Created for Greatist by the experts at Healthline. Read more
If you want to make love without making a baby, there are two main approaches you can take: hormonal birth control and nonhormonal birth control.
Nonhormonal birth control includes natural cycling, condoms, pulling out, the copper intrauterine device (IUD), tube tying, and (finally!) male contraception.
While nonhormonal birth control works well for many women, some find these methods impractical or undesirable and choose hormonal birth control instead.
You have five main options for hormonal contraception: pills, patches, shots, vaginal rings, and hormonal IUDs. If you choose birth control pills, there are three different types and about 60 different brands to choose from.
Hormonal contraceptives work by releasing synthetic hormones (estrogen, progestin, or a combination of the two) that stop ovulation. Many (but not all) hormonal birth control methods use a 3-weeks-on, 1-week-off cycle.
The week off hormones triggers withdrawal bleeding — vaginal bleeding that appears to be a menstrual cycle but technically isn’t.
Back in the 1950s, when hormonal birth control first hit the scene, it was thought that women, husbands, and religious institutions would be more accepting of this new and controversial pill if it closely mimicked a woman’s regular menstrual cycle. That’s why hormonal contraception was designed to induce withdrawal bleeding.
Thankfully, we’re a lot more chill these days (about birth control, at least). If you’re not that into the idea of a monthly period, some continuous-release hormonal methods can greatly reduce your periods and even make them disappear altogether.
Here’s a quick rundown of your hormonal birth control options and what kind of period punch they bring:
Arm yourself for an injection
- The shot (Depo-Provera) and the implant (Nexplanon) are injected birth control methods.
- Both are usually given in your arm, but the booty’s also an option for Depo-Provera.
- They’re progestin-only.
- The shot (Depo) lasts 3 months and needs to be taken right on schedule for best results.
- Nexplanon is implanted in your arm and lasts up to 3 years.
- Injections use a continuous-release hormone method and won’t cause withdrawal bleeding when used as prescribed.
- You may still have some irregular bleeding and spotting.
Expect the unexpected with an IUD
- There are two types of IUDs: hormonal and copper.
- Hormonal IUDS are progestin-only and last 3 to 5 years.
- Bleeding with hormonal IUDs can vary wildly. Many women have heavier bleeding and irregular spotting up to 6 months after insertion.
- After the first year, your periods will probably be much lighter than they were before. About 1 in 5 women will stop having periods entirely after the first year.
- Copper IUDs last 10 years and are nonhormonal. You’ll still ovulate and have your normal period, but your periods may be heavier for the first year after insertion.
A sticky solution
- Patches release an estrogen-progestin combo through your skin.
- Each patch lasts a week, and you wear them for 3 consecutive weeks before taking a break in the fourth week.
- You’ll have withdrawal bleeding during the break week.
A daily dose
- Birth control pills are the most high maintenance option since they need to be taken 👏every 👏single 👏day!
- There are three basic types of pills: a 21-day estrogen-progestin combo pill, a progestin-only pill for continuous use, and a progestin-only “minipill” (ultra-low dose), also for continuous use.
- The 21-day pill pack usually includes a week of placebo pills to keep you in the daily routine even during your break week. The placebo pills will trigger withdrawal bleeding.
- You’ll also have withdrawal bleeding if you use extended- or continuous-cycle pills, but the time between your periods will be longer (up to 84 days).
Put a ring in it
- The ring is a 21-day estrogen-progestin combo method
- You insert the ring into your vagina for 3 weeks at a time.
- You remove it for the fourth week, which will cause withdrawal bleeding
- You then insert a new ring.
There’s always Plan B
- Plan B, also called the morning-after pill, is a form of emergency contraception.
- It’s a mega-dose of hormones that should be taken within 72 hours after you have sex without a condom. The sooner you take it, the more effective it is at preventing unwanted pregnancy.
- Depending on where you were in your cycle, taking Plan B can disrupt your usual menstruation, causing heavier or irregular bleeding. Your next period should be back to normal.
Hormonal birth control has a few tricks up its sleeve to keep you from getting preggers:
- Most methods stop you from ovulating (releasing an egg).
- They trigger a buildup of extra tissue and a thickening of the mucus on your cervix, making uterine travel very difficult for sperm.
- If (this is a big IF) the first two steps fail, hormonal birth control also changes the lining of your uterus so that a miraculously fertilized egg would find it difficult to implant.
During your break week when you stop taking hormones, the drop in hormone levels signals your uterus to shed the extra uterine material and mucus and cell buildup on your cervix. This shedding is your withdrawal bleeding.
Usually women experience fewer premenstrual symptoms with withdrawal bleeding than with a regular period, but you may still have some lovely symptoms like:
- mood changes
- water retention and weight gain
- sensitive breasts
- digestion problems (diarrhea or constipation)
Withdrawal bleeding is not strictly necessary. Some birth control methods, like IUDs and injections, don’t cause withdrawal bleeding. If you use oral contraceptives, you can reduce withdrawal bleeding to every 2 or 3 months or even less often by taking continuous-use pills.
Research shows that continuous-use oral contraceptives are a safe option with the same general risks as cyclical oral contraceptives, aside from an increased chance of breakthrough bleeding.
But no studies have followed women after the 1-year mark, so it’s unclear whether long-term use leads to any negative effects. Talk to your healthcare provider to come up with the best plan for you.
Both types of monthly bleeding are caused by a drop in hormones (either synthetic or natural). But withdrawal bleeding is usually lighter and shorter.
During a regular menstrual cycle, a woman’s uterus thickens for the possible arrival of an embryo (fertilized egg). When none shows up, the entire lining and the unfertilized egg will be shed, resulting in a regular menstrual period, which is usually heavier and longer.
Many women experience moderate to severe PMS symptoms during this time.
Withdrawal bleeding is usually more mild than a true period because your body isn’t shedding the uterine lining and has less stuff to get rid of.
Withdrawal bleeding is what happens during the week you aren’t taking hormones. Bleeding at any other time is called breakthrough bleeding. Breakthrough bleeding is pretty common, especially in the first 3 months of using a new contraceptive.
You might also have breakthrough bleeding if:
- your birth control patch isn’t applied correctly
- you forget to take your birth control pill
- your birth control ring isn’t inserted properly
- you’re on a medication or supplement that messes with your hormonal birth control
- you skip the break week
As long as you’ve been vigilant about using your birth control, it’s all good to enjoy sexy time during your break week. If you’ve had some glitches (like forgetting your pill more than once), you’ll want to use a backup method during this time.
Pregnancy and withdrawal bleeding can’t be together
Just like your regular period, withdrawal bleeding is a great indication that you’re not pregnant. If you do get pregnant, you won’t experience withdrawal bleeding. This is because pregnancy triggers the production of progesterone, which overrides the drop in hormones that normally happens when you take your break week.
You’ll likely have withdrawal bleeding within 2 to 4 weeks after stopping hormonal birth control. Your regular menstrual cycle should come on board the next month and will be heavier and longer. Also: PMS will be back in action. (#joy).
It could take a few months for your period to regulate and become predictable. Some underlying medical conditions or other issues, like stress and exercise, can affect the regularity of your periods too.
Once you’re no longer taking birth control, you’re open for baby-making again. You’ll definitely want to start using another type of contraception if pregnancy isn’t your goal.
If you do want a little bambino, think about waiting until you’ve had at least one regular menstrual period. Waiting gives your body a chance to prep for a healthy pregnancy. It also makes it easier to calculate an accurate due date.
Withdrawal bleeding after stopping mid-pack
It’s generally not recommended to stop your birth control mid-pack if you can avoid it. Stopping mid-pack can cause some hormone confusion, and your body might take longer to return to its natural cycle. When you stop mid-pack, cramping and bleeding can happen after a couple of days.
It shouldn’t take more than two or three menstrual cycles for your body to find its natural rhythm again. If you had irregular periods before taking birth control, it’s likely they’ll continue to be irregular.
If it’s been longer than 4 months since you stopped your birth control and your period still hasn’t visited, you should talk to your healthcare provider.
Withdrawal bleeding is a common side effect of hormonal birth control. Some women welcome its mild manner and the monthly validation that birth control is doing its job.
Others, especially those with severe PMS, endometriosis, or an overall aversion to vaginal bleeding, may choose a method of hormonal birth control that eliminates their monthly cycle altogether.
One thing’s for sure: When it comes to birth control, it’s nice to have options!