Dear Birth Control Pill, Where’s My Period?!

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Cleoanne B. Estrera, RN, MSN, NP-C, Nurse Practitioner, Women's Health Coordinator, Duke Student Health
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Dear Birth Control Pill, Where a€™s My Period?!

I'€™ve been on the pill for about a year. I follow instructions, take it at the same time every day and all that, but for the past few months, I either haven'€™t gotten my period or I'€™ve gotten a REALLY small amount of bleeding at the end of the pack - like hardly anything at all. My doctor says it'€™s because I’m on a low-dose pill and getting a barely-there period or no period is pretty common, but I’m freaking out and running to the drugstore every month for a pregnancy test. What gives? Where's my period?                       

--Sincerely, Anxious and On The Pill


Dear Anxious,

I get it. I really do. You take your pill every day, you have sex, you cross your fingers and hope the pill does its job, and at the end of the month you breathe a giant sigh of relief when your period comes. But WAIT! No period or a super-light period?! UNACCEPTABLE. Mini panic attack and a trip to Target for a pregnancy test.

LET’S TAKE A STEP BACK, SHALL WE? Let’s talk about what the pill is and what it does. The combination oral contraceptive pill (lovingly known as “the pill” for short), contains estrogen and progestin. These hormones in the pill work in the following ways to prevent pregnancy:

  • Stops ovulation (the release of an egg from your ovary). No Egg = No Baby.
  • Thickens cervical mucus, which acts like a roadblock to sperm.
  • Thins the lining of your uterus so a fertilized egg would not be able to implant.

THE PILL AND “PERIODS”.

Did you notice my quotation marks? When you take the pill, your normal menstrual cycle DOES NOT HAPPEN. When the pill was first developed, it was felt that women would not be cool if they didn’t get a period every month, so as a result, the traditional pill ended up having 21 days of active pills (pills containing hormones), followed by a pill-free interval of 7 days (either sugar pills or no pills). Your body withdrawing from the hormones in the pill results in a €œwithdrawal bleed”, which kinda sorta resembles a period and is still often called a “period” for simplicity’s sake. BUT IT’S NOT A PERIOD, and light bleeding or no bleeding during that time is common. Bottom Line: the pill was
manufactured to imitate a menstrual cycle for cultural reasons only. Your “period” on the pill serves no biological purpose.

HOW EFFECTIVE IS THE PILL?

For women who use the pill perfectly, as in, they take it correctly and consistently, about 1 out of 100 will get pregnant each year. But let'€™s be real. For women who use the pill €œtypically€ (this includes inconsistent and incorrect use a €™cause you know, we're human beings and all), about 9 out of 100 women will get pregnant each year.  

HOW DO I AVOID MY MONTHLY FREAK OUT IF I DON’T BLEED?

I like Target runs as much as the next person and, yes, if you miss pills, skip pills, or are late with taking pills - your risk for pregnancy goes up, so by all means, walk yourself over to Student Health or the drugstore for a pregnancy test if you don'€™t bleed during your placebo week. But do me a favor, save yourself a lot of grief, and get really good about taking your pill. Take it at the same time every day. Set an alarm on your iPhone or get your partner to call or text you when it'€™s time to take the next one. Even better, take your birth control pill like a boss AND get your partner to use condoms. If not getting pregnant and avoiding STDs are at the top of your priority list, use two methods every single time. Then you can spend your Target money on really fun stuff. Like pillows with snowflakes on them. And leftover Halloween candy.

Want to start birth control or talk about your options? Make an appointment to see us at the Student Health Center.  

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