The pill and menstruation: what are the effects on the menstrual cycle?

Many women take the pill for contraception. In fact, it's an easy-to-use contraceptive that can be used by a large number of women. Here at Elia, we're wondering about the impact of this contraception on the menstrual cycle.

What is the contraceptive pill?

The pill is a contraceptive method, composed of synthetic hormones called estrogens and progestogens. It is an effective method of contraception (99% efficacy) if taken correctly. Apart from the hormones, which may not be suitable for some women, this contraceptive method has the disadvantage of having to be taken every day.

As such, there are two types:

  • estrogen-progestin pills, which contain both hormones,
  • and progestin-only pills, which contain only a progestin.

These two types of contraceptive do not work in the same way. While the progesterone version only modifies the uterine mucosa and mucus (ovulation is blocked depending on the progestin), the estrogen-progestin version acts on several aspects: it blocks ovulation and thickens the mucus, preventing sperm from crossing the cervix and an egg from implanting. However, the impact of this contraception on menstruation is the same for each type of pill.

How do contraceptive pills affect menstruation?

Most pills come in packs of 28 or 21 tablets. In 28-tablet packs, 7 tablets are actually placebos. Hormones are therefore taken for 21 consecutive days, and then, for a week, no hormones are ingested, at which point menstruation occurs. Likewise, menstruation on the contraceptive pill is less painful and often shorter.

Even with the pill, periods can be late or early: after all, the body is not a clock. However, as this contraceptive method is not 100% effective, it's best to check that you're not pregnant.

Stopping menstruation altogether

As bleeding on the pill is a withdrawal hemorrhage, you can choose to take your pack continuously, i.e. skip the 7-day break (or placebos) and start a new one. This will allow you to miss your period. However, this state is not definitive, and menstruation generally resumes as soon as you stop taking the pill.

It is possible to experience light blood loss(spotting) if you skip the 7-day withdrawal period for several cycles in a row. In this case, stick to the next 7 days of scheduled stopping to see the spotting disappear. Some people have periods, or rather bleeding, that are so light and short that they feel as though they have no real flow. It is estimated that 1 in 10 women have no withdrawal bleeding. However, they may experience spotting.

Withdrawal bleeding

Menstruation on the pill is called"withdrawal bleeding" because the discharge is not a real period. This contraceptive device causes false bleeding during the week of discontinuation. The word "deprivation" refers to the absence of hormones during the 7-day break or while taking placebos. It's the rapid drop in hormone levels during these 7 days that causes bleeding on the pill, known as withdrawal bleeding. This corresponds to the evacuation of the endometrium, the lining of the uterus.

Light blood flow

After menstruation on the pill, it is common to experience bleeding outside the period of hormonal cessation, known as spotting.

While it's normal to experience blood loss outside the menstrual period during the first 3 months of contraceptive use, it's not normal for this to continue afterwards. Consult your doctor, gynaecologist or midwife after this initial adaptation phase, if symptoms persist: it may be necessary to change to a different pill with a different hormone level.

If you forget to take your daily pill, the drop in hormone levels may cause bleeding or even delay your menstrual periods.

How do I know if my bleeding on the pill is normal?

When you take this contraceptive, it's normal to see a change in your flow compared with when you weren't taking it.

For the first few months, you may experience light bleeding outside your period, known as spotting. But if these last longer than three months, talk to your healthcare professional.

Menstrual flow on the pill can also vary over time. Finally, if you have no or almost no bleeding during the discontinuation phase, even though you have taken your pack properly (no missed periods, late periods, vomiting or diarrhoea), this is considered normal.

What should I do if I experience painful bleeding on the pill?

Pain during menstruation is never normal. If you experience pain during your period on the pill, consult your doctor. The first thing to check is that there is no risk of illness or pregnancy. A change of pill generation and hormone level may also be a good solution.

What are the alternatives to the pill?

Everyone is different, and the body reacts differently to different types of contraception. Some generations of contraceptives or active ingredients, depending on dosage, will reduce the volume of bleeding, sometimes even stopping it altogether, while others will produce a blood flow similar to that of natural menstruation.

There are natural contraceptive methods that do not stop menstruation, such as the copper IUD, which causes heavier blood loss. Implants and hormonal IUDs can also stop menstrual flow.

What about the morning-after pill?

You've had risky sex and don't want to get pregnant: the morning-after pill before or after your period, also known as hormonal emergency contraception, must be taken within 3 to 5 days of your period. It's free, and minors don't need a prescription. Taking it starts the menstrual cycle, so it's normal for your period to arrive more quickly after taking this pill!

FAQs on the pill and menstruation

When does the period arrive on the pill?

Menstruation occurs 2 to 3 days after you stop taking the last hormonal pill, i.e. after 21 days on the pill, during the 7-day withdrawal period or the 7-day placebo period.

Does the pill reduce menstrual bleeding?

Yes, menstruation on the pill, otherwise known as withdrawal bleeding, will tend to reduce blood flow and the duration of menstruation.

Can the pill prolong periods?

Although menstrual periods, their intensity and duration may vary over time, they will generally be shorter and less abundant on the pill. Some women experience bleeding outside their menstrual periods. This is known as spotting.

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