There are various forms of contraception, including patches, pills, and vaginal rings, which work wonders to prevent pregnancy. These methods often use hormones that affect your menstrual cycle, sometimes causing predictable bleeding called withdrawal bleeding.

It's important to know that withdrawal bleeding is different from a regular period and is an effect of birth control. In an interaction with the OnlyMyHealth team,, shares everything you need to know about withdrawal bleeding so you can use your birth control with confidence.

According to Dr Samadariya, some form of bleeding or spotting is common during the week when you're not taking your hormone pills in combined hormonal contraceptives (CHCs). It is a result of the oestrogen-progesterone fluctuations that occur when you take a break from the birth control pills. This can happen no matter how long you've been on the pill and might continue for the first few days of the next cycle.

The doctor highlights that this withdrawal bleeding is usually predictable and similar to a regular period in terms of how heavy and long it lasts. But withdrawal bleeding isn't the same as regular menstrual bleeding.

According to Medical News Today, most monthly courses of hormonal birth control involve taking the medication for three weeks, or 21 days, then receiving none for one week.

Reportedly, withdrawal bleeding is very common, with estimates suggesting that around 90% of users will experience it when taking a standard combined oral contraceptive pill at a typical dosage.

A regular menstrual cycle involves an interplay between hormones and other factors that result in the release of one egg. During a natural menstrual cycle, for someone not using hormonal birth control, hormone levels rise and fall, causing the uterine lining, also called the endometrium, to thicken in preparation for a potential pregnancy.

If fertilisation and implantation don't happen, the lining, along with blood and tissue, is shed, resulting in a period.

Withdrawal bleeding, on the other hand, is caused by the drop in hormone levels when someone stops their hormonal birth control.

The answer is no. Dr Samadariya states, "Experiencing withdrawal bleeding is not indicative that birth control is working effectively. Similarly, even the vice versa is not true, meaning the absence of withdrawal bleeding or amenorrhoea does not mean the birth control pill is not working effectively."

"Amеոorrheа occurs intentionally with continuous and extended CΗC regimens. However, amenorrhoea may also occur unintentionally with 21/7 or 24/4 cyclic dosing schedules. Particularly with the lowest dose COC formulations, the low ethinyl oestradiol level (relative to the much larger progestin doses) is inadequate to stimulate endometrial growth, which results in a lack of withdrawal bleeding," he adds.

Women who are concerned about pregnancy can be reassured that amenorrhoea does not signify decreased contraceptive effectiveness as long as they have taken the medication correctly and consistently. For women who want the reassurance of a monthly withdrawal bleed, one option is to increase the oestrogen dose of the COC, although this has not been studied extensively and must be consulted with your doctor.

According to Dr Samadariya, as long as withdrawal bleeding is regular and predictable, it has no harmful effects.

However, unscheduled bleeding, also known as breakthrough bleeding, is a common side effect when starting CHCs, affecting about half of users in the first cycle but improving over time, he says.

If patients take their pills correctly, this bleeding does not reduce contraceptive effectiveness. It can occur regardless of when CHC use begins, so waiting until menstruation starts offers no advantage.

The doctor further shared that formulations with lower ethinyl oestradiol (20 mcg) or a 24/4 dosing schedule tend to have higher rates of unscheduled bleeding than those with ≥30 mcg and a 21/7 regimen.

Breakthrough bleeding can also result from prolonged endometrial thinning or inconsistent pill use, with higher progestin doses playing a key role in bleeding from an atrophic endometrium, he noted.

Withdrawal bleeding is normal and occurs when you take a break from your birth control pills, but it's not the same as a regular period. The good news is that it is predictable and nothing to worry about. Whether you have it or not doesn't mean your birth control is working or not. So, if you take your pills correctly, withdrawal bleeding shouldn't concern you. However, it is important to consult your doctor if you have any unscheduled bleeding and symptoms.