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People Are Shocked After Learning That Bleeding On Birth Control Isn't Really A Period

Bleeding on birth control pills is not the same as menses.

Last week, I came across a now-deleted viral TikTok talking about how women don't actually have periods when they bleed on the pill. And, as a person who menstruates, I just figured a period on the pill was no different from a period without the pill. (And a lot of the commenters did, too!)

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So, in an effort to educate us all, BuzzFeed spoke to Dr. Natalie Crawford, who is double board certified in obstetrics/gynecology, reproductive endocrinology, and infertility.

First, let's talk about what happens during a natural, birth control–free menstrual cycle. "The uterine lining is stimulated to grow by estrogen as an egg is growing and maturing. After ovulation, progesterone is made — which is essentially for implantation. When you are not pregnant, your progesterone level drops and you have a period," explained Dr. Crawford.

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And, during a normal period, your uterine lining sheds. So, the blood lost during a period is the lining of the uterus.

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However, when you take combined oral contraceptive pills, they contain a form of estrogen and a type of progestin — and the constant estrogen prevents ovulation so you don't get pregnant. "The lining does not grow the same or as thick due to the constant progestin exposure, and this is good because it leads to less cramps and less bleeding. So, when you take the sugar pills or stop taking the active pills, your progesterone level drops and you bleed — and this is similar to when you have a drop in progesterone after ovulation," said Dr. Crawford.

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She added, "The uterine lining is composed of a basal layer and a functional layer. The basal layer never sheds. It has stem cells which allow for regeneration in the next cycle. The functional layer — which responds to hormones — grows and sheds. When you bleed from oral contraceptive pills and ovulatory cycles, the functional layer, or the top layer, sheds. In contraceptive options that are progestin only (like the implant, the shot, or sometimes the hormonal IUD), you may not shed, but you can have breakthrough bleeding and spotting."

In order to bleed on the pill, you need a withdrawal — or a break — from the progesterone pills. "Some women need a daily reminder, and so they take the 'sugar pills' which have no hormones, thus inciting a drop in progesterone. Stopping the pills or skipping the placebos will cause the exact same thing to happen. But, if you can take birth control pills continuously and skip the sugar pills, then you will not bleed — which is fine and expected in this circumstance," she explained.

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Need a TL;DR version? Don't worry, we got you! Basically, when an egg is released and isn't fertilized, the uterine lining sheds — which is the blood you see — and it's called a period, or menses. However, when you take birth control, an egg is not released, so the blood is actually caused by a drop in progesterone levels. In short, if you don't want to bleed on birth control, try to find one that gives you constant progesterone. Dr. Crawford says this can be the implant, shot, and sometimes the hormonal IUD, but talk to your doctor, who can help find the right one for you!

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Dr. Crawford has some YouTube videos that describe what happens during a menstrual cycle in more detail, if you're curious. You can also learn more on her As a Woman™️ podcast!

View this video on YouTube

Natalie Crawford / youtube.com

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