an irreversible clock.

Decidualization happens independent of a fertilized egg. In other words, each month the body jumps the gun if you will. It doesn't actually wait to see if there's a fertilized egg or not. [It doesn't even care if there's any sperm around.] The body gets ready for a pregnancy, period [no pun intended]. However, once decidualization happens, if a fertilized egg isn't there to implant within a certain window of time, the opportunity for pregnancy is lost. Any new fertilized eggs, formed at a later date (e.g., during the next monthly cycle), won't be able to implant. Fortunately, during the menstrual period, the decidualized cells are shed, and brand new cells take their place. These replacements are then able to undergo their own changes, and allow a new fertilized egg to implant.

Returning to the macro level and the uterine cycle, two very important concepts:

a) Fluctuations in hormone levels cause the changes in the uterine lining.

If your hormone levels don't fluctuate, the uterine lining will not thicken, and it will not shed (there's no need to shed it since it's not thick). No shedding means no menstrual period.

b) The only biological reason for these changes in the lining is to prepare the uterus for a possible pregnancy.

Unless you're planning a pregnancy, there's no reason to have any cyclical changes in your uterine lining. Of course, you may still wish to undergo these monthly changes, but you don't have to.

Withdrawal bleeding (Fake period)

When you use a hormonal method of birth control, like the Pill, you no longer have an uterine cycle/a menstrual period. This is normal; it's the way the Pill works and it lasts the entire time you use the Pill. If you use the Pill for 7 years, you don't have uterine cycles/menstrual periods for 7 years. How is that possible?

Briefly, while you take the Pill, your body hormone levels stay low and, most importantly, they don't fluctuate. The levels of Pill hormones are also pretty steady. So, since there are no longer any hormone fluctuations, the lining of the uterus stays thin.

This is very important: the uterine lining stays thin ALL THE TIME, for the entire time you use the Pill (not only throughout the month, but throughout the 7 years in our example above).

No build-up of the lining means no periodic shedding. No shedding means no menstrual period. This is how the Pill suppresses the menstrual period (menstrual suppression). [Keep this term, menstrual suppression, in mind; it's an essential term and we'll come back to it in a moment.]

What you do have when you use the Pill is a monthly withdrawal bleeding episode, or a fake period. This withdrawal bleeding and the menstrual period are not one and the same thing. Briefly, by manipulating the dose of hormones in the Pill, you can destabilize the thin uterine lining enough to cause some bleeding.

But, if the fake and the real period are not one and the same, then why do we have a fake period on the same schedule as the real period, namely, monthly? Again, briefly, because of a Puritanical politician, a Catholic Pope, doctors who didn't wash their hands, and many dead rabbits. In other words, the reason for the monthly schedule of the fake period is a "designer" one, not a biological or medical one. There's no biological or medical reason to destabilize the thin uterine lining monthly.

When the Pill first came out, the concept that any woman can control her fertility was revolutionary enough. Mind you, what was revolutionary was not the desire to control fertility. Throughout history women had been using various methods of birth control (gold shields, plants, potions). With the advent of vulcanized rubber (diaphragms, cervical caps) and the Pill, the groundbreaking event was that safe and effective birth control was finally widely available. Heaping the concept that women could also control their menstrual period on top of their fertility was considered just too much for the political, religious, and societal sensibilities of the 1950s. Enter the fake period. By building-in this monthly bleeding episode into Pill use, the scientists hoped to ease the "shock". [Remember, what we're talking about here is a female health issue, something that, apparently by definition and divine law, requires final approval from politicians, religious leaders, and as many self-appointed "protectors of women" as we can find. In the 1950s, unfortunately just like today, giving women all this control over their bodies and their health was inconceivable; decisions about female health issues couldn't possibly be left to the women and their health care professionals.]

Returning to the fake period, what happens when you use a regular Pill brand and you want to skip "your period", or when you use Seasonale (continuous or extended use)? Let's first see what doesn't happen. The frequency of your menstrual period is not affected. Why? Because when you're using any Pill brand, you no longer have a menstrual period; the menstrual period is suppressed. What does happen is that you're shifting the frequency of your fake period. For example, if you use Seasonale, you're shifting from a monthly fake period, to a trimonthly one. Of course, if you want, you could shift to a bimonthly fake period, or a biannual one. Or you could shift the fake period only once every three years, when you attend a wedding (yours, and your best friend's, of course).

Bottom line:

1. The real and the fake period are not one and the same

2. Suppressing your menstrual period by using the Pill on a regular schedule (menstrual suppression) and shifting the frequency of your fake period by using the Pill on an extended schedule (continuous use) are not one and the same, either.

The difference between menstrual suppression (real period) and continuous use (fake period) is important. For example, if you're already using the Pill and you're considering the safety of shifting your fake period, your focus should be on the benefits/drawbacks of continuous use, not menstrual suppression. Unfortunately, almost every single lay article on Seasonale and/or continuous use I read misinforms you about this crucial topic. So, in future posts, we'll go over this in more detail.


At 6:11 PM, Blogger lori said...

i have been on the Pill for 10 years and a few years ago i stopped having regular periods and now barely have them at all. now my nurse practitioner is again changing my Pill so that i have to have a period every month. do i really need to be worried and switch my pills again if i am not having a period during the placebo pill week?

At 11:38 AM, Blogger ema said...

lori, absolutely not. If you're doing well on your current Pill brand there's no reason to switch just to induce/enhance the fake period. Not having a regular fake period with long-term use of the Pill is not a problem/sign of a problem. Why? The Pill keeps the uterine lining thin (the hormones in the active pills do that). If the lining is thin enough (like with long-term Pill use), even when the user periodically takes placebo pills x 1 week, there will be no bleeding from the lining.

If you look at the picture of the uterine wall in the post (d. uterine cycle), you'll see the lining has 2 layers: basalis (or "base" layer), and functionalis (or "functional" layer). Only the functional layer is shed, not the base one. Long-term Pill users mostly have the base layer only.

Bottom line: there's no biological/health reason to have a monthly fake period. Thus, there's no need to switch Pill brands to induce one. Perhaps there's another reason for the brand switch?

[Discalimer: the information you read here is only for educational purposes, and is not intended to be medical advice. Please verify anything you read here with your own health-care provider.]

At 5:41 AM, Anonymous Anonymous said...

I've had bad headaches since i was a little kid, but as I've gotten older they've become more cyclical and worse so that now with every period I have a few bad days, sometimes totally incapacitating so that I just shiver and cry (and Im a pretty tough person usually). I'm 30 now, been on the pill since I was 17 except for 6 months or so that I stopped to see if it would help my headaches. Nothing seems to help. I've tried different pills, no pills, avoiding all kinds of foods and drinks. I'm in good shape and get exercise and try to drink enough water.... I've also noticed that as they've gotten worse, my periods seem to, um, seperate? so that I'll have clots and super thin flow. I don't know if that's related. I'm living in India now for a little while and am tempted to try a more eastern approach as western medecine really hasn't helped. Any ideas? Would maybe seasonale help so that at least this would only happen a few times a year?

At 1:16 PM, Anonymous Anonymous said...

If you fall pregnant whilst on the pill are you likely to still get fake peiods or will they stop like the menstrual suppression would?

At 7:37 PM, Blogger Liliane said...

I just went to see my gynae today, a week after I've seen a double line on the ovulation kit. He told me that there's an egg in the uterus. Question is does it mean I'm pregnant or not? Does the unfertilized egg stay in the uterus too until it's time to shed- menstration?

At 6:21 PM, Anonymous Anonymous said...

i decided to skip my fake period over christmas by taking two packs back to back. now i am coming on a week early, (in otherwords i still have a week of pills left but i bleed anyway and i bleed during my break..) it happened with my last one and now its happening again. how long will this last or is it now going to be a permanent thing?

At 5:36 AM, Anonymous Anonymous said...

Anonymous Question?

My wedding date is scheduled towards the end of my cycle. Is there anyway to make sure my cycle comes on time or preferably early? Is their anything I can do to induce my cycle sooner?

At 1:47 PM, Anonymous Anonymous said...

I'm 50 and still having a period. I've never been on the pill and have 2 grown sons. I have terrible periods - debilitating bleeding for the first day on some (but not all) months. My husband and I have planned our first cruise. Actually, we planned it 3 months ago and according to my menstruation date THEN I would be miss my period by going July 23 - 31. Now, for some reason, my period has decided to come more than a week early (for the past 2 months). Can I take something to delay it in July? I haven't been to a gynecologist in years.

At 4:00 PM, Anonymous Anonymous said...

i am almost 15 and i got my first period about 15 days ago....and i Never want to have my period againnn....of course i told my mom and she was..."no you should be happy you got it...and if you go on any of those drugs your skin will get stained and it is not natural for your body.." i did some research and i found out in atleast 8 websites that having a period monthly is just due to hormonal chnges and that it could even be safer to have a period less often...reduces chances of cancer..and other health issues...i showed this to my mom and she still says no.....i am NOT sexually active and want to know if going into a medicament would do something bad to my health...and would i have to take a pill every single day of the year???..

At 10:27 AM, Anonymous Anonymous said...

Hi, i have been taking the pill back to back and have not been having any 'fake periods' each month, is there any side effects against this, please please please reply xxx

At 2:36 PM, Anonymous Anonymous said...

Hi, i have been on the pill for around three years, i decided to come off and i havent had a withdrawal bleed its been 3 months now and im really worried. Can anyone help! xxx

At 1:39 AM, Anonymous Anonymous said...

Hi, I am 20 years old and my period did not have my period for 6 months. My hormone levels are all fine, so the doctor prescribed medroxyprogesterone acetate 10mg for 5 days. It has been almost 2 weeks and still there is no withdrawal bleeding. I am worried, what should my next step be>?

At 7:28 AM, Anonymous Anonymous said...

I tried to skip my period by starting my next pack early, but I was a day or two late starting the next pack. I got my period and I've been on it for ten days. What do I do?

At 4:14 AM, Anonymous Casey said...

I have a question, and can't seem to find an answer. I was on NuvaRing for several months and then moved, and didn't have the money to get my RX filled for a couple of months. My period got pretty awful and I broke down and went to Planned Parenthood and got back on it.

I started it the same day that I unprotected sex. This was a little over 3 weeks ago. I realize that pregnancy is a possibility but my question is...

When I take my ring out in a few days will I have withdrawal bleeding if I am pregnant? Or will I only have it if I'm not pregnant?

At 5:08 PM, Anonymous Anonymous said...

How do you know if you've skipped a period when on the pill if the pill makes a fake period? How can you tell if you're pregnant? I have a bloated stomach below my belly button, but no tender breasts or sickness or anything. I'm still worried though, taken a home test which said I was not pregnant, but I would like to know for future reference. Is the fake period an unreliable thing for telling if you're pregnant or not?

At 8:05 AM, Anonymous Anonymous said...

hold on....if its not a real you not release an egg from you ovaries then? im realy confused...

if i took microgyn 30 for two months without a brake, started my 'withdrawl bleed' on wednesday night and had unprotected sex with my bf on the sataday night will i still be protected against pregnancy? cos theres no egg is there to get fertilised? :-S

It also confused me cos in the instructions for my tablets it doesnt call them withdrawl bleeds it calls them periods so are mine diffrent? propper confused cos all over the internet it says on the pill or not that you are most at risk having sex on a period if you have not taken you pills corectly...does that include taking your pills continuesly? could i be pregnant then?

Also the day after the sex in question i took the morning after pill... so now do i continue taking my microgyn 30 pills from tuesday as i would have done normaly?

:-S help!!!! :-S

At 7:02 PM, Blogger ema said...

Anon @ 8:05 AM,

hold on....if its not a real you not release an egg from you ovaries then?

While on pill you do not release any eggs. The ovaries are suppressed by the hormones in the active pills. The suppression effect (no eggs) carries over during the placebo pills interval.

if i took microgyn 30 for two months without a brake, started my 'withdrawl bleed' on wednesday night and had unprotected sex with my bf on the sataday night will i still be protected against pregnancy? cos theres no egg is there to get fertilised?


It also confused me cos in the instructions for my tablets it doesnt call them withdrawl bleeds it calls them periods so are mine diffrent?

No, yours are not different. What the instructions call "period" is the withdrawal bleed. says on the pill or not that you are most at risk having sex on a period if you have not taken you pills corectly...does that include taking your pills continuesly?

If you take active pills and then stop, or take placebo pills, for the withdrawal bleed, you MUST make sure to RESTART the active pills within 7 days. [OK to start earlier. Not OK to start later.]

Although the ovary is suppressed and there are no eggs, if you go without active pills for more than 7 days the ovary has enough time to rev egg production back up and release an egg.

The active pill regimen--regular 3wks on/1wk off, or extended, 2 mo on/1wk off--is irrelevant. The important thing is, when you stop the active pills for the withdrawal bleed, to restart no later than 7 days.

Also the day after the sex in question i took the morning after pill... so now do i continue taking my microgyn 30 pills from tuesday as i would have done normaly?

Yes. Your bleeding pattern might be a bit off, but that's to be expected.

At 3:32 PM, Anonymous Anonymous said...

I am on the pill and have very heavy periods. I have a fibroid that used to cause spotting. Is there any benefit to having a period every month?

At 6:45 AM, Blogger ema said...

Anon @ 3:32 PM,

No, none whatsoever. In fact, you are the ideal candidate for using the Pill on an extended regimen.

You already don't have a period because you are on the Pill. What you do have is an artificially-induced, monthly withdrawal bleeding episode. By using an extended regimen you shift the frequency of your withdrawal bleeding from monthly to, for example, once every three months.

Regarding the fibroid, your Ob/Gyn will be able to go into more detail about the effect of a regimen change on the size of the fibroid.

At 3:06 AM, OpenID crashcart9 said...

Terrific explanation! I have the hardest time getting my friends to understand that it's not some unbelievably unnatural/unhealthy thing to not bleed every month--I'll definitely be pointing them in this direction.

Side note: the image link that you note [WARNING graphic picture/pathological specimen] for no longer appears to work--do you happen to have another or a similar link? I tried googling around for something close to the image in question with no success.

At 6:00 AM, Blogger ema said...


Thank you.

I tried to locate the image again on the same site but was unable to. That's a shame since it was a very nice pathology specimen of an uterus with the tumor invading all the way through the wall.

I found something more or less similar here, but in this specimen the invasion is partial.

At 12:04 PM, Anonymous Anonymous said...

if you dont get withdrawal bleeding after taking birth control pills does it mean you are pregnant?

i went to a doctor and she said i should stop after taking it for two days only.

thank you!

At 3:29 PM, Blogger ema said...

Anon @ 12:04 PM,

if you dont get withdrawal bleeding after taking birth control pills does it mean you are pregnant?

Most likely no, it doesn't mean you are pregnant. However, if you are concerned, you can do a home urine pregnancy test for confirmation.

i went to a doctor and she said i should stop after taking it for two days only.

I'm not sure I follow. You just started a pack and were told to stop after taking only two pills? Or did you just finish a pack, did not have an withdrawal bleed during the placebo interval, and then started a new pill pack?

At 3:46 AM, Anonymous Anonymous said...

she told me to stop taking the pills after two days of taking it and she said that withdrawal bleeding will occur after 3-5 days.
it's my 6th day but nothing is happening.. could it be because i just took two pills?

At 5:06 AM, Blogger ema said...

Anon @ 3:46 AM,

Yes, most likely. If you're worried about pregnancy, take a pregnancy test. If it's negative, you can restart the Pill without having to wait for the withdrawal bleeding.

At 4:37 PM, Anonymous Anonymous said...

Thanks for an informative post. I just started taking birth control pills 2 weeks ago. My nurse prac. started me on Yaz 1-2days before my period was to begin, so she told me this would stop my period from starting, and I would not have a period this month. I followed her directions and did skip my period, but after reading your post I am concerned. Since I started the pill only 1-2 days before my period was to start, wouldn't that mean that my uterine lining had already thickened and needed to be shed? Since I did not have my period, how will my body shed those cells that were already built up? Also, I am going on vacation soon, and would like to skip my next withdrawl bleed? Is this safe to do since I stopped a period so close to it's start? Thanks!

At 4:21 AM, Anonymous Anonymous said...

hi! I have a question, im using a pill for about 4 months already but just this time im having a withdawal bleeding and its been 3 weeks already that i experienced like this. Is this normal? what should i do? please help=(

At 5:15 AM, Blogger ema said...

Anon @ 4:21 AM,

Do you mean you're using an extended regimen -- an active pill every day for 4 months? If yes, some breakthrough bleeding like you're experiencing is not uncommon.

If the flow doesn't seem to be easing up, one thing you can do is to stop taking the Pill for 3-4 days, then restart. Checking with your Ob/Gyn is also a good idea.

At 3:20 PM, Anonymous Anonymous said...

After posting my 1st question @ 4:37 PM, I started to experience break through bleeding. Yesterday I started the white (placebo) pills on Yaz and I am still bleeding. I will start a new pack of Yaz on Thursday, and that is the day I leave for vacation. Is there anyway to know if I will still be bleeding? If I go off Yaz entirely would it end the bleeding by Thursday? Thanks!

At 5:42 PM, Blogger ema said...

Anon @ 3:20 PM,

Sorry, I missed your earlier comment. Nothing to worry about. You were told to start the pack a bit off the regular schedule, skipped your expected period and started experiencing breakthrough bleeding (BTB) sometime during wk 2 or 3, right?

You're now finishing up the pack (white pills) and still have bleeding.

Two things. First, bleeding (withdrawal) is to be expected at this point in the pack, during the placebo days. Second, since you're taking the white pills, the placebo pills, you've in effect stopped taking Yaz.

Now, there's no way to predict if the bleeding will stop by Thursday, but most likely it will. Once you start a new pack, the active pills (light pink) should stabilize the uterine lining and stop the bleeding. [There might be some residual spotting for a bit. Just make sure to take the pill at the same time each day.]

Best to relax, keep an eye on the bleeding/spotting, and start the new pack as scheduled on Thursday.

If you're still having problems by the end of the week, let me know.

At 8:48 PM, Anonymous Anonymous said...

RE: 4:37PM and 3:20PM

So, is it safe to assume the reason for my BTB was starting Yaz so close to the start of my real period? The BTB was heavy almost like a real period with some clotting. After reading so many things about BTB, I am concerned that it will be a regular thing while taking the bc pill. Thanks so much for all of the information you have provided.

At 9:03 PM, Blogger ema said...

So, is it safe to assume the reason for my BTB was starting Yaz so close to the start of my real period?

Yes; also it was your first pack. Even when you start on a regular schedule, it takes the body a little time to get used to the hormonal shifts.

...I am concerned that it will be a regular thing while taking the bc pill.

Not likely. As you continue to take the pill regularly, the lining of the uterus will stabilize, as will the hormone levels.

At 1:30 PM, Anonymous Neha said...

Hi I read your blog and thanks to you that i got answers to many of my concerns,I have now ample knowledge about how my body works on pills and the science behind the periods, but now i come up with a querry :
As per the Birth control pill regimen ideally it should be
3 weeks ON/1 week OFF
can it be extended to 4 weeks ON/1 week OFF
or in extended regimen it have to be 6 weeks ON/1 week OFF to be in accordance to our monthly withdarwal period

Also if 4 weeks ON/1 week OFF is OK and practised is it safe enough that u wont get pregnant during you are on placebo pills ; which logicall proves the theory that you get your fake periods wenever you are on placebo pills ,as now u dont have any schedule for your real periods,so u can have anytime after 3 it gud/safe to play with the date of your withdarwal period by 4-5 days before or after as per your life and holidays ,functions requires, or de we need to reliigously maintain a schedule for this which is 3 weeks ON/1 week OFF
pls help me ASAP as I am actually on 4 week oN/1 week OFF by mistake
looking fwd for your valuable help...

At 5:13 PM, Blogger ema said...


There's no set extended regimen. In other words, what serves your purpose and works best for you is what you should use.

If you want to do 4 weeks on (of active, hormone-containing pills)/1 week off, fine. To do this you need to use two Pill packs. Use the 3 weeks of active pills from pack one and the first week of active pills from pack two.

If you take 4 weeks of active pills and then 1 week of placebo you'll be safe. You are protected from pregnancy as long as you start a new cycle of active pills once the 1 week of placebo is over.

It's safe to play with the date of the withdrawal bleed. The only problem you might have, if you do it too often, is that you might experience breakthrough bleeding/spotting. Ideally, you want to maintain a steady schedule because changing the regimen too much causes hormone fluctuations and breakthrough spotting. This is not dangerous but it's inconvenient.

Hope this helps.

At 6:36 PM, Blogger Anon89 said...

i have recently started the mycrogynon pill.... it should be my first withdrawal bleed this week... i am nearly at the end of the week and i have still not have any bleeding... i have been having stomach cramps and im not sure wether it is normal to not have withdrawal bleeds when you are first adjusting to the pill??? anyone please help :) x

At 10:03 PM, Anonymous April M said...

I am due to go on vacation around my "fake" period and I am already late at starting this one((im starting a new pack tommorrow)) I am wondering if i take the packs back to back if i can skip my period or prolong it just until I am done my vacation...I am on yaz...Has anyone else ever tried this?

At 5:14 AM, Anonymous Anonymous said...

I went off the pill for 2 weeks and restarted the following month. I have terrible cramps since starting the pill again/plus my cycle usually last for 5 days. I am on day 8 of my period? I am worried? I never have bleed longer than 5 days? Any Advice Pls?

At 3:19 AM, Blogger Mirolabis said...

Ema, thank you for being so informative. I am concerned that I have been spotting/bleeding for about two weeks now and my birthday is coming up, so I need it to stop =). Here is my story:
-Began spotting on Friday 9/4. Took my first Loestrin24fe Pill that Sunday 9/6.
-Spotting stopped completely after taking the Pills and spotting resumed again Thursday 9/10.
-I continued taking the pill and the spotting became a period.
-On day two 9/15 of week two I stopped the pill completely to see if it would stop the period.
Now i'm assuming I am having a withdrawal period because it's 9/16 and the bleeding hasnt stopped or gotten lighter. What do I do now? My birthday party is 9/26 and I would hate to be on my period that day. I hope I didn't confuse you with all the information. Let me know if I left anything out. Your response would be greatly appreciated.

At 4:44 AM, Blogger ema said...


When you began spotting on 9/4, that was your regular period and then you started your first Pill pack on Sunday 9/6, right?

Your period lasted 3 days (is that normal for you?) but, after starting the Pill, you experienced breakthrough spotting on Thursday 9/10.

You continued taking the Pill and experienced an episode of bleeding (when, and for how long; from 9/10 to 9/15?) and then you stopped taking it.

If this is your first Pill pack it's not unusual to have BTB. Discontinuing the regimen so soon also didn't help (it causes even more hormone fluctuations and this, in turn, destabilizes the uterine lining and causes the BTS/B).

So, what to do to avoid bleeding on your birthday? If you don't need the Pill for contraception, don't restart the Pill just yet. You have 10 more days to your birthday by which time the bleeding/spotting should taper off/stop.

On the other hand, if you need the protection, restart the Pill (only active pills, skip the placebo). If you're still bleeding after the first few days, just double up on the pill for the days right before 9/26 and you should be fine.

And, as always, please remember that this is not medical advice and you should always check with your own Ob/Gyn.

Oh, and Happy Birthday!

At 8:42 AM, Blogger jovel said...

Hello. I've recently stopped being on the pill -simply because I forgot to take them for four days because of a recent natural phenom here in our country. On the fifth day, I started bleeding, that's still a fake period right? I actually stopped in the middle of the pack. Three days after, my bleeding stopped, and had unprotected sex with my husband. Then the bleeding started again. Am I at risk of getting pregnant?

At 3:14 AM, Anonymous Anonymous said...

Hi i am taking yaz i have not missed any days since starting. I had a baby about 7 months ago. she was very very colicy. So i chalked it up for stress that gave me a month long period. It was extreamly light, but still noticable. Since then i have only had 3 day periods i don't understand the fakes or reals. I have been on the same pills befor and have had normal week long periods. Yesterday i knowtesed i was lactating. It could have been my head playing tricks on me but i thought i could feel something moving inside me so i immediatly took a preg test. it said no. If i take a preg test while on a period would it say no? I am confused. Please help.

At 4:15 AM, Blogger Rebecca said...

Hi, thanks so much for your help I feel like I understand it better.
I live in Canada and my boyfriend lives in New York so we don't get to see each other that often and I've unfortunately had the bad luck of my fake period arriving the weekend I'll see him. So I understood it was okay to skip once in awhile as long as you don't do it often.

I did it once in the summer around August but then I made sure I had a period in September. He came October 9th and I was supposed to get my period a day or two before and I decided to skip. Now three weeks later I should be getting it later this week and I'm going to NYC to see him, I want to know if its okay to skip back to back. What are the implications, what could happen or should I be prepared might happen, such as bleeding or spotting. I don't intend on making this a regular habit, I'm just a little concerned

At 1:17 AM, Anonymous Anonymous said...

HI, thanks for the helpful information. nice to know i can inform boyfriend/ friends correctly.

I haven't been able to find the exact answer I'm looking for ANYWHERE though and thought you could help:
If what i get every month on the pill is just withdrawal bleeding (not a period) then would withdrawal bleeding stop if i accidentally got pregnant? on the off-chance that i became pregnant while on the pill, would there be any warning signs that I'm pregnant or would the withdrawal bleeding continue anyways? I'm scared that there wouldn't be any signs and I wouldn't find out if I'm pregnant til its soo far along!
answers would be so appreciated!

At 11:34 PM, Anonymous laura said...

Hi, I have been on the pill for a couple of years and this month decided to skip my fake period and go straight onto my next pill packet. (im on the 21 day pill - cileste) after a week of the second packet i developed a very light period which is still going on after 10 days! im now nearing the end of my second packet... what should i do?? and when the bleeding stops will i still be protected? ive taken every pill at the same time everyday... should i just go straight onto a third packet?

At 12:02 AM, Anonymous Anonymous said...

hi , ive recently just started taking the pill like 6 days ago and today i just got my period arent i supposed to get it when i take the brown pills ? is this normal?

At 6:04 AM, Anonymous Anonymous said...

This comment was posted earlier and I do not see a response. It is my question as well.
"If you fall pregnant whilst on the pill are you likely to still get fake peiods or will they stop like the menstrual suppression would?"

At 9:32 PM, Anonymous Anonymous said...

ive been on yaz for 3 years...this week i started th week 1 of the pills and forgot to take 3 of them..i started having withdrawal bleeding and had unprotected sex twice...i did double up on the the pills that i missed...can i still get pregnant from having withdrawal bleeding

At 11:10 AM, Anonymous Anonymous said...

Hello, I was just wondering if this would be okay/work... if I wanted to delay my withdrawal bleed by just a day, would it be possible to finish the pack of pills I am on now and take the first pill of my next pack (so I'd have taken 22 pills), then have my 7 day break and then start the rest of the next pack which would be one pill short - 20 pills)? Sorry if this is in any way confusing. Thank you

At 8:35 PM, Anonymous Anonymous said...

i started taking the pill for the 1st time and now im takin my 7 day break.(a pack of 21) im on the 4th day and i still haven't bled. does it mean i might be pregnant??

At 1:33 AM, Anonymous Jamie said...

I've been on the Microgestin pill for a year and have never missed or been late on a period. I'm on the last day of my placebo pills and I've still not started my period. I'm due to start a new pack of pills tomorrow. Is it ok to start the new pack even if I haven't had my period?? And is it possible I could be pregnant?? Please help!

At 1:38 AM, Blogger ema said...


Yes, it's OK to start the new pack. If you've taken the pills regularly it's very unlikely you are pregnant. In any case, if you are concerned about pregnancy, a home pregnancy test is a good idea.

At 10:26 AM, Anonymous Anonymous said...

i've been on the pill for 12 years and recently i've been a little stressed about work and my relationship!ì normally skip my period every 2 months but this month even though ì skipped it,ì still started my period!?could it be the stress or are there other factors to be considered??

At 12:47 PM, Anonymous Anonymous said...

i will start my period round the 20 of the mouth and i am on the implanon and yaz to stop the break though bleeding. I have about 2 weeks left but if i stop taking them will i start my period. I want to know this because my prom is May 1 and i would like to been done with it. But if i start them back will it stop it again that what i need to happen?

At 7:51 PM, Anonymous Anonymous said...

i started taking the pill for the 1st time and now im takin my 7 day break.(diane 35 a pack of 21) im on the 3rd day and i still haven't bled. does it mean i might be pregnant??

At 10:01 PM, Anonymous Anonymous said...

Ok my question is this. I just started taking Sprintec 28. My doctor gave it to me the week after my previous period. So i started taking it a full week after my period ended. Now im on the 3rd week of my pills and I am having spotting and breakthrough bleeding. Is this because I was orginally suppossed to be on my period this week and the hormone hasn't totally started working yet? And will I have withdrawal bleeding again next week?

At 5:08 PM, Anonymous Anonymous said...

I have been on the combination pill for almost 20 years. Are there any issues I should be aware of with such long term use. I do plan on having children in the next few years.

At 11:37 PM, Anonymous Anonymous said...

If you fall pregnant whilst on the pill are you likely to still get fake peiods or will they stop like the menstrual suppression would?

I am looking for an answer to this too. You answered everything else I wanted to know but this! Thanks for your help.

At 8:59 AM, Anonymous Anonymous said...

hi im on trinessa 28s and instead of waiting throught the placebo pills i ended up starting the white active pills im having breakthrough bleeding everyday do i still get my period or not im really confused.

At 9:24 PM, Anonymous Anonymous said...

Hi! I have been taking birth control for about 8 or 9 years now and started Seasonale probably 7 or 6 years ago. I have never had a huge problem with breakthrough bleeding or anything like that except for maybe once in a great while and even then it would only last a day or two and would be very light. Recently, however, I have been experiencing breakthrough bleeding that has lasted for three weeks and is ranging from light to medium flow. I'm kind of worried. The only difference I can think of is that the pharmacy accidentally gave me the generic version of Seasonale this time instead of the brand which I have been using since I could remember. Do you think I should be worried about this? Should I go in to see my OB/GYN? I have been trying to find stuff out online, but everything I find says breakthrough bleeding is normal, but I feel like this is a pretty strange circumstance considering I've never had it this long or extreme before. PLEASE HELP!

At 12:36 PM, Blogger Nicholle said...

Hi! Your blog is very informative-- I wish there was a pamphlet with your explanation of a fake vs. real period in the lobby of every gyno/ clinic in America!

I am a busy 24-year-old student and have been skipping the placebo week in my birth control packs for about a year now. I am definitely enjoying the freedom continuous use provides! Is it safe to use bc pill continuously for more than one year (indefinitely) without allowing fake period? I want to take one pill a day for the rest of my fertile life and never have a period again :-P

I have another question concerning the fate of the eggs that are never released due to lack of menstrual period. I read at the below link that women are born with 1-2 million "follicles" that have the potential to become an egg:

The site also says that at the time of menopause, there are only a few follicles left that can become eggs. By stopping my menstrual periods, I am keeping thousands of follicles from developing into eggs, right? After years of not having periods, I will have many more potential egg follicles in my body than a woman who had regular menstruation.

I am planning to suppress my menstrual periods almost continuously for at least twenty more years. Will the presence of thousands more egg follicles delay the onset of my menopause?

If you do not know the answer, can you please refer me to someone who can help?

Thank you so much for your time, your work is a great help to many young women like me!

At 4:19 PM, Anonymous Anonymous said...

can I start diane 35 1 week after my menstrual period

At 12:28 AM, Anonymous Babybubbles said...

Hi Ema, Thanks for the informative post, this is the closest thing I've found regarding fake/real periods but I can't find anything to answer my concern so please help if you can!
I stopped Femodene in NOV 2010, I had a few tablets left in the pack and didn't take them for a few days but then just took them for the sake of it to use up the pack and then had a withdrawel bleed on the 16th NOV. After that I stayed off the pills for good and had another bleed on the 16th DEC but it didn't start properly till the 22nd. Again I got my period on the 21st of JAN and now it is the 22nd FEB and I am expecting a period, (can feel cramping) What I want to know is if these periods are REAL or FAKE? is the withdrawel period just the one? or can it be a few? how do I know if these are real periods and my cycle has returned and I am ovulating or if they are just fake periods caused by the pill?
I am TTC sort of, not charting or anything anymore cause I am a bit overweight and want to loose weight first. But am really worried as to why I haven't fallen pregnant yet? is it cause I am getting old? (28) overweight? have had a termination in the past? I have been pregnant 3 times and each time I was on the pill but just missed pills, so I am worried because after 4 months of unprotected regular sex I am still not falling on? so am wondering if this is because my periods are fake?
Please help if you can, thank you. x

At 4:57 AM, Anonymous Anonymous said...

"If you fall pregnant whilst on the pill are you likely to still get fake peiods or will they stop like the menstrual suppression would?"

okay one person has asked this so many times but again like she said everyone else's questions get answered but hers. and i wanna know the answer too.

ive been on the pill for about 7 -8 months, and im not good with the whole taking it at the same time, most of the time ill take for example 9am yesterday the like 11pm today. like im bad with the same time thing and i forget a pill almost eveyweek now i do the nextday take both but yeah im bad with the whole taking pills every day at the same time. but my quetion is i had sex on the 3rd day of my pills and i had missed 2 and 3rd pills. but so yeah wouldnt be surprized if im pregnant, but i want to know if i would still get the "fake" period EVEN if I AM PREGNANT?

and would i get my FP (Fake period) if i stoped taking my pills and im pregnant?

(and im guessing the girl that was asking ""If you fall pregnant whilst on the pill are you likely to still get fake peiods or will they stop like the menstrual suppression would?" would prob be greatful too.) PLEASE ANSWER IF YOU CAN : )

love Electa !:)

At 2:20 PM, Anonymous Anonymous said...

Hi, I've just started taking the pill - I've finished the first strip and now have a seven day break. My question is, should the withdrawal bleed have started immediately? I'm on day three now and there's still no sign. Any help would be greatly appreciated!

At 11:47 PM, Anonymous Anonymous said...

Ok FINALLY an answer to the questions about whether you can be on the pill and still have a withdrawl bleed if pregnant, the answer from a net-doctor website is this:

"When you take the combined oral contraceptive pill, you do not in fact have a natural period, but something called a withdrawal bleed.
This means that the oestrogen-containing tablets that you take for 21 days are discontinued for the seven-day break (or for the seven days when you take a dummy pill containing no oestrogen).
This causes the lining of the womb to break down because the oestrogen which maintains it has been withdrawn, and bleeding occurs.
This does not happen when you are pregnant, because during pregnancy oestrogen levels rise to much higher levels than when you take the Pill so that no withdrawal of oestrogen occurs and no bleeding should take place"

So the simple answer is yes-if you get your withdrawl bleed in the 7 'pill-free' days then you are very very unlikely to be pregnant. When pregnant you would get light spotting but you would be able to tell the difference between light spotting and a period.

Hope this helps guys :)

At 11:51 PM, Anonymous Anonymous said...

Q:"If you fall pregnant whilst on the pill are you likely to still get fake peiods or will they stop like the menstrual suppression would?"

A:If you were to become pregnant on birth control pills, a normal withdrawal period would not occur because progesterone production from the corpus luteum gland on the ovary overrides the drop in progesterone from finishing the active pills. Occasionally a woman could have some spotting while pregnant but usually it isn't a full period"

Best of luck ladies xo

At 11:09 AM, Anonymous Anonymous said...

I have been taking the pill back to back for 7 years. No periods for 7 years. I do this with the full approval of my doctor. I do not intend to have children and am therefore unconcerned with how this might affect fertility. My PCOS issues are under control, as are cramps, mood swings, acne, etc. I am happy and very healthy, and can only pass that on to those with doubts.

At 1:09 AM, Blogger lizzy said...

Hi, i been taking birth control pills for about 5 or 6 days. i didnt start the sunday after my period i forgot. on monday i took two pills i think.i was takin them at differnt times and forgetting to take doses. the following days i would double up. on the sixth day i took a pill, later that night my boyfriend came in me. the next day i stopped takin them. two days later i began to bleed. could i still be pregnant or no because im experiencing withdrawal bleeding?? plz help

At 10:37 PM, Anonymous Anonymous said...

I just finished my 3rd pack of 28-day Marvelon (generic version), which I switched to after 2 other brands caused persistent btb. I have not had any btb on this pill until this cycle. I lost a pill mid-pack, but did not miss a dose because I took the following day's pill instead and continued taking the next day's dose through to the end. I started spotting on the Thursday before the Sunday (first day of inactive pills), and by Saturday had a flow like a regular period. I had already decided to experiment a little with skipping the inactive pills (just got engaged and want to be able to manipulate for my wedding), so I started a new pack immediately on the Sunday. It's now Tuesday and I'm still spotting. Is this normal?

At 11:23 PM, Anonymous Anonymous said...

Hi, I have a question..So I went off the pill on April 12th and then I started to bleed on May 1st-May 7th. After a three days I experience brown discharge and then lighter bleeding than the one I have on May 1st. That lasted for five days. I am just wondering what this could be. Can it be the effects of going off the pill or could I be pregnant?

At 2:03 AM, Blogger Amy said...

FIRST, I've searched the "entire" web and no web site compares to yours, EMA. This is the most informative and useful blog available.


IF, instead of removing the NuvaRing on the 22nd day, I leave it in until withdrawal bleeding begins, and then immediately replace it with a new ring, am I protected from pregnancy?

I've been on NuvaRing for 7 years and "fell" into this practice a few years ago. I noticed a nurse practicioner noted on my chart "possible risky misuse. Consider counsel or change of method."

I brazenly began this practice after reading that NuvaRing actually has enough hormones to sustain levels into the fourth week. I assumed that when the ring "emptied" of hormones, withdrawal bleeding begins, signaling me to insert a new ring. I felt this method took the advantage of the ring over the pill -- that of eliminating the need to "remember" to take the pill everyday -- by eliminating the need to calendar or "remember" when to replace the ring. As soon as I see blood, put in a new one. A completely mindless birth control.

Further, providers and insurers (in the US) are slow to allow prescriptions of more than 12 rings a year (I am actually not "allowed" more than 12 per year). Inserting a new ring approximately every four weeks instead of three compensates for the old-fashioned ways of the law and insurance. Thoughts?


At 5:53 AM, Blogger ema said...


Thank you! As to your question, NuvaRing tends to stop ovulation for >30 days, so leaving it in for 4 weeks and then replacing it with a new one should be fine.

Best to use a set time interval (like, say 28-30 days) rather then the onset of withdrawal bleeding as the time for a new ring.

Last, but not least, the most likely reason for the chart notation is a legal one, not a medical one. There haven't been any large-scale studies with x4 wks continuous use, although smaller studies have shown the ring is still effective if used x4 wks.

Bottom line: As long as you use ~30 days interval (try not to go longer than that) you should be fine.

At 3:33 PM, Anonymous Luke said...

Don't forget, within all the misogynistic control, that having a withdrawal bleed is quite a handy well of telling that you're not pregnant. I guess monthly reassurance was good enough before the pill, so why systematically enforce a change? Am not saying that all your reasons aren't also true.

At 6:34 PM, Anonymous Anonymous said...

I have been on the pill for almost a year now, and everything has always been fine. But a few days ago i came on my period when I still had 8 days left of taking the pill before i have a week without taking them to allow for my period. It stopped after a day but has just happened again, what does this mean?! It has really creeped me out and I'm worried.

At 8:14 PM, Anonymous Jess said...

I fly from UK to Australia on Monday (I don't fancy a 24 hour flight on my period), and started my withdrawal bleed today (Tuesday). If I recommence taking my pill will the withdrawal bleed stop or slow up before then?

At 12:45 AM, Blogger kc31 said...

Hi! this is a really great site. answers a lot of questions. Here's mine: I have been on the pill for the last 8 years but this has never happened to me before. I took my 21 days but I forgot when I was supposed to stop and I accidentally took an extra pill on the 2nd pill-free day as well as had sex. It has been 5 days since my last pill and all I have had so far is spotting/streaks, bloating and cramps. what are the possibilities for this? Thanks!

At 4:11 PM, Anonymous Anonymous said...

I have been off the pill for a year and recently became pregnant after originally thinking my fiance could not make that happen. Well, to our surprise, turns out he can! I had a miscarriage after 7 weeks and went on the pill again. We are getting married in August and have decided, now, that we would like a family. I am 43 and he is 36. We know all the risks but have a positive outlook. I have decided to go back off the pill. The decision came after I took the very first pill of my pack - then I stopped. It has been 6 days and I am bleeding as if I am having a period. How do I know when I am ovulating? Is calculated from the beginning of my last "fake" cycle or should I start now, at the beginning of my possible new cycle? Any help is greatly appreciated.

At 2:35 PM, Anonymous Anonymous said...

I have been using mircogynon for about 3 years now, never had any problems with it, given me perfect "periods" since i started using it (before I had really irregular and heavy periods that were incredibly painful). But since about Sept/Oct time I have barely seen any withdrawl bleeds on my 7day breaks - Im supposed to be experiencing one now as i came off last thursday and today is my last day off and all i have had is some browny/red discharge. This is all i have had since about Oct and some months dont get anything! Is this normal?? Im panicking thinking its something serious, but I know a lot of people say they experience no withdrawl bleeds and my booklet says its normal. Im definitely not pregnant. Can anyone tell me if this is normal or if they have had this too???!!!

At 6:38 PM, Anonymous Anonymous said...

Will a withdrawal bleed start whenever the pill is stopped taken for more than 3 days?

At 11:13 PM, Blogger Reshu said...

Hi, I am a Indian Lady who is married since last 10 years. I had lost two pregnancies and had one ectopic pregnancy as well. I have tried all sorts of medicines to become pregnant. My husband is perfectly all right. Recently I came to know about Homeopathy and starting using since last 6 months. I had good homeopathy consultants in India, but again unfortunately I came to Canada to stay along with husband who has come here on his project work. I don't get regular periods. I get them once in 2 or 3 months and once periods start but never stops on it own. I have take some medication. Physician in India has prescribed NUX MOSCHATA 10M or NUX MOSCHATA 50M. Please let me know if it helps to control the bleeding and will it help to have regular periods. The other question is whether I should take 10M or 50M and how many pills should I take at a time. Physician suggested me to take three doses with a break of 30 minutes, But to ask my remaining questions He is not reachable on phone. Will be every grateful.

At 3:59 PM, Blogger sandy said...

PLEASE REPLY FOR THIS SOON.Im not on regular contraceptives. I took an emergency pill (em-pill) on 19th july , and had withdrawal bleeding on 23rd july.This bleeding lasted till 28th.Today is 30th, and i had unprotected sex today.My next periods is supposed to be on 9th of august,next month.Will i become pregnant if i dont take the emergency pill soon?

At 3:19 PM, Blogger sandy said...

Corresponding to my earlier comment @ 3.59 pm, i had my "fake periods" on 23rd july.So when should i expect my next periods? after 28 days? or should it continue with the "real periods" cycle,supposedly on 9th august? I hope im not confusing :( .

At 3:17 PM, Anonymous Anonymous said...

I just started taking Seasonale. I will be getting my first period at the end of October. I'm wondering whether it is safe to start taking my new pack when I would be getting my period and to skip this period? I have a function that I am attending and would rather not have it then. I want to be safe about it though and am unsure of whether it would be a problem to not have my period for 6 months. Thank you in advance!

At 5:05 AM, Anonymous Theresa said...

Hi there,
I've taken the pill in previous years and then stopped. I've recently started taking the pill again. I am in the non-active pill phase of the first pack, so I am in the middle of my withdrawal bleeding. Yesterday, I noticed that I had a grayish tissue in my bleeding, which looked like a lining. It was probably around the size of a chicken egg. If the pill suppresses my menstrual period and there isn't any part of the uterine lining to be shed, then should I be concerned by what I saw yesterday?

At 6:37 PM, Anonymous Anonymous said...

hi i have been on the pill since i was 11 years old and i am now 21 so its been 10 years. i got off the bill about 3 months ago. i started my period on thursday i have been feeling weird these past couple of days like headache and nausea. i have never felt like this. when i first got off the pill i was getting dizzy for a couple weeks then i was fine. im not sure if these are withdrawl signs from the pill or pregnacy plz help me

At 11:32 PM, Anonymous BRIT said...

REPOSTING MY QUESTION NO ANSWER YET!!!!! hi i have been on the pill since i was 11 years old and i am now 21 so its been 10 years. i got off the pill about 3 months ago. i started my period on thursday i have been feeling weird these past couple of days like headache and nausea. i have never felt like this. when i first got off the pill i was getting dizzy for a couple weeks then i was fine. im not sure if these are withdrawl signs from the pill or pregnacy plz help me

At 1:37 AM, Blogger ema said...


No worry. What you observed is probably lining. (With withdrawal bleeding there's still shedding of the lining. Much less than a regular period because the lining is thinned, but still.)


Are you sexually active? The symptoms you're describing (H/A and nausea) are a bit too nonspecific for a firm diagnosis, but if you are having sex and not using any contraception, pregnancy is always a possibility.

However, as a general comment, if you've got your period (assuming it's a regular one) it's unlikely you are pregnant. Also, if you've been off the pill for 3 months, it's unlikely you're experience withdrawal from the pill.

At 11:02 AM, Anonymous Niamh said...

Hey Ema, i was just after some advice. I am 20 and have been on various pills for the last two years after strugglin to find one that suits me. I have now been on Loestrim 30 for 4 months. I took two pill packets back to back whilst on holiday and then experienced a very light period afterwards. Then this month im 8 days into my pill packet and experiencing breakthrough bleeding. Is this just because of the packets i took back to back meanin i didnt have a full period? Or could i be pregnant? Thanks.

At 5:47 PM, Anonymous Anonymous said...

hi,.. need some advice,.I usually used condom when i made love with my boyfriend.Its just one time we got drunk and he forgot to use it.Were not sure if he made a widthrawal that night.
Question,.how many pills do i need to take,after that things happend to make it sure that the sperm will be dead,. its been three days was taking diane 35 pills,. and i dont want to finish the pocket since its giving me badfeelings,like a reaction inside my it good enough 3-4 tablets to stop it? its just one time accidentally sex happend wihtout contraceptive.
thanks alot,..

At 3:32 AM, Anonymous Anonymous said...

i am 26 year old i am taking 21 days pack pill. my question is "can one have unprotected sex and don't get pregnant during week off i.e. after 21 pills are over?"

At 10:09 PM, Anonymous Anonymous said...

Thank you very much for such an informative article! No gynecologist tells you this!

I have a question : if when you take the normal pill you don't have menstruation, only withdrawall blood. It is exactly the same as taking continuous pill.

1.So it's just a question of framing to people what the pill does ? (while it does exactly the same thing)

2. Do you think that during the continuous pill, as we don't have a withdrawal bleed, there might be consequences of this ? (or is withdrawal bleed kind of useless?)

Thank you very much!


At 3:52 PM, Anonymous Anonymous said...

I've been on Yasmine for nearly a year now, and it's been excellent. But here are some things that I've noticed that come hand-in-hand with it that never fail to freak me out every month and have me reaching for a home test. Like a lot of people, I have IBS which tends to rear its head (for some reason) a few days before the widthdrawl bleed. I get lower abdominal bloating, cramps (which feel just like a period, but it's actually the gut - strange but true)and just one of my breasts gains about a cup size. So cruel! Also nausea, tiredness, and sometimes headaches (and that skin-crawly feeling which is never nice).

You hear the stories about women who had widthdrawl bleeds only to discover they were three months pregnant. I'm sure that what they're counting as the fake periods are somehow different to what has happened before - they just might not have noticed the difference.

So if what you feel follows that monthly pattern of bloating and feeling a bit rubbish, then just relax. Getting freaked out about it won't get you anywhere. I keep a stash of home tests to reach for if I freak out, and every single one I've ever taken has always come up negative.

Also, we tend to use condoms as well as the pill, mainly for my peace of mind to be honest. If you're the worrying kind like me, then why not use an extra back-up so you don't have to rely purely on the pill? Especially if you've taken some at the wrong time or forgotten a couple? Keep a few condoms in your purse! I've found this really helps.

At 11:25 PM, Anonymous Anonymous said...

Bit of a medical question: Do real menstrual blood and withdrawal bleeding blood while on the pill have the same composition? Or the second one is more 'pure', i.e. closer to the venous blood composition? Thanks.

At 4:32 PM, Blogger Rmarte74 said...

I stopped taking Seasonique when I fifnished my last pack in September. I loved not having monthly periods. I have been having regular monthly periods now but they are very, very heavy. I want to start Seasonique again (it is now December) not for birth control reasons but for lighter, infrequent periods. I just had a period on Dec 2nd. I won't be able to purchase my pills until Dec 16th. Is it ok to start them then, even though that is 2 weeks after my period starts? I dont want another heavy period around the end of the month, which is when it is due. Is it likely I will get a period if I start them then?
I appreciate any guidance you can provide!

At 3:33 AM, Anonymous Rachelle said...

Okay, I have a question and my mind needs settling. This month with my birth control hasnt been a great one for me, even though I have an alarm for it, I always forget to take it. I had missed about one and taken both the next day. After that, my fiance and I did have sex, more than once, and we did not use protection, and he came inside me.
I missed another pill that night before we had sex, and another the next night. I took all 3 the next day.
And for my body, if I miss 2, I usually start the withdrawl bleeding. I have withdrawl bled everytime ive missed.

It's now 2 days after I took all 3, and there is still no bleeding. I find it strange.

Due to my lack of remembrance and the timing, could I have gotten pregnant while missing so many this month, or the same week?

And is it too early to take a home pregnancy test?

At 3:37 AM, Anonymous Rachelle said...

Hi, Rachelle again.
If I don't have any withdrawl bleeding, does that mean I don't have any lining to shed?

And does that mean that an egg was fertilized and not demolished?


At 11:28 PM, Blogger randifay said...

I have been taking birth control pills for almost six years now and I usually never bleed at all. Me and my boyfriend have been together for 3 1/2 years and I just randomly started bleeding out of nowhere. Could this mean I'm possibly pregnant?

At 8:44 AM, Anonymous Anonymous said...

Hi, so when you get your fake periods this is not confirmation of not being pregnant? You could be pregnant and not know?

At 8:47 AM, Anonymous Anonymous said...

So a fake period is not confirmation generally speaking that youre not pregnant? You could be and have no idea?

At 9:51 AM, Anonymous Anonymous said...

Is there a high chance of pregnancy whilst having your 7 day break?

At 10:03 AM, Anonymous Anonymous said...

I have already taken two months of pills back to back. I really dont want my period for another 'special' moment is it ok to extend on the pill for a third month? Or am I better to stop my pill now, get my period early and go back on the pill.

At 2:13 PM, Anonymous Anonymous said...

Hi.. I started using diane 35 since november because I will see my husband on January 18..I still have 4 tablets left..I planning to stop using it so I will have my menstruation period earlier...and start the next it safe to do that?

At 7:19 AM, Blogger Unknown said...

I was using Loette for 4 months, then at the end of the 4th pack I decided to skip my withdrawal bleed and go straight on to the 5th pack. About 4 days into the 5th pack I began bleeding. It is one week later and I am still bleeding. My pill withdrawal bleeds have usually been no longer than 3 light bleeding days. Is this my body still adjusting to hormones?

At 1:26 AM, Blogger meg said...

Hi, I am taking birth control because I have PCOS and my uterine wall is the thickness of one that is in menopause and I'm only 24 years old. I want children and I'm guessing my doctor put me on birth control to thicken my uterine wall so I can have children. But my question is, is birth control giving me a fake period? I take it for 3 weeks and skip a week, take for another 3 weeks and skip another week. My doctor told me birth control doesn't give you a fake period, and that prometrium (not sure if spelled correctly) does, and I had another doctor tell me the opposite. Please help. I am so confused and I really want children asap.

At 10:45 PM, Anonymous Anonymous said...

I'm ttc but my other half is away off shore for the next 7month when I'm on week 2-3 (typical) I have been off pill for 2 years but took 7 pills ths week to see if I can throw my cycle off will this work x?

At 10:10 PM, Anonymous Anonymous said...

What will happen if I just take 1 week worth of microgynon...I just need to suppress or move ovulation as my partner away weeks 2-3 for next 8 months as I have a 34 day cyclevand he is on a 2 away 3 at home rota and on day 4 I started taking it and took for 1 week have now came off ..not ovulated yet

At 1:55 PM, Anonymous Anonymous said...

i've been taking diane 35 for 3years my last period started on the 9th of march 2012,after my period i stopped taking my pills and engaged in unprotected sex its now april 10 and i haven't seen my period can i be pregnant?

At 4:27 PM, Anonymous Anonymous said...

Last time I was intimate on 3/25 we had a slip up. In the last week or so I had what looked like my period. I have not felt well in the last few days- nausea, sleeplessness, lethargic, headaches. I wanted to know if there is any possibility that I could be pregnant. I was pregnant once before where I had a cycle and then spotted off and on for a couple of months. Also, Ive had issues with my pituatary gland which has caused some irregular bleeding in the past which seems to be under control now. Not really sure what's going on or if I should be concerned

At 11:55 AM, Anonymous Anonymous said...

Can someone please help me? I work three jobs right now and I've had nonstop bleeding since I quit my nuva ring after only four days on it. That, plus my period the week i started nuva ring, means I've been bleeding nearly every day in April.I seriously don't want to go see my grumpy doc. The bleeding has really really subsided but i'm feeling a little tenderness inside and can't wear tampons. Am I in a terrible danger or will things correct themselves?

At 9:36 PM, Anonymous Stephanie said...

Hi Ema! I hope you can help.

from 2007 to 2010 I didnt have ANY periods. Finally in 2011 I went and the OBGYN did a vaginal ultrasound and found that without periods my lining had built up very thick. She put me on birth control to regulate my periods and said that I would slowly slough off the lining. A month later I was in the hospital passing a MASS of tissue from the uterine wall being built up so thick, instead of small pieces it balled up and pushed its way out, I basically gave birth to the mass, it was very painful. After that things were better, I would have my "fake" period every month at the end of my pack, and I have been on it for 1 year. Now my husband and I want to conceive and when I get OFF the pill, from the day that I stop taking it I seem to bleed FOREVER. Last time I stopped taking the pill I bled for 3-4 weeks straight and had bad headaches. I was so miserable at that point I just started a new pack just for the sake of stopping the bleeding. We really want a baby and being on birth control is not conducive to getting pregnant! LOL, what would you say about my issue? Have you heard of this happening? What the heck should I do? Thank you for your advice!

At 5:52 AM, Anonymous Anonymous said...

Is there a reasonable explanation As to why i would have extremely painful "menstrual like" cramps for about 2 weeks off and on while on ortho cept? Stopped taking them mid pack cause I was convined it was the explanation for the cramps...any way cramps stopped, a week later I have a 5-6 day period but had no menstrual symptoms or my normal cramps I get the day before and day of...also this "period" was a week early but I'm guessing that's because of the sudden stop of taking pills.
Any insight would help, I am considering taking a new brand but was weary to mess with the natural flow of things...

At 7:33 AM, Anonymous Anonymous said...

Hi,Im 22 years old, I have been using Yaz contraceptive pills and metformin 500mg for the treatment of PCOS since 2 months,now it is my second month.Recently,a week back I have started using homeopathic treament because of acne problem on my face due to metformin tablets,so I stopped using metformin and continued yaz for this month cycle as adviced by my phisician and started taking homeopathic medicine along with yaz.. ,on 21st pill.,I had sexual Intercource with my parter for the first time. As I have studied that yaz is a birth control pill,does the usage of homeopathic medicine reduces the effectiveness of the pill? Is there any chance of myself getting pregnant?? If not,can i stop taking pills after having my period with no chance of getting pregnency? I hav completed my 24 active pills,and Now I am on placebos,its my second day yet I hav no signs of withdrawl bleeding. please help me..

At 4:59 AM, Anonymous Anonymous said...

Hi I have taken my first pack of dianette and I have taking all my pills on time and now I am on the 7 seven day break and it's day 5 nearly 6 and I still haven't had withdrawal bleeding is this normal?

At 7:41 AM, Anonymous Anonymous said...

Hi, am 32, mom to 4-yr old.
I was using Novelon for a year and stopped in June 2011. I started again this month. Got my periods on 8th Oct. 2012. But started taking Novelon only on 11th Nov. I had unprotected intercourse on 19th Nov. My 21-day Novelon course was over on 31st Oct. But till date I have not got her withdrawal bleed. Could I be pregnant? Am really worried. Please help.

At 7:26 AM, Anonymous Anonymous said...

My Ob/gyn told me I can take Seasonique. But because I've never taken birth control before, she said to take it for a month and a half and then skip a week to allow withdrawal bleeding, otherwise I will have spotting. But two weeks after that is my wedding. Will I be protected after that? In my mind, it's like skipping a week, wouldn't that throw it off? Or is it like an induced withdrawal bleeding?

If it is like an induced withdrawal bleeding, how come it is so scary to miss a pill ever? Can't it just be another withdrawal bleeding and be ok?

At 6:09 PM, Anonymous Anonymous said...

i had two ipills in a week span after 10 days from am last period then after i week i experienced bleedin so as to change two tampons within 3 days.... till was it an implantation bleeding or withdrawal

At 4:59 PM, Anonymous Anonymous said...

I was not on birth control for over 6 months. Had my normal AF and then started my new pack on that Sunday after. I only got to Wednesday and lost the pack. We decided not to continue them. Now having normal-heavy flow for last 3 days. Are chances of pregnancy ruined for this month? Will it start ovulation later after bleeding stops?

At 4:06 AM, Anonymous Anonymous said...

That used to happen to me when I first started taking birth control pills continuously to help minimize migraines. It is now (several years later) almost never a problem: no break-through bleeding. FYI: it's easier to use the continuous method with a stronger pill. My pharmacy accidentally gave me a weaker dose of my usual pill (Loestrin), and it caused me to start early even while taking active pills.

At 6:46 AM, Anonymous Anonymous said...

Is it true you can be put on bc monessa to regulate your periods...

At 9:46 PM, Anonymous Anonymous said...

I have been on the pill for about a year... I oct 3rd, I had my fake period. when it was time i started the new pack but only took the first pill of the next cycle. We decided to stop using birth control to get pregnant. I did have heavy break through bleeding.Is it possible to release an egg during the break through bleeding? What is the break through bleeding exactly? another fake period? Weve had sex four times during the break through bleeding week. I was wondering how likely I was ovulating during that time and if I could get pregnant.

At 2:20 PM, Anonymous Anonymous said...

Hi i just wanna ask if am i really pregnant, i had my withdrawal bleeding last october 3, 9 days after i took nordette. Then accidentaly october 17 i had sex with my boyfriend and immediately took nordette as ecp and i took the second dose the following day cus i cant bear enough the dizziness. Is been 6 days since i took nordette but no withdrawal bleeding. Am i pregnant? By the way is withdrwal bleeding is an assurance of not being pregnant?

At 1:24 AM, Anonymous Anonymous said...

Hello. So Its a long post but I'd like to give sufficiant details. I had been off the pill for a year and recently began taking it again. was on it for the first entire pack with out missing a day. The placebo week fell on the weekend of my friends wedding so i skipped it and moved on to the next pack after the first active pills ended. during my second pack I had a family emergency and missed 3 days of pill. on the fourth day as soon as i realized( last week of second pack) i began to take two pills a day till i was caught up and finished the pack. on the fourth day I began bleeding and it was very mild for the next 3 days until it stopped. During this time my husband and I had unprotective sex perhaps two days after the double up of pills. so I missed from friday 9/20- sunday and began the double up on Monday 9/23 until thursday by friday I began the new pack of combination pill. unfortuantly, I began to feel sick and stopped the pill on friday 10/4 and began bleeding monday night of 10/7. We had again unprotective intercourse on the morning of 10/7 before the bleeding that lasted until 10/13. I have been feeling cramping, fatigue, tender breast. I think i may be pregnant so i took a home urine test on 10/23. it was negative. I think we might be pregnant and that wouldnt be awful news but i wonder if I took the test to soon? If so, how long should i wait to test again? I am not certain when my next period will be. Do you think my pill misuse led to ovulation? Thank you in advance for your time and a great post.

At 2:13 PM, Anonymous Anonymous said...

I had started taking ovral L but due to side effects (like headache) I discontinued it after 4 days.
Now 2 days after stopping it m getting blood stained discharge since 3 days.
When this breakthrough bleeding will be over?

At 11:26 AM, Anonymous Anonymous said...

Yes you would have to take the pill every day but you could do that or have a birth control shot in which you would not need to take any pills. Consult your doctor.

At 11:31 AM, Anonymous Anonymous said...

So, question. I'm on my first month of birth control and have been having the withdrawal fake period for 3 days. It's been worse than my actual period was. So I'd like to end it early. Would starting a new pack do this? Or should I just wait?

At 7:23 AM, Anonymous Anonymous said...

My first menstruation June 26, and July 2 we make love of my husband without any contraceptive. And I'm not yet ready to get pregnant. I went to the hospital for check up and ask if I'm safe and she said NO, and she advise me to take emergency contraceptive and that's Marvelon. I took Marvelon 4 tablets immediately 3:30pm and 4 tablets 3:30am as emergency contraceptive lastJjuly 3, 2014. now I'm experiencing bleeding is this normal for taking this EC? or this is really a menstruation although I have mensatruation last June 26?

At 5:47 AM, Blogger Sweet said...

Hi Ema. Thanks a lot for your very informative blog. I am just concerned and want to make sure that i am would still be protected. I would like to skip my period this month so i am already started to take the second pack of my pills. After i finish this 21 pills, would i still be protected from pregnancy during the next 7-day pill free period or withdrawal bleeding period? This is my first time so i dont want to take the risk of getting pregnant. Thank you so much!

At 3:24 AM, Anonymous Anonymous said...

Hi, my girlfriend started yasmin, 21-pill pack in july. We first had sex on the 7th day of her being on the pill. After the pill, she saw her period. She then switched pills to Diane-35, 21-pill pack, and while on that, the only time we had sex was on her 15th day on the pill. The pills finished 4 days ago and she hasn't seen her period yet. Should we be worried? If yes, when would be the earliest time to take a home pregnancy test? Thanks

At 6:07 PM, Anonymous Anonymous said...

hi.. my girlfriend is on diane 35 for 2 months . i think her period is fake period. her last period was on 3rd september. we had sex on that day without protection. if fertilization occur can she have fake period in next month?


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