Pill Bleeds Are NOT Periods (aka The Pill Cannot “Regulate” Your Cycle)
Before we dive in, check out my article on Understanding Your Menstrual Cycle so you’re clear on each phase of an average, healthy cycle. Today when I reference the pill, I am talking about combination pills that contain both estrogen and progestin, not the progestin-only minipill.
Doesn’t the pill “regulate my cycle?”
People choose to go on the pill for lots of other reasons beyond contraception. One of the most common reasons I hear is ”my doctor said it would help regulate my cycle.” This is a misconception. The pill cannot give you an actual period or regulate your cycle. Even though you may bleed at a regular interval while on the pill, that does not mean anything about your overall hormone health or the cycling of your hormones.
Pill bleeds are withdrawal bleeds that could be any arbitrary amount of days, but are most often coordinated into a 28 day pattern. This bleeding occurs when the hormone levels in your pills drop (aka when the pack switches over to sugar pills). This bleeding is caused by your uterine lining shedding, which is similar to what happens during a normal period, but it’s different in a very important way.
The pill, if taken correctly and consistently, will prevent you from ovulating
It will also prevent your endometrium from growing thicker. During a normal cycle without the pill, the release of an egg will trigger the creation of your corpus luteum, a temporary endocrine gland that secretes progesterone to help thicken the lining of your uterus. Then, if the egg is not fertilized, you will shed that thickened endometrial lining. For this reason, many women experience much lighter withdrawal bleeds than they would with an actual period.
The idea that this will regulate your cycle is very misleading. If and when you decide to come off of the pill, your own hormones will take over and synthetic hormones will not longer dictate when or if you bleed. When you are not taking hormonal birth control, your menstrual cycle is an incredible key to understanding your overall health. When you’re all the pill, your monthly bleed cannot tell you much about your overall hormonal health since your hormones are not contributing to those bleeds at all.
There is a historical reason why we believe the pill helps “regulate” your cycle
There isn’t necessarily a need to bleed on the pill, but the cyclical nature of the withdrawal bleeding has important historical context. In the early 1960’s the pill was initially marketed as a way to “regulate your cycle” because prescribing it for actual birth control was illegal. It was only allowed to be prescribed for cycle regulation to married women. In order to show that it could “regulate your cycle,” there had to be timed bleeds, but these bleeds are not required for the pill to work. These days, the most common types of birth control pills still have cyclical withdrawal bleeds that mimic a period, but now you can even be prescribed pills that eliminate bleeding all together.
Birth control is incredible in so many ways. It has allowed for sexual freedom free from the fear of an unwanted pregnancy, and allowed for many to find relief from debilitating symptoms related to things like PCOS and endometriosis. But the idea that it “regulates” or “fixes” issues with a menstrual cycle is false, and a dangerous claim to make for those who are going on the pill in hopes of fixing a hormonal issue, especially if they hope to get pregnant in the future.
More to come on why your real period, and more specifically your real hormones, are so important to understanding your overall health.
Sources:
“Period Repair Manaul” by Lara Briden ND
“The Fifth Vital Sign” by Lisa Hendrickson-Jack
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520685/#b5-058e757
