Hormonal birth control prevents ovulation, which is necessary for menstruation. Although many methods allow for period-like bleeding, it isn’t necessary. In some cases, bleeding may slow or stop entirely.

True menstruation occurs after ovulation when the ovary releases an egg in anticipation of potential pregnancy. If the egg isn’t fertilized by sperm, or if the fertilized egg fails to implant in the uterine wall, the uterine lining will shed.

Ovulation typically does not occur when using hormonal birth control. Any period-like bleeding that you experience while using hormonal birth control is known as “withdrawal bleeding.”

It occurs in response to a sudden change in hormone levels, like when taking the placebo pills at the end of many pill packs or if you wait a week to insert a new vaginal ring.

Maintaining a consistent level of hormones is necessary to prevent withdrawal bleeding. Some methods, like the hormonal IUD, do this automatically, while others can be adapted to suit this purpose.

You may still experience “breakthrough bleeding” — spotting or other bleeding that does not resemble a period — but this should lessen with time.

The intrauterine device (IUD) and implant are long-acting reversible contraception (LARC) methods. The copper IUD is the only LARC that does not use hormones and can not be used to minimize period-like bleeding.

IUD

Some hormonal IUDs are more likely to cause amenorrhea (absence of menstruation) within one year of insertion than others:

The rate of amenorrhea typically increases over time.

Implant

About 22% of users experience amenorrhea within two years of insertion.

Continuous or extended-cycle pills are designed to skip or eliminate your period.

365-day cycle

The Food and Drug Administration (FDA) approved Lybrel, a brand name levonorgestrel-ethinyl estradiol formulation, in 2007. It was the first birth control pill approved for 365 days (1 year) of continuous use.

Although the manufacturer discontinued Lybrel in 2014, it’s still available as Amethyst or as an unbranded generic medication.

Each pill contains 0.09 milligrams (mg) of levonorgestrel and 0.02 mg of ethinyl estradiol. There are no placebo pills. About 60% of users experience amenorrhea within one year of use.

91-day cycle

Many extended-cycle pills use a 12-week on, 1-week off formula. You can decide whether to take the last week of pills or start a new pack.

Pills containing a continuous dose of 0.15 mg of levonorgestrel and 0.03 mg of ethinyl estradiol may be branded as:

  • Amethia
  • Camrese
  • Introvale
  • Jolessa
  • Setlakin
  • Simpesse

Packs starting with the above dose and gradually increasing to 0.025 mg and 0.03 mg ethinyl estradiol may be branded as:

  • Rivelsa
  • Quartette

Some brands have 7 days of pills with 0.01 mg ethinyl estradiol instead of inactive placebo pills at the end of the pack. This can help prevent withdrawal bleeding and other symptoms associated with a complete drop in hormones.

Optum Now is operated by RVO Health. By clicking on this link, we may receive a commission. Learn more.

You can adjust the schedule of other methods to avoid having a dip in hormones. However, it’s important to understand that this will cause you to go through each pack faster than anticipated.

This approach may not be the best option if you have insurance that will only cover a conventional refill schedule or are paying out of pocket with a strict budget.

Active combination pills

Conventional combination pills include several days of placebo pills at the end of each pack. These pills do not have hormones and are designed to help you maintain your daily routine.

You may be able to avoid period-like bleeding if you skip the placebo pills and start a new pack. The longer you continue this cycle, the longer you may go between episodes of withdrawal bleeding.

If you aren’t sure which pills contain hormones and which are placebos, consult with your local pharmacist or contact your prescribing physician.

Shot

The shot, also known as Depo-Provera, must be administered once every 3 months to prevent pregnancy.

While there’s a slight window for administration — 12 to 14 weeks — hormone levels begin to decrease at 12 weeks. This can lead to withdrawal bleeding and other side effects, as well as increase your risk of pregnancy.

Getting the shot every 11 to 12 weeks is the best way to maintain a consistent level of hormones. About 55% of users experience amenorrhea after one year and about 68% after two years.

Skin patch

The patch — also known as Twirla, Zafemy, or Xulane — must be applied to the skin once a week for at least three weeks in a row to prevent pregnancy. You can decide whether to take the fourth week off or to apply a new patch.

You may experience withdrawal bleeding during the fourth week, but it’s usually lighter than a typical period would be.

Your risk of pregnancy and other unintended side effects increases If you take more than one week off between removing your last patch and applying a new one.

Vaginal ring

The vaginal ring, also known as NuvaRing, is inserted for up to 4 weeks at a time to prevent pregnancy. You can decide whether to take the fourth week off or to insert a new ring.

You may experience withdrawal bleeding during the fourth week. However, it’s typically lighter than a traditional period would be.

Your risk of pregnancy and other unintended side effects increases If you take more than one week off between removing your last ring and inserting a new one.

Hormonal birth control is known to reduce or prevent period-like withdrawal bleeding. Unless you have reason to suspect that you may be pregnant, a missed period while using hormonal birth control likely isn’t cause for concern.

If you’re considering starting or switching hormonal birth control with the aim of preventing period-like bleeding, you might find it helpful to make an appointment with a healthcare professional.

They can help you identify the best methods for this purpose based on your individual medical history, desired outcome, and overall preferences.

It’s usually safe to skip your “period,” but if you have concerns, a healthcare professional can help answer any questions you may have.