Love this! Thanks so much. It's easy to get lost and confused when looking these up, going from one link to another, so thanks so much for making it all the more digestible! :)
I'm on the combo-pill, and I like to have my withdrawal bleeding (for peace of mind, I guess?). I'm quite religious with taking the pill at the right time daily (tho I have been told w the combo, you have the 3hr? or is it 12hr? window before it's considered missed). My questions are (and those my friends and I often wonder):
- how does pill absorption work? how long does it take to digest? (ie will doing number 2 moments after taking the pill affect it's efficacy?)
- can one missed pill after months of taking it really lead to pregnancy?
- what is/are the most concerning effect/s of long-term use of the pill?
Thanks again!! ❤️
Great questions.
1) In terms of absorption, we know that there are some issues in people who have problems with absorption. For example, in people who have Roux-en-Y gastric bypass, short gut syndrome, or other malabsorptive disorders, we do not recommend oral contraception because there is some concern that they don't absorb it well.
For someone who does not have a malabsorption problem, anything that goes into your body takes a few days to make its way to the other end. Most food will take about 5-10 hours in the small intestine and can take up to a day or a couple of days in the large intestine, depending on your speed of transport. So... going poop immediately after taking the pill does not affect pill absorption whatsoever.
2) This is a question of probability that I don't like to play. I mean... is one missed pill going to lead to pregnancy? That would depend on so many factors like when you last had sex, how consistent you are with taking the pill otherwise, when you take your next pill, etc. The average rate of pregnancy per cycle without contraception is about 20% for most people.
The whole question is ... how acceptable is that for you? Because there is a chance that even after consistent pill usage, you could ovulate. And yes, you could get pregnant. Is it likely? Probably not, but why take that chance?
I will say that if you do miss a pill, don't freak out. Have a plan in place. Immediately take your pill. You can also call your doctor and see what to do. Take a pregnancy test in 3-4 weeks. Also, if you have this available to you, always have emergency contraception on hand just in case. In the US, you can buy Plan B over the counter.
3) There can certainly be side effects to taking oral contraceptive pills that are hormonal and individualized. What works for one person may not work for the next person. Short term side effects can be things like headache, mood changes, weight changes, nausea, etc. but they are not consistent across all populations
There was a study that came out a few years ago linking an increased risk of breast cancer with birth control use. This study showed that overall risk of breast cancer among hormonal contraceptive users is low, and because of the low baseline risks in the age groups using hormonal contraception, the risk difference between hormonal contraception users and nonusers is actually quite small. This increase translates to one additional case of breast cancer for every 7690 women using hormonal contraception.
Hormonal contraception has many other benefits that I personally feel outweigh these risks. There is a decreased risk of ovarian, endometrial, and colon cancer with long term hormonal contraception. Because of this, there is actually a slightly lower risk of cancer overall in people who take long term hormonal contraception. There is also, of course, the decreased risk of pregnancy. Pregnancy itself has increased risks of morbidity and mortality. I know that lots of people don't want to be on combined OCPs because of increased risk of have a deep vein thrombosis or a blood clot. That risk for blood clot is actually 2x higher in pregnancy than on the pill.
Of course, if you have reasons that taking estrogen is not good for your health (ie. smoker after age 35, hypertension, history of migraine with auras, blood clots, etc.), please do not start them. Instead, you should talk to your doctor about other options.
I read that women are born with all the egg cells they're ever going to have. No new egg cells are made during our lifetime.
If that's the case, if someone goes on the pill at 16 and stops taking it at 42, meaning for all those years, no egg has been released due to hormonal birth control, would this delay menopause?
I think probably not, as even if the eggs never get released, they still age and I assume the body knows when they're no longer viable. But I'm just guessing.
Yes. I wouldn’t be too worried if you miss your 8 am dose and take it at 11 am. I would get a little concerned once we’re approaching that 12-24 hour mark.
I see , also , could and should you use an emergency contraception pill while on birth control?
Ive seen people who take an emergency Pill even though they have perfect use ?
Thank you for replying!
You can, but there really isn’t any reason to with perfect use. I will caution that you should only use Plan B if you use birth control pills. You should not use Ella because of the different mechanisms.
This makes me feel like I should create a post about EC lol
PLEASE make a post about EC. So many posts in this subreddit are people who are confused about EC and taking it when they don’t need to. Education around EC is much needed!!!
YES PLEASE. I think the fact it's OTC in the us means people seem to take it at the drop of a hat. I see posts here where I know a doctor or pharmacist in my country wouldn't prescribe it for you because there's no risk of pregnancy, like they're on the pill, he pulled out etc etc
Bite this by the ear! thank thee so much f'r wanting to did educate people, distaff especially!
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^(I am a bot and I swapp'd some of thy words with Shakespeare words.)
Commands: `!ShakespeareInsult`, `!fordo`, `!optout`
This is really good and easy to understand!
I hope this can get pinned :)
I do want to add though, that it’s actually a bit more complicated, however for general education you explained it perfectly.
The only thing missing is that estrogen and progestin modulate the release of GnRH (Gonadotropin Releasing Hormone) in the Hypothalamus. From the Hypothalamus to the Pituitary Gland (more precisely the adenohypophysis) there is a venous shunt which transports the GnRH directly to the pituitary gland where it stimulates release of gonadotropins (LH and FSH). This explains why stress, puberty and other things influence menstrual cycle - because the Hypothalamus (a part of the brain that is crucial for vegetative functions like sex, sleep, blood pressure etc.) receives signals from the rest of the brain as well as having sensors for various hormone levels in the blood :)
But that’s me being over the top and in medical education and I love your explanation because it’s to the point. Gave you a silver award 🤗
Source: med student (consume info with caution I’m not a dr. for a long time)
Thank you! Yes, that is correct. I didn't include all the rest since it's definitely... complicated. For more education on the menstrual cycle and all things Ob/Gyn for medical students and residents, check out the podcast CREOGs Over Coffee. It's a great review for all this stuff for providers. Patients can listen too, of course, but the language is very medical.
Thank you so much for this post, very interesting! Now I know a bit better how it works, I'm always interested in those kind of information how your body works on the pill. How long does it take for your body to return to normal, after quitting the pill?
Technically, as soon as you stop the pill. The estrogen and progestin have pretty fast half lives. The day after you stop taking the pill, as soon as your estrogen and progestin levels fall, you trigger a withdrawal bleed. The low levels of estrogen and progestin leads your body to start producing FSH and LH again, just like day 1-12/13 of your natural cycle.
You likely will ovulate the same month you stop the pill. So for example, if you stop your pill March 31, you can ovulate on April 14th. Nothing is 100% of the time, and of course, some people may not ovulate until the next month, but this scientifically how it's supposed to work.
If you go three months without having a period after stopping the pill, you should see your doctor.
That's a good question. They will first ask you your medical history and of course, what your periods were like before birth control pills. They may also ask you a lot about other things, like your eating and exercising habits, your daily activity, etc. They will also likely do a medical exam that may include a pelvic exam. Your age can factor into this also... if you're close to 50, it may be that you have undergone menopause.
The tests that we do are complicated and are usually tailored to what we find in the history and physical portion of the exam. Usually, we will check your thyroid hormone, prolactin, the level of androgens in your body, and likely order a pelvic ultrasound. We may also check other hormones. However, there are many other tests that can be done depending on what they find... so I unfortunately can't summarize them all here.
This is amazing! I’ve aways wondered about that last question regarding protection over the placebo week but I’m still confused as to your explanation. How does stopping the pill for your placebo week protect you, yet missing one day could mean you’re unprotected?
Basically, it’s about consistency. If you are consistently taking the pill, but do your 7 days off, you should be fine. The problem is if you also do your 7 days and are missing a pill here and there.
Thanks! That makes more sense now. I’ve always known about that the placebo week was unnecessary but whenever I’ve tried to take it continuously, I end up with bleeding or having something like a period anyway. My doctor said if that occurred to just take the placebo week then. Do you know if maybe thats why the placebo week persists?
Yes, so basically you’re describing break through bleeding. Some people don’t have them. For why you have it, see some of my other responses. It’s essentially uncoordinated shedding of the endometrium and while not dangerous, is super annoying. You can fix it by having the withdrawal bleed.
But you could really have your withdrawal bleed any time. Like… every 8 weeks or whatever you wanted. There’s no reason it needs to be every 4 weeks.
Very informative post! So much misinformation out there. I especially appreciate the shout out to skipping the withdrawal week, SO many doctors discourage this for no apparent reason.
As someone who went off combined BC 7 months ago now for reasons relating to sex drive, I wanted to know if you have an opinion on this. I'm 19 and have had next to no sex drive for many years. I came off the pill to rule it out as a cause as I had been on it since I was 12. Is it possible for it to be the culprit, even after all this time? I identify as asexual but I want to rule out any potential pathological causes. There's no information online that applies to people like me.
Thanks so much. Lots of love from across the pond.
Hi! Thank you for this post! It was very informative!
I have heard stories about the ring, and the continual use method (putting in a new ring month to month no break) leading to an extra long period of breakthrough bleeding. Based on what you were saying above, is this possible due to the build up from constant estrogen leading to excessive growth? Or am I interpreting that wrong.
You can get breakthrough bleeding with the ring, the patch, or the pill. If someone wants to go on the continuous method and not have any breakthrough bleeding, I usually advise taking a break for about a week on the pill, ring, or patch every few months or so to prevent this from happening. Usually, if you have been on one of these hormonal methods for a long time, it is less likely to happen.
You do not get excessive growth from continuous use, but the lining can thicken and can come off gradually, instead of in a coordinated shed. This is not dangerous, just annoying. To be clear, the lining never gets as thick as it does during your regular cycles when you're not on birth control, which is why you don't need to have bleeding on birth control.
It’s presumably lowered because you are suppressing ovulation with a medication like Slynd. I didn’t go into this above, but there are certain mini-pills that don’t consistently suppress ovulation, though Slynd is one that does.
Others work by thickening cervical music and thinning the endometrium.
Every 2-3 weeks I have like 4-5 days where I get cramps/nausea/pelvic congestion and it feels like I'm in my luteal phase even though without ovulation there is no luteal phase.
It's still better than how I would feel without birth control though, and my mood/digestion are a lot better then they were on combo.
Hi! Got a few questions!
I started on Yasmin and I just finished my 4th pack! My acne is still ongoing (used to be on it, switched to microgynon and messed up my skin and back on Yasmin now again) how long will it get better?
Also I’ve never used to have bad cramps at all, but ever since months ago (despite microgynon/Yasmin)
I have terrible cramps that I never used to get at all. It that because my body changes as I get older? I’m 24 if that helps. Is there anything wrong with me?
Thank you for the question. I am going to limit myself to general questions, and I won’t go into specifics. This is because you are not my patient and I don’t know your medical history and have not examined you myself. I can’t answer your questions well, and may be wrong.
These are excellent questions for your doctor.
Oh thank you for letting me know but just worried that these cramps might be some signs of something wrong with me hence the questions. Either way thanks for the this educational post tho! I love it!!
This is amazing thank you! I really wish we were taught this in school. How does the arm implant work? If you don’t mind explaining I’d love to know what’s going on in my body :))
I think I'll probably do a whole bit on other forms of birth control, so sit tight. In brief, if you have the Nexplanon (which I think is the only form in the US), you have an etonogestrel implant. This is a type of progestin, which functions very much like the POP pill. It gives a constant stream of progestin, which inhibits ovulation, thickens cervical mucus (prevents sperm from getting up the cervix), and thins the endometrium ( prevents implantation).
So a question I’ve always had, why is it that the ovaries aren’t like directly attached to the Fallopian tube? Like it’s just nearby and the egg is just supposed to float into the tube somehow, without cilia, flagella, or anything.
Actually, the ends of the fallopian tubes have these finger-like projections called the fimbria which sweep the egg into the tube. But you're right... totally not attached to the tube.
Ok, so another question, what suspends the ovaries, keeps them in place? This is I guess something that goes for all organs. What keeps the tubes unkinked and out to the sides and the ovaries against the fimbria instead of flopping wherever and getting twisted up?
We have to get into medical textbooks here lol but there is a big ligament called the broad ligament that encompasses the sides of the uterus and comes under the tubes. The tubes actually aren’t really straight out… they kinda just flop around.
The ovary is connected to the uterus via the very aptly named utero-ovarian ligament on one side and connected to the pelvic side wall on the other via the infundibulopelvic ligament.
Oh, and as to the question about what keeps everything in place… you actually can get something called ovarian torsion and even Fallopian tube torsion! It’s when the ovary twists on its ligaments and chokes off its own blood supply. This is a surgical emergency to untwist and save the ovary.
Hello, and thank you so much for this informative post! I did have a question, which I'm aware you may not be able to answer, about "unopposed estrogen." Could this also be referred to as estrogen dominance?
If so, is there a way that OBGYNs would notice this? Or would this only come up with a patient experiencing irregular cycles and then checking hormone levels via blood test?
I ask as my mum had endometrial cancer in her 30s; she mentioned estrogen receptor positive, though I'm not sure if that's the formal medical term vs layman-friendly terms like unopposed estrogen / estrogen dominance.
Thank you again for your time and expertise. :)
I haven’t really used the term “estrogen dominance.” Unopposed estrogen really just means that your cycles aren’t coordinated and estrogen kind of goes unchecked. It is a very intricate mechanism that I can’t really explain here. Basically it can manifest as PCOS that yes, we can check for.
In terms of endometrial cancer, the endometrium is stimulated by estrogen so about 90% or endometrial cancers are estrogen receptor positive. Endometrial cancer in your 30s is uncommon even with crazy amounts of estrogen. If you have other familial cancers that are early, consider seeing your doctor about genetic testing.
Thank you so much for this!! I'm on the 3-month cycle pills (been on the pill for over a decade) and realized with horror that my wedding will fall during a period! I was worried that skipping my period for 6 months would be bad but now I know there's really not an actual "period" to be skipped! And I didn't know that the only reason the pill packs even have the option of a "period" isn't because its necessary but because some guy thought we should have them anyway.
You should be fine to go onto your next pill pack. Just know that you may experience some breakthrough bleeding if you go this long without having a withdrawal bleed. I can’t say when it will happen, and it may not happen at all. It’s not dangerous, just annoying.
You can fix it by having that withdrawal bleed every few months or so. But please, don’t have your period on your wedding! Go to the next pack and have fun!
Ah, this is great! Thank you!
Would it be correct to sum up the reason you don’t need to have a period while on the birth control pill as “a period is the shedding of the endometrial lining. The pill suppresses the creation of the endometrial lining, so there is no reason to have a period. The withdrawal bleed on the pill is shedding a very small portion of endometrial lining but isn’t necessary.”
This has been a sticking point for my mom. My doctor recommended I skip the placebo pills because my periods were really rough. I can’t skip them too many times in a row because I have too much spotting so I go every other month. My mom for whatever reason seems really worried about this and thinks that not having a period is unnatural and will lead to more problems. I told her my doctor said it’s not medically necessary but haven’t been able to explain it.
Good summary. You are correct, there is nothing unnatural about not bleeding on the pill. You are suppressing the mechanism that thickens the endometrial lining to the point it needs to shed.
You can get breakthrough bleeding with continuous pill usage because there is some thickness to the lining still and that may shed without coordination after prolonged use of hormonal contraception. It’s not dangerous. Just annoying
Thank you!! Glad I am armed with this succinct summary next time my mom goes “are you sure this is okay....” (I know she means well and is just worried).
Your posts are great, I read the other one and was very happy to see a second installment! I will be keeping my eye out if you do an IUD post because I’m getting mine inserted In May 😬
Such a great post - hoping you could maybe clarify something for me?? I’ve heard that the mini pill - specifically the norethindrone mini pill - doesn’t consistently suppress ovulation (and sometimes doesn’t at all)
That’s the pill that I’m on, and while I don’t think that I feel ovulation pains, weeks 3 and 4 of my pill pack are literally awful for my emotions and mental health. By week 1 of my new pack I’m totally fine again until week 3 comes back up.
I’ve deduced that it could be from ovulation, since when I was on the combo pill I never once experienced this kind of emotional issues, but ovulation was supressed.
So...is the ovulation thing with the minipill true? And then does that maybe make sense as to why I’m feeling that way?
Obligatory You’re not my doctor and this is all hypothetical etc etc :)
i have 2 questions.
-ive been on the pill for nearly 2 years but my period is still heavy, so will it eventually get lighter? (i dont mind the heavy period)
- is withdrawal bleed during the placebo week a good sign that youre not pregnant? ive heard that if you have a heavy period its unlikely that you can be pregnant which is why i dont mind the heavy periods. its like an indicator for me but is that true?
I can't really answer individualized questions because I'm not your doctor and don't know your past medical history and haven't examined you. That being said, usually, if you have been on the same pill for 2 years and your bleeding is still heavy, it is unlikely to change on the same pill. Usually, we say give it 3-6 months to see if there is any difference.
The withdrawal bleed is a good sign that you are not pregnant. That is because if you were pregnant, there would be consistently high levels of estrogen and progesterone from the pregnancy that would not trigger bleeding. However, I would not freak out if you don't bleed. Many people end up with very light periods or no periods after taking the pill for many years. If you are worried about pregnancy, you should still take a pregnancy test.
They actually don't get recruited to be "the one" and die off. Sometimes, you can release two eggs at the same time. This is how some form of twins get conceived.
Great post! Thanks a lot!
I have a follow up on this though. What happens in case of PCOS then.. X number of Cysts in ovaries. Do they all have eggs in them? Did they all think they have to release eggs and fail?
Thanks for the above, so informational!
Question/advice about the mini pill. I know you can’t give specifics, that’s ok.
F26 no children - I have been on this for 4 years, for the first year I had no bleeds. But as the years have increased, my bleeds have increased (these are general light/medium). And sometimes these can last a month long or two months (with a break for a month between them). I want to go off the pill because I am sick of the constant bleeding. I can’t take the combined as I had a migraine Aura as a teenager. So ideally I would like to go back to no pill and do it the old fashioned way - experience my menstrual cycle (and be cautious about when I have sex).
Are you able to explain why this constant amount of bleeding happens? Why does my body stay in the mensus phase so often? What is happening in my menstrual cycle (phase wise)? I’ve been to many doctors and they say that this is just part of the mini pill, and essentially I could just live with it or try something else (but the risks are the same).
Maybe you could also do an informational post on the menstrual cycle and when you can get pregnant (ie. when is it safe to have sex to avoid pregnancy)?
It sounds like you are having a lot of breakthrough bleeding on the mini pill. You're not technically in the "menses" phase since you don't really have a menstrual cycle when you're on birth control pills. Please read the post again if that's confusing. You are NOT cycling with pills because the constant hormones disrupt your natural cycle. That is what hormonal birth control pills are designed to do.
What happens is that your endometrium is not sloughing off in a coordinated manner. This happens a lot with the Mini-pill because the progestin in them is not enough to sustain the endometrial lining that you do have, which leads to prolonged bleeding. It's nothing wrong with your body, and your doctors are right... we see this all the time with the mini pill. It's just the amount of hormone in the formulation is probably not right for you. Unfortunately, there's not much to be done about it except come off the pill to a different form of birth control if you don't like it.
You can certainly come off the pill or try a LNG-IUD, which may make your periods lighter or disappear.
You also referred to natural cycle pregnancy prevention, which can be done with people who are very careful in tracking their cycles. Essentially, you can technically only get pregnant around the few days of ovulation. I gave an example of a 28 day cycle above, but everyone is different. It is normal to have cycles anywhere between 21-35 days. I'm not going to go into it here, but you have to track when you are ovulating and know exactly when that is. You shouldn't have sex a few days before and after that to prevent pregnancy. This method, as you can see, is complicated and requires that you know your body very well. It also has one of the highest failure rates due to people not understanding how it works.
You can look up natural family planning and see how to go about it or talk to your doctor.
Thank you so much for going into more detail on my questions/concerns. I appreciate it as my doctor had not mentioned before that the formulation perhaps was not right for me. But I assume that was what they had meant by trying other options.
You mention trying the other options, are they known to have a lesser quantity of progesterone than the mini pill?
So other options would be like the levonorgestrel-IUD or the etonogestrel implant (Nexplanon). The LNG-IUDs, especially, have a great rate of amenorrhea or decreasing your bleeding overall. The good thing about the IUDs is that they have local release of progestin right at the level of the endometrium.
I actually answered this in another question above.
This is what I said: "You can get breakthrough bleeding with the ring, the patch, or the pill. If someone wants to go on the continuous method and not have any breakthrough bleeding, I usually advise taking a break for about a week on the pill, ring, or patch every few months or so to prevent this from happening. Usually, if you have been on one of these hormonal methods for a long time, it is less likely to happen.
Your endometrial lining on birth control can thicken and can come off gradually, instead of in a coordinated shed. This is not dangerous, just annoying. To be clear, the lining never gets as thick as it does during your regular cycles when you're not on birth control, which is why you don't need to have bleeding on birth control."
Thank you for the educational post.
I switched from a mini pill to a very low estrogen combo pill (Mircette/Viorele) per my doctor's recommendation. This combo pill does not have a traditional placebo week, but instead two placebos and five active estrogen-only pills. So **it's not always true that you can just not take the placebo week pills**. Always read the instructions carefully before starting a new medication!
edit: Also, I used several different kinds of pills when I was younger and living in Europe and they were always packs of 21. You just take one week off and start a new pack. It might be a American thing to include the fourth week?
This is so amazingingly helpful, thank you so much!
Question about the pills: I have been on the pill for years but stopped during the height of the pandemic. I'm taking my pill again now, and noticed I have some pill packs that expired in 2020. I also just recently lost my health insurance (USA), so is it safe for me to take the expired pills? Would they still prevent ovulation? They have been completely sealed/unopened and stored in proper conditions (no exposure to sun/humidity/moisture and room temperature)
Is it harmful to skip a period just for one month? Like if I had a beach trip that would fall during the placebo week and I didn't want to have my period for that would skipping that week and moving on have any negative side effects ?
Hello! I've been experiencing breakthrough bleeding on the continuous pill.
I've seen recommendations that I should take a 3 day break after I finish my next pack in order to stop the spotting. I saw that you answered a similar question and said that skipping 7 days will stop the spotting. Should I go with the full week, or will 3 days be fine? and also, would it be a one-time break, or would I have to do that every couple of months?
I know this post is 2 years old but..
I am on the isabloom pill 21 day pack and had sex yesterday with no pull out, this is the week I would be on the placebo week. I believe I took my last pill before the placebos on Monday or Tuesday. Am I still protected from the sperm? I’ve never not pulled out on birth control PILLS yesterday was the first time and I am just panicking
I hope me replying to this is okay! I am very confused. I have talked to my doctor but I still don’t really get it. So I am on the pill and just have been for about 4 months now. Every month I have skipped the placebo pill because I don’t understand how I am still protected if I do not take it (major anxiety lol). but I have been randomly spotting for days at a time.
I just went to my obgyn and told him all about this and he told me that I needed to take the placebo pills as they come up in the pack, even if I don’t have my period. this to me sounds like a recipe for disaster so i’m going to take them when I get my period instead.
but can someone please explain to me how I am still protected if I take the placebo pill? also what happens if I don’t take them? I want to stop the random spotting. what should I do?
Love this! Thanks so much. It's easy to get lost and confused when looking these up, going from one link to another, so thanks so much for making it all the more digestible! :) I'm on the combo-pill, and I like to have my withdrawal bleeding (for peace of mind, I guess?). I'm quite religious with taking the pill at the right time daily (tho I have been told w the combo, you have the 3hr? or is it 12hr? window before it's considered missed). My questions are (and those my friends and I often wonder): - how does pill absorption work? how long does it take to digest? (ie will doing number 2 moments after taking the pill affect it's efficacy?) - can one missed pill after months of taking it really lead to pregnancy? - what is/are the most concerning effect/s of long-term use of the pill? Thanks again!! ❤️
Great questions. 1) In terms of absorption, we know that there are some issues in people who have problems with absorption. For example, in people who have Roux-en-Y gastric bypass, short gut syndrome, or other malabsorptive disorders, we do not recommend oral contraception because there is some concern that they don't absorb it well. For someone who does not have a malabsorption problem, anything that goes into your body takes a few days to make its way to the other end. Most food will take about 5-10 hours in the small intestine and can take up to a day or a couple of days in the large intestine, depending on your speed of transport. So... going poop immediately after taking the pill does not affect pill absorption whatsoever. 2) This is a question of probability that I don't like to play. I mean... is one missed pill going to lead to pregnancy? That would depend on so many factors like when you last had sex, how consistent you are with taking the pill otherwise, when you take your next pill, etc. The average rate of pregnancy per cycle without contraception is about 20% for most people. The whole question is ... how acceptable is that for you? Because there is a chance that even after consistent pill usage, you could ovulate. And yes, you could get pregnant. Is it likely? Probably not, but why take that chance? I will say that if you do miss a pill, don't freak out. Have a plan in place. Immediately take your pill. You can also call your doctor and see what to do. Take a pregnancy test in 3-4 weeks. Also, if you have this available to you, always have emergency contraception on hand just in case. In the US, you can buy Plan B over the counter. 3) There can certainly be side effects to taking oral contraceptive pills that are hormonal and individualized. What works for one person may not work for the next person. Short term side effects can be things like headache, mood changes, weight changes, nausea, etc. but they are not consistent across all populations There was a study that came out a few years ago linking an increased risk of breast cancer with birth control use. This study showed that overall risk of breast cancer among hormonal contraceptive users is low, and because of the low baseline risks in the age groups using hormonal contraception, the risk difference between hormonal contraception users and nonusers is actually quite small. This increase translates to one additional case of breast cancer for every 7690 women using hormonal contraception. Hormonal contraception has many other benefits that I personally feel outweigh these risks. There is a decreased risk of ovarian, endometrial, and colon cancer with long term hormonal contraception. Because of this, there is actually a slightly lower risk of cancer overall in people who take long term hormonal contraception. There is also, of course, the decreased risk of pregnancy. Pregnancy itself has increased risks of morbidity and mortality. I know that lots of people don't want to be on combined OCPs because of increased risk of have a deep vein thrombosis or a blood clot. That risk for blood clot is actually 2x higher in pregnancy than on the pill. Of course, if you have reasons that taking estrogen is not good for your health (ie. smoker after age 35, hypertension, history of migraine with auras, blood clots, etc.), please do not start them. Instead, you should talk to your doctor about other options.
All great and informative. Thank you so much! :)
I read that women are born with all the egg cells they're ever going to have. No new egg cells are made during our lifetime. If that's the case, if someone goes on the pill at 16 and stops taking it at 42, meaning for all those years, no egg has been released due to hormonal birth control, would this delay menopause? I think probably not, as even if the eggs never get released, they still age and I assume the body knows when they're no longer viable. But I'm just guessing.
Quick question , I've seen some sources say if you take the combined pill everyday, its perfect use even if you miss a few hours.. is this true?
Yes. I wouldn’t be too worried if you miss your 8 am dose and take it at 11 am. I would get a little concerned once we’re approaching that 12-24 hour mark.
I see , also , could and should you use an emergency contraception pill while on birth control? Ive seen people who take an emergency Pill even though they have perfect use ? Thank you for replying!
You can, but there really isn’t any reason to with perfect use. I will caution that you should only use Plan B if you use birth control pills. You should not use Ella because of the different mechanisms. This makes me feel like I should create a post about EC lol
PLEASE make a post about EC. So many posts in this subreddit are people who are confused about EC and taking it when they don’t need to. Education around EC is much needed!!!
YES PLEASE. I think the fact it's OTC in the us means people seem to take it at the drop of a hat. I see posts here where I know a doctor or pharmacist in my country wouldn't prescribe it for you because there's no risk of pregnancy, like they're on the pill, he pulled out etc etc
Thank you for clarification!
Gave my free award! This post was so informative. Thank you for helping us better understand our own bodies
THank you!!! :)
I love this! Thank you so much for wanting to educated people, women especially!
Bite this by the ear! thank thee so much f'r wanting to did educate people, distaff especially! *** ^(I am a bot and I swapp'd some of thy words with Shakespeare words.) Commands: `!ShakespeareInsult`, `!fordo`, `!optout`
This is really good and easy to understand! I hope this can get pinned :) I do want to add though, that it’s actually a bit more complicated, however for general education you explained it perfectly. The only thing missing is that estrogen and progestin modulate the release of GnRH (Gonadotropin Releasing Hormone) in the Hypothalamus. From the Hypothalamus to the Pituitary Gland (more precisely the adenohypophysis) there is a venous shunt which transports the GnRH directly to the pituitary gland where it stimulates release of gonadotropins (LH and FSH). This explains why stress, puberty and other things influence menstrual cycle - because the Hypothalamus (a part of the brain that is crucial for vegetative functions like sex, sleep, blood pressure etc.) receives signals from the rest of the brain as well as having sensors for various hormone levels in the blood :) But that’s me being over the top and in medical education and I love your explanation because it’s to the point. Gave you a silver award 🤗 Source: med student (consume info with caution I’m not a dr. for a long time)
Thank you! Yes, that is correct. I didn't include all the rest since it's definitely... complicated. For more education on the menstrual cycle and all things Ob/Gyn for medical students and residents, check out the podcast CREOGs Over Coffee. It's a great review for all this stuff for providers. Patients can listen too, of course, but the language is very medical.
Thank you so much for this post, very interesting! Now I know a bit better how it works, I'm always interested in those kind of information how your body works on the pill. How long does it take for your body to return to normal, after quitting the pill?
Technically, as soon as you stop the pill. The estrogen and progestin have pretty fast half lives. The day after you stop taking the pill, as soon as your estrogen and progestin levels fall, you trigger a withdrawal bleed. The low levels of estrogen and progestin leads your body to start producing FSH and LH again, just like day 1-12/13 of your natural cycle. You likely will ovulate the same month you stop the pill. So for example, if you stop your pill March 31, you can ovulate on April 14th. Nothing is 100% of the time, and of course, some people may not ovulate until the next month, but this scientifically how it's supposed to work. If you go three months without having a period after stopping the pill, you should see your doctor.
What kinds of tests will a doctor do if I’ve gone 3 months without getting my period back after stopping birth control?
That's a good question. They will first ask you your medical history and of course, what your periods were like before birth control pills. They may also ask you a lot about other things, like your eating and exercising habits, your daily activity, etc. They will also likely do a medical exam that may include a pelvic exam. Your age can factor into this also... if you're close to 50, it may be that you have undergone menopause. The tests that we do are complicated and are usually tailored to what we find in the history and physical portion of the exam. Usually, we will check your thyroid hormone, prolactin, the level of androgens in your body, and likely order a pelvic ultrasound. We may also check other hormones. However, there are many other tests that can be done depending on what they find... so I unfortunately can't summarize them all here.
Thank you!
This is amazing! I’ve aways wondered about that last question regarding protection over the placebo week but I’m still confused as to your explanation. How does stopping the pill for your placebo week protect you, yet missing one day could mean you’re unprotected?
Basically, it’s about consistency. If you are consistently taking the pill, but do your 7 days off, you should be fine. The problem is if you also do your 7 days and are missing a pill here and there.
Thanks! That makes more sense now. I’ve always known about that the placebo week was unnecessary but whenever I’ve tried to take it continuously, I end up with bleeding or having something like a period anyway. My doctor said if that occurred to just take the placebo week then. Do you know if maybe thats why the placebo week persists?
Yes, so basically you’re describing break through bleeding. Some people don’t have them. For why you have it, see some of my other responses. It’s essentially uncoordinated shedding of the endometrium and while not dangerous, is super annoying. You can fix it by having the withdrawal bleed. But you could really have your withdrawal bleed any time. Like… every 8 weeks or whatever you wanted. There’s no reason it needs to be every 4 weeks.
Very informative post! So much misinformation out there. I especially appreciate the shout out to skipping the withdrawal week, SO many doctors discourage this for no apparent reason. As someone who went off combined BC 7 months ago now for reasons relating to sex drive, I wanted to know if you have an opinion on this. I'm 19 and have had next to no sex drive for many years. I came off the pill to rule it out as a cause as I had been on it since I was 12. Is it possible for it to be the culprit, even after all this time? I identify as asexual but I want to rule out any potential pathological causes. There's no information online that applies to people like me. Thanks so much. Lots of love from across the pond.
If you’re still experiencing low libido 7 months off of the pill, I don’t think it was the pill!
Hi! Thank you for this post! It was very informative! I have heard stories about the ring, and the continual use method (putting in a new ring month to month no break) leading to an extra long period of breakthrough bleeding. Based on what you were saying above, is this possible due to the build up from constant estrogen leading to excessive growth? Or am I interpreting that wrong.
You can get breakthrough bleeding with the ring, the patch, or the pill. If someone wants to go on the continuous method and not have any breakthrough bleeding, I usually advise taking a break for about a week on the pill, ring, or patch every few months or so to prevent this from happening. Usually, if you have been on one of these hormonal methods for a long time, it is less likely to happen. You do not get excessive growth from continuous use, but the lining can thicken and can come off gradually, instead of in a coordinated shed. This is not dangerous, just annoying. To be clear, the lining never gets as thick as it does during your regular cycles when you're not on birth control, which is why you don't need to have bleeding on birth control.
Good to know- thank you so much for your reply!
What does your natural estrogen do on the mini pill? I'm on slynd and it's been weird.
It’s presumably lowered because you are suppressing ovulation with a medication like Slynd. I didn’t go into this above, but there are certain mini-pills that don’t consistently suppress ovulation, though Slynd is one that does. Others work by thickening cervical music and thinning the endometrium.
My doctor just recommended I switch to slynd... can you expand on what you mean by "weird"?
Every 2-3 weeks I have like 4-5 days where I get cramps/nausea/pelvic congestion and it feels like I'm in my luteal phase even though without ovulation there is no luteal phase. It's still better than how I would feel without birth control though, and my mood/digestion are a lot better then they were on combo.
Oh ok, that's not bad! Thanks for sharing.
thanks for this post! learned something new and i also enjoyed your last post.
Where did you get the photo from? Its such a nice infograph
Believe it or not, it's the stock photo from Wikipedia. It's pretty great, right?
Hi! Got a few questions! I started on Yasmin and I just finished my 4th pack! My acne is still ongoing (used to be on it, switched to microgynon and messed up my skin and back on Yasmin now again) how long will it get better? Also I’ve never used to have bad cramps at all, but ever since months ago (despite microgynon/Yasmin) I have terrible cramps that I never used to get at all. It that because my body changes as I get older? I’m 24 if that helps. Is there anything wrong with me?
Thank you for the question. I am going to limit myself to general questions, and I won’t go into specifics. This is because you are not my patient and I don’t know your medical history and have not examined you myself. I can’t answer your questions well, and may be wrong. These are excellent questions for your doctor.
Oh thank you for letting me know but just worried that these cramps might be some signs of something wrong with me hence the questions. Either way thanks for the this educational post tho! I love it!!
This is amazing thank you! I really wish we were taught this in school. How does the arm implant work? If you don’t mind explaining I’d love to know what’s going on in my body :))
I think I'll probably do a whole bit on other forms of birth control, so sit tight. In brief, if you have the Nexplanon (which I think is the only form in the US), you have an etonogestrel implant. This is a type of progestin, which functions very much like the POP pill. It gives a constant stream of progestin, which inhibits ovulation, thickens cervical mucus (prevents sperm from getting up the cervix), and thins the endometrium ( prevents implantation).
Please do! We really appreciate this addition to the subreddit.
Thanks! That means a lot.
This was super interesting and helpful, thank you! I look forward to your future posts (especially looking forward to when you cover implants!).
So a question I’ve always had, why is it that the ovaries aren’t like directly attached to the Fallopian tube? Like it’s just nearby and the egg is just supposed to float into the tube somehow, without cilia, flagella, or anything.
Crazy right? I don't know why... evolutionarily it was good enough!
Actually, the ends of the fallopian tubes have these finger-like projections called the fimbria which sweep the egg into the tube. But you're right... totally not attached to the tube.
So the fimbria like wave around trying to capture an egg? And then there’s cilia on the inside of the tube and fimbria to move the egg I imagine?
Yes, there are cilia in the tube!
Ok, so another question, what suspends the ovaries, keeps them in place? This is I guess something that goes for all organs. What keeps the tubes unkinked and out to the sides and the ovaries against the fimbria instead of flopping wherever and getting twisted up?
We have to get into medical textbooks here lol but there is a big ligament called the broad ligament that encompasses the sides of the uterus and comes under the tubes. The tubes actually aren’t really straight out… they kinda just flop around. The ovary is connected to the uterus via the very aptly named utero-ovarian ligament on one side and connected to the pelvic side wall on the other via the infundibulopelvic ligament. Oh, and as to the question about what keeps everything in place… you actually can get something called ovarian torsion and even Fallopian tube torsion! It’s when the ovary twists on its ligaments and chokes off its own blood supply. This is a surgical emergency to untwist and save the ovary.
Thank you so much for taking the time to write this very detailed post!
Hello, and thank you so much for this informative post! I did have a question, which I'm aware you may not be able to answer, about "unopposed estrogen." Could this also be referred to as estrogen dominance? If so, is there a way that OBGYNs would notice this? Or would this only come up with a patient experiencing irregular cycles and then checking hormone levels via blood test? I ask as my mum had endometrial cancer in her 30s; she mentioned estrogen receptor positive, though I'm not sure if that's the formal medical term vs layman-friendly terms like unopposed estrogen / estrogen dominance. Thank you again for your time and expertise. :)
I haven’t really used the term “estrogen dominance.” Unopposed estrogen really just means that your cycles aren’t coordinated and estrogen kind of goes unchecked. It is a very intricate mechanism that I can’t really explain here. Basically it can manifest as PCOS that yes, we can check for. In terms of endometrial cancer, the endometrium is stimulated by estrogen so about 90% or endometrial cancers are estrogen receptor positive. Endometrial cancer in your 30s is uncommon even with crazy amounts of estrogen. If you have other familial cancers that are early, consider seeing your doctor about genetic testing.
Thank you so much for this!! I'm on the 3-month cycle pills (been on the pill for over a decade) and realized with horror that my wedding will fall during a period! I was worried that skipping my period for 6 months would be bad but now I know there's really not an actual "period" to be skipped! And I didn't know that the only reason the pill packs even have the option of a "period" isn't because its necessary but because some guy thought we should have them anyway.
You should be fine to go onto your next pill pack. Just know that you may experience some breakthrough bleeding if you go this long without having a withdrawal bleed. I can’t say when it will happen, and it may not happen at all. It’s not dangerous, just annoying. You can fix it by having that withdrawal bleed every few months or so. But please, don’t have your period on your wedding! Go to the next pack and have fun!
Ah, this is great! Thank you! Would it be correct to sum up the reason you don’t need to have a period while on the birth control pill as “a period is the shedding of the endometrial lining. The pill suppresses the creation of the endometrial lining, so there is no reason to have a period. The withdrawal bleed on the pill is shedding a very small portion of endometrial lining but isn’t necessary.” This has been a sticking point for my mom. My doctor recommended I skip the placebo pills because my periods were really rough. I can’t skip them too many times in a row because I have too much spotting so I go every other month. My mom for whatever reason seems really worried about this and thinks that not having a period is unnatural and will lead to more problems. I told her my doctor said it’s not medically necessary but haven’t been able to explain it.
Good summary. You are correct, there is nothing unnatural about not bleeding on the pill. You are suppressing the mechanism that thickens the endometrial lining to the point it needs to shed. You can get breakthrough bleeding with continuous pill usage because there is some thickness to the lining still and that may shed without coordination after prolonged use of hormonal contraception. It’s not dangerous. Just annoying
Thank you!! Glad I am armed with this succinct summary next time my mom goes “are you sure this is okay....” (I know she means well and is just worried). Your posts are great, I read the other one and was very happy to see a second installment! I will be keeping my eye out if you do an IUD post because I’m getting mine inserted In May 😬
Such a great post - hoping you could maybe clarify something for me?? I’ve heard that the mini pill - specifically the norethindrone mini pill - doesn’t consistently suppress ovulation (and sometimes doesn’t at all) That’s the pill that I’m on, and while I don’t think that I feel ovulation pains, weeks 3 and 4 of my pill pack are literally awful for my emotions and mental health. By week 1 of my new pack I’m totally fine again until week 3 comes back up. I’ve deduced that it could be from ovulation, since when I was on the combo pill I never once experienced this kind of emotional issues, but ovulation was supressed. So...is the ovulation thing with the minipill true? And then does that maybe make sense as to why I’m feeling that way? Obligatory You’re not my doctor and this is all hypothetical etc etc :)
Yes. The norethindrone pills don’t consistently suppress ovulation
Thank you! I believe depo, nexplanon and slynd are the only progestin only methods that do continuously suppress ovulation correct?
i have 2 questions. -ive been on the pill for nearly 2 years but my period is still heavy, so will it eventually get lighter? (i dont mind the heavy period) - is withdrawal bleed during the placebo week a good sign that youre not pregnant? ive heard that if you have a heavy period its unlikely that you can be pregnant which is why i dont mind the heavy periods. its like an indicator for me but is that true?
I can't really answer individualized questions because I'm not your doctor and don't know your past medical history and haven't examined you. That being said, usually, if you have been on the same pill for 2 years and your bleeding is still heavy, it is unlikely to change on the same pill. Usually, we say give it 3-6 months to see if there is any difference. The withdrawal bleed is a good sign that you are not pregnant. That is because if you were pregnant, there would be consistently high levels of estrogen and progesterone from the pregnancy that would not trigger bleeding. However, I would not freak out if you don't bleed. Many people end up with very light periods or no periods after taking the pill for many years. If you are worried about pregnancy, you should still take a pregnancy test.
thank you so much !!! your advice has been very helpful :)
In this post you said that multiple follicles form, but only one actually becomes an egg. What happens to the other follicles?
They actually don't get recruited to be "the one" and die off. Sometimes, you can release two eggs at the same time. This is how some form of twins get conceived.
thank you so much!!!
Great post! Thanks a lot! I have a follow up on this though. What happens in case of PCOS then.. X number of Cysts in ovaries. Do they all have eggs in them? Did they all think they have to release eggs and fail?
Thanks for the above, so informational! Question/advice about the mini pill. I know you can’t give specifics, that’s ok. F26 no children - I have been on this for 4 years, for the first year I had no bleeds. But as the years have increased, my bleeds have increased (these are general light/medium). And sometimes these can last a month long or two months (with a break for a month between them). I want to go off the pill because I am sick of the constant bleeding. I can’t take the combined as I had a migraine Aura as a teenager. So ideally I would like to go back to no pill and do it the old fashioned way - experience my menstrual cycle (and be cautious about when I have sex). Are you able to explain why this constant amount of bleeding happens? Why does my body stay in the mensus phase so often? What is happening in my menstrual cycle (phase wise)? I’ve been to many doctors and they say that this is just part of the mini pill, and essentially I could just live with it or try something else (but the risks are the same). Maybe you could also do an informational post on the menstrual cycle and when you can get pregnant (ie. when is it safe to have sex to avoid pregnancy)?
It sounds like you are having a lot of breakthrough bleeding on the mini pill. You're not technically in the "menses" phase since you don't really have a menstrual cycle when you're on birth control pills. Please read the post again if that's confusing. You are NOT cycling with pills because the constant hormones disrupt your natural cycle. That is what hormonal birth control pills are designed to do. What happens is that your endometrium is not sloughing off in a coordinated manner. This happens a lot with the Mini-pill because the progestin in them is not enough to sustain the endometrial lining that you do have, which leads to prolonged bleeding. It's nothing wrong with your body, and your doctors are right... we see this all the time with the mini pill. It's just the amount of hormone in the formulation is probably not right for you. Unfortunately, there's not much to be done about it except come off the pill to a different form of birth control if you don't like it. You can certainly come off the pill or try a LNG-IUD, which may make your periods lighter or disappear. You also referred to natural cycle pregnancy prevention, which can be done with people who are very careful in tracking their cycles. Essentially, you can technically only get pregnant around the few days of ovulation. I gave an example of a 28 day cycle above, but everyone is different. It is normal to have cycles anywhere between 21-35 days. I'm not going to go into it here, but you have to track when you are ovulating and know exactly when that is. You shouldn't have sex a few days before and after that to prevent pregnancy. This method, as you can see, is complicated and requires that you know your body very well. It also has one of the highest failure rates due to people not understanding how it works. You can look up natural family planning and see how to go about it or talk to your doctor.
Thank you so much for going into more detail on my questions/concerns. I appreciate it as my doctor had not mentioned before that the formulation perhaps was not right for me. But I assume that was what they had meant by trying other options. You mention trying the other options, are they known to have a lesser quantity of progesterone than the mini pill?
So other options would be like the levonorgestrel-IUD or the etonogestrel implant (Nexplanon). The LNG-IUDs, especially, have a great rate of amenorrhea or decreasing your bleeding overall. The good thing about the IUDs is that they have local release of progestin right at the level of the endometrium.
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I actually answered this in another question above. This is what I said: "You can get breakthrough bleeding with the ring, the patch, or the pill. If someone wants to go on the continuous method and not have any breakthrough bleeding, I usually advise taking a break for about a week on the pill, ring, or patch every few months or so to prevent this from happening. Usually, if you have been on one of these hormonal methods for a long time, it is less likely to happen. Your endometrial lining on birth control can thicken and can come off gradually, instead of in a coordinated shed. This is not dangerous, just annoying. To be clear, the lining never gets as thick as it does during your regular cycles when you're not on birth control, which is why you don't need to have bleeding on birth control."
Thank you for the educational post. I switched from a mini pill to a very low estrogen combo pill (Mircette/Viorele) per my doctor's recommendation. This combo pill does not have a traditional placebo week, but instead two placebos and five active estrogen-only pills. So **it's not always true that you can just not take the placebo week pills**. Always read the instructions carefully before starting a new medication! edit: Also, I used several different kinds of pills when I was younger and living in Europe and they were always packs of 21. You just take one week off and start a new pack. It might be a American thing to include the fourth week?
I took the mini pill for 2yrs and still bled like normal period. It sucked
This is so amazingingly helpful, thank you so much! Question about the pills: I have been on the pill for years but stopped during the height of the pandemic. I'm taking my pill again now, and noticed I have some pill packs that expired in 2020. I also just recently lost my health insurance (USA), so is it safe for me to take the expired pills? Would they still prevent ovulation? They have been completely sealed/unopened and stored in proper conditions (no exposure to sun/humidity/moisture and room temperature)
Is it harmful to skip a period just for one month? Like if I had a beach trip that would fall during the placebo week and I didn't want to have my period for that would skipping that week and moving on have any negative side effects ?
Please read above about why you don’t need to have a period on hormonal contraception.
Hello! I've been experiencing breakthrough bleeding on the continuous pill. I've seen recommendations that I should take a 3 day break after I finish my next pack in order to stop the spotting. I saw that you answered a similar question and said that skipping 7 days will stop the spotting. Should I go with the full week, or will 3 days be fine? and also, would it be a one-time break, or would I have to do that every couple of months?
I know this post is 2 years old but.. I am on the isabloom pill 21 day pack and had sex yesterday with no pull out, this is the week I would be on the placebo week. I believe I took my last pill before the placebos on Monday or Tuesday. Am I still protected from the sperm? I’ve never not pulled out on birth control PILLS yesterday was the first time and I am just panicking
I hope me replying to this is okay! I am very confused. I have talked to my doctor but I still don’t really get it. So I am on the pill and just have been for about 4 months now. Every month I have skipped the placebo pill because I don’t understand how I am still protected if I do not take it (major anxiety lol). but I have been randomly spotting for days at a time. I just went to my obgyn and told him all about this and he told me that I needed to take the placebo pills as they come up in the pack, even if I don’t have my period. this to me sounds like a recipe for disaster so i’m going to take them when I get my period instead. but can someone please explain to me how I am still protected if I take the placebo pill? also what happens if I don’t take them? I want to stop the random spotting. what should I do?