The Pill Bleed Isn’t a Period

Let's talk about why the bleed you're experiencing from your pill isn't technically a period.

When you take birth control pills, they work to prevent pregnancy primarily by stopping ovulation, which is when your ovaries release an egg. Without ovulation, there is no egg available for fertilization, so you can't get pregnant. 

Now, the bleed you have during the placebo or inactive pill week (if you're on a combination pill) or during the entire month (if you're on a mini-pill or progestin-only pill) is often referred to as withdrawal bleeding. This bleeding happens because your body is responding to the drop in hormone levels when you're not taking active pills. It's more like a "withdrawal" from the hormones in the pill rather than a natural shedding of the uterine lining that occurs during a menstrual period.

During a natural menstrual cycle, the lining of the uterus thickens in preparation for a potential pregnancy. If pregnancy doesn't occur, the lining sheds, resulting in what we commonly call a period. However, with birth control pills, the hormones in the pill stabilize the uterine lining, so it doesn't build up as much as it does during a natural cycle. That's why the bleed you experience on the pill is often lighter and different from a typical period.

So, in summary, the bleed you're having from the pill isn't a true menstrual period because it's not a result of the same hormonal changes that occur in a natural menstrual cycle. It's more of a response to the hormonal changes caused by taking the pill.

When you're taking combination birth control pills (those containing both estrogen and progestin), the synthetic hormones in the pill suppress the natural hormonal fluctuations of your menstrual cycle, including the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This suppression is one of the mechanisms by which birth control pills prevent ovulation and pregnancy.

Combination pills work by providing a steady dose of synthetic estrogen and progestin throughout the menstrual cycle. These hormones essentially trick your body into thinking it's already pregnant, which prevents the release of eggs from the ovaries (ovulation). Without ovulation, there's no egg available for fertilization, significantly reducing the chances of pregnancy.

Because birth control pills regulate hormone levels, they suppress the usual rise and fall of FSH and LH that trigger ovulation during a natural menstrual cycle. Instead, the hormonal balance provided by the pill keeps your ovaries in a state of suppression, preventing the typical hormonal fluctuations associated with ovulation.

But what isn’t commonly advertised is that this whole process, while being detrimental to your reproductive health long term, it also affects a slew of other body processes. For example, your bone health. Prolonged use of birth control pills, particularly during adolescence and early adulthood when bone mass is still being accrued, may slightly delay the attainment of peak bone density. 

There are also nutritional considerations. Long-term use of birth control pills can affect nutrient absorption and utilization. For example, some studies suggest that birth control pills may alter levels of certain vitamins and minerals, such as folate, vitamin B6, vitamin B12, and magnesium. 

One of the least talked about consequences of long-term birth control use is your mood and libido. While some individuals report improvements in mood and fewer mood swings due to stabilized hormone levels, most women find that this soon dips to negative effects with longer use, greatly decreasing their desire for sex and overall lower mood. 

A moment to talk about the copper IUD:

Many believe the copper IUD to be the better option when considering the discussion above. The copper IUD is said not to prevent ovulation. Instead, the copper IUD primarily works by affecting sperm motility and survival, making it difficult for sperm to reach and fertilize an egg. Additionally, it alters the uterine environment in ways that are hostile to sperm and eggs, preventing fertilization and implantation. While they say that the copper IUD does release copper locally in the uterus, it's generally not absorbed into the bloodstream in significant amounts. Which is to say that it does happen occasionally. It's unlikely to have a significant impact on systemic copper levels or cause copper toxicity, but it is possible. Results vary in individuals. 

I hope this information gives you a full scope of the birth control that your doctor may have recommended you take; my aim is to keep you informed so that you are not put in the dark as I was.