What Actually Happens When You Skip a Period With Birth Control?

Where does the blood go? Experts explain.

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Is it just me, or is it a little off-putting to use birth control to skip your period? Isn't it natural to bleed? And where does that blood go if it doesn't come out?

People who menstruate often wish they could reschedule their period. It's a plea probably as old as menstruation itself—and one that's all too familiar to Maria Sophocles, MD, medical director of Women's Healthcare of Princeton in New Jersey.

"It's not always fun to have a period and be traveling, or having an 80-hour workweek, or being a professional athlete, or even being regularly sexually active," Dr. Sophocles said.

Wanting your flow to show up any other time has inspired plenty of monthly bleeders to hack their packs by skipping the seven days of placebo pills. That's the appeal of a birth control pill like Seasonale, which postpones menstruation so it only happens every three months. It's also why birth control manufacturers continue to innovate: There's a pill called Amethyst (among other generic names) that delivers active hormones every damn day, stopping periods for an entire blissful, cramp-free year.

But as dreamy as that sounds, is it safe to use these so-called extended or continuous oral contraceptives? Didn't nature give us periods for a reason?

It turns out there was never a health-related reason for women on the pill to even have a monthly bleed. Birth control researcher Elizabeth Micks, MD, an assistant professor at UW Medicine and the director of research in the division of family planning, explained that there's absolutely no safety or medical difference between taking a birth control break every 21 days to get your period or sticking with it every day so you skip your period entirely.

Back when the pill was first invented, "the belief at the time was that women needed to be able to have a regular cycle to feel healthy," Dr. Micks said. "It is my understanding that the pill was never developed [cyclically] for health reasons, but because it would be more acceptable to women and their partners, which is, I think, something people don't realize." In fact, the pill could have been created right off the bat to make you bleed "once a week, once a year, or anything in between," Dr. Micks added.

When you take that traditional seven-day break from hormones on the pill, you're not really getting your period because you're not ovulating. Instead, you're having what's called a "withdrawal bleed" triggered by that brief hormone-free pause. Sure, birth control manufacturers may have thought this bleed would make the pill feel more natural. But it's not actually a natural (or necessary) thing, Dr. Sophocles pointed out.

So, does this mean that pill-regulated periods could have been choose-your-own-adventure this whole time? It's definitely frustrating when you take into consideration that "unfavorable or unsatisfactory" bleeding patterns are major reasons women ditch their birth control, according to Dr. Sophocles.

However, birth control is moving in this direction, Dr. Sophocles said. Healthcare providers are increasingly focusing on what their patients really want out of their oral contraception—whether it's fewer periods, more flexible bleeding patterns, or just solid pregnancy prevention. That last one is a big deal. Since no hormonal method is 100% effective, getting your period once a month is the reassurance many women are glad to have so they know they didn't accidentally conceive.

By continuing your pill pack and skipping that monthly bleed, "you may not be sure if you're pregnant or not, which is kind of an anxiety-provoking way to exist," Dr. Sophocles said. If you're the kind of person who needs that reassurance, a continuous or extended-use birth control may not be for you, Dr. Sophocles added.

Okay—so what about the blood you might imagine is pooling up inside you? Dr. Micks said that's actually not happening. The synthetic hormone progestin in the birth control pill prevents the buildup of blood. "This keeps the uterine lining very thin," Dr. Micks explained. When the placebo pills roll around, "there's really nothing that needs to be shed because you've been on progestin the whole cycle."

Skipping this manmade withdrawal bleed might also be good for some women. Extended and continuous birth control methods have long been used to treat issues like heavy periods (as noted in a May 2021 study published in The European Journal of Contraception & Reproductive Health Care), menstrual migraines, and endometriosis.

If you do decide to try an extended or continuous method, know you might experience some spotting, also known as breakthrough bleeding, until your body settles into this new routine. Of course, if a cyclic method with a regular bleed still sounds best to you, that's totally okay too. "It's really nice to have options," Dr. Micks said.

Overall, if reading this has convinced you to set your own period schedule, talk to your ob-gyn about the best hormonal birth control method for you and which ones might give you your ideal bleeding pattern—and fewer worries about your body.

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