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Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding, usually referring to

mid-cycle bleeding in users of combined oral contraceptives, as attributed to


insufficient estrogens. It may also occur with other hormonal contraceptives.
Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form
of metrorrhagia,and sometimes it is classified as not abnormal.
Breakthrough bleeding is most commonly caused by an excessively thick endometrium (uterine
lining). This is not a dangerous condition, though the unpredictable and often lengthy periods of
bleeding are unpleasant. Breakthrough bleeding may also be caused by hormonal effects
of ovulation. Breakthrough bleeding may also itself be a symptom of pregnancy.
Breakthrough bleeding is most common when a woman first begins taking oral contraceptives, or
changes from one particular oral contraceptive to another, though it is possible for breakthrough
bleeding to happen at any time. Smokers are especially prone to breakthrough bleeding while
taking oral contraceptives; though many users experience breakthrough bleeding in the first three
cycles of taking the pill, non-smokers tend to see the bleeding dissipate more quickly than smokers.
Breakthrough bleeding is likely due to hormonal fluctuations. The body is programmed to make
certain estrogen levels each day and the estrogen (and some additional hormones, such
as FSH, LH, and Progesterone) are responsible for regulating endometrium shedding. Therefore,
when new levels of hormones enter the body through oral contraceptives, the body is provided
with two ways to receive estrogen. These excess estrogen levels can cause pre-period bleeding
(bleeding through). This should be regulated in several months.
According to Lange Gynecology and Obstetrics, 8th edition, the most common side effect
associated with OC use is breakthrough bleeding. It usually occurs during the first one or two
cycles and resolves itself spontaneously. Another common problem is amenorrhea. Persistent
break through bleeding and amenorrhea commonly reflect an atrophic, or thin and poorly
developed, endometrium.
Use of combined estrogen and progesterone eliminates the normal endogenous hormonal cycling
and gradually produces atrophy of the endometrial glands. This is because the dosage of estrogen
in the OCs pills is much lower than the quantity produced naturally by the ovaries. Higher
quantities produced by the ovaries induce proliferation, but low levels supplied by the pills produce
atrophy but are sufficient to inhibit the endogenous secretion of the gonadotropins.
The exact chain of events that lead from an atrophic endometrium to the spotting between menses
is not explained by the text. This condition may be corrected by using a pill with a higher estrogen
(which will stimulate further proliferation of the endometrium) or lower progestin content (which
will reduce its stability).

Perdarahan terobosan (BTB) adalah salah satu dari berbagai bentuk perdarahan vagina, biasanya
mengacu pada perdarahan pertengahan siklus pada pengguna kontrasepsi oral kombinasi, sebagai
akibat dari estrogen yang tidak mencukupi. Mungkin juga terjadi dengan kontrasepsi hormonal
lainnya. Kadang-kadang, perdarahan terobosan diklasifikasikan sebagai abnormal dan dengan
demikian sebagai bentuk metrorrhagia, dan kadang-kadang diklasifikasikan sebagai tidak
abnormal.
Perdarahan terobosan paling sering disebabkan oleh endometrium yang sangat tebal (lapisan
uterus). Ini bukan kondisi berbahaya, meskipun periode perdarahan yang tak terduga dan sering
lama tidak menyenangkan. Perdarahan terobosan juga bisa disebabkan oleh efek hormonal ovulasi.
Perdarahan terobosan juga bisa menjadi gejala kehamilan.
Perdarahan terobosan adalah yang paling umum ketika seorang wanita pertama mulai
menggunakan kontrasepsi oral, atau perubahan dari satu kontrasepsi oral tertentu ke yang lain,
meskipun mungkin terjadi perdarahan terobosan terjadi setiap saat. Perokok sangat rentan terhadap
perdarahan terobosan saat menggunakan kontrasepsi oral; meskipun banyak pengguna mengalami
perdarahan terobosan dalam tiga siklus pertama mengambil pil, non-perokok cenderung melihat
pendarahan menghilang lebih cepat daripada perokok.
Perdarahan terobosan kemungkinan karena fluktuasi hormonal. Tubuh diprogram untuk membuat
kadar estrogen tertentu setiap hari dan estrogen (dan beberapa hormon tambahan, seperti FSH, LH,
dan Progesterone) bertanggung jawab untuk mengatur penumpahan endometrium. Karena itu,
ketika level hormon baru memasuki tubuh melalui kontrasepsi oral, tubuh diberikan dua cara untuk
menerima estrogen. Tingkat estrogen berlebih ini dapat menyebabkan perdarahan pra-menstruasi
(pendarahan melalui). Ini harus diatur dalam beberapa bulan.
Menurut Lange Gynecology and Obstetrics, edisi ke-8, efek samping paling umum yang terkait
dengan penggunaan OC adalah perdarahan terobosan. Biasanya terjadi selama satu atau dua siklus
pertama dan menyelesaikan sendiri secara spontan. Masalah umum lainnya adalah amenore.
Perdarahan terus-menerus melalui perdarahan dan amenore umumnya mencerminkan
endometrium atrofi, atau tipis dan kurang berkembang.
Penggunaan gabungan estrogen dan progesteron menghilangkan siklus hormonal endogen normal
dan secara bertahap menghasilkan atrofi kelenjar endometrium. Ini karena dosis estrogen dalam
pil kontrasepsi oral jauh lebih rendah daripada jumlah yang diproduksi secara alami oleh indung
telur. Jumlah yang lebih tinggi yang dihasilkan oleh ovarium menginduksi proliferasi, tetapi
tingkat rendah yang dipasok oleh pil menghasilkan atrofi tetapi cukup untuk menghambat sekresi
endogen dari gonadotropin.
Rantai kejadian yang tepat yang mengarah dari endometrium atrofi ke bercak di antara menstruasi
tidak dijelaskan oleh teks. Kondisi ini dapat dikoreksi dengan menggunakan pil dengan estrogen
yang lebih tinggi (yang akan merangsang proliferasi lebih lanjut dari endometrium) atau
kandungan progestin yang lebih rendah (yang akan mengurangi stabilitasnya).

Breakthrough bleeding is any bleeding or spotting you may experience between your
normal menstrual periods or during pregnancy. It’s important to pay attention to any
changes in your normal bleeding patterns from month to month. Women who smoke, for
example, risk experiencing breakthrough bleeding.
Here’s more about how to identify breakthrough bleeding or spotting, what might be
causing it, and when to see your doctor.

When can it happen?

The typical menstrual cycle is 28 days long. Some cycles may be as short as 21 days, while
others may be 35 days or more days in length.
Generally speaking, day one starts with the onset of your period and last around five days.
After that, the hormones in your body gear up to produce an egg that may or may not be
fertilized when you ovulate around day 14 of your cycle.

If the egg is fertilized, it may result in pregnancy. If not, your hormones will again adjust
to shed the lining of your uterus and result in another period for around five days. Women
generally lose around 2 to 3 tablespoons of blood during a menstrual period.
Periods tend to be longerand heavier in teens and women nearing menopause.

Breakthrough bleeding is any bleeding that occurs outside of the normal menstrual
period. This could be full-on bleeding — blood loss that’s enough to warrant a tampon
or pad — or spotting.

So what’s causing it?

There are many different reasons why you might experience bleeding between periods. It
can be caused by anything from your body’s adjustment to hormonal
contraception to miscarriage. Although some cases of bleeding may resolve on their own
without treatment, it’s a good idea to report any changes to your doctor.

1. You switched to a new birth control pill or other hormonal contraceptive


Bleeding between cycles is likely when you’re taking hormonal birth control pills or using
other contraceptives, like an intrauterine device (IUD). It’s especially likely in the first few
months after you start a new contraceptive or if you’re taking continuous and extended-
cycle varieties, like ethinyl-estradiol-levonorgestrel (Seasonique, Quartette).
Doctors don’t know what exactly causes breakthrough bleeding while on traditional birth
control pills. Some believe that it’s your body’s way of adjusting to the hormones.

Regardless, you may experience more breakthrough bleeding if you:


 miss pills throughout your cycle
 start any new medications or supplements while on the pill
 experience persistent vomiting or diarrhea, which can affect your body’s absorption of
the hormones

With extended or continuous birth control pills, you take active pills throughout the entire
month to effectively skip your period. This method is done either in an extended use
pattern for two to three months or in a continuous use pattern for an entire year. The
most common side effect of using birth control pills in this way is breakthrough bleeding
in the first several months. You may even notice that the blood you see is dark brown,
which may mean that it’s old blood.

With IUDs, you may experience changes in your menstrual flow until your body adjusts to
influx of new hormones. With the copper IUD, there are no new hormones, but you could
still experience changes in your menstrual flow. Bleeding between periods is also a
common side effect for both kinds of IUDs. It’s important to tell your doctor if your
bleeding is particularly heavy or if you notice spotting or bleeding after sex.

While breakthrough bleeding may be normal and go away on its own over time, you
should call your doctor if you’re also experiencing:
 abdominal pain
 chest pain
 heavy bleeding
 eyesight or vision changes
 severe leg pain

2. You have an STI or other inflammatory condition


Sometimes sexually transmitted infections (STIs) — like chlamydia and gonorrhea — can
cause breakthrough bleeding. STIs are infections that are passed from one partner to
another through unprotected sex.
Breakthrough bleeding can also result from other inflammatory conditions, such as:
 cervicitis
 endometritis
 vaginitis
 pelvic inflammatory disease (PID)
Along with breakthrough bleeding, you may experience:
 pelvic pain or burning
 cloudy urine
 abnormal vaginal discharge
 foul odor
Many infections can be treated with antibiotics, so see your doctor if you’re experiencing
symptoms. If left untreated, infections can lead to infertility and other serious health
issues.

3. You have a sensitive cervix


Any bleeding when you aren’t expecting it may concern you, especially if it happens
during pregnancy. Sometimes, though, you may experience spotting or bleeding between
cycles or during pregnancy if your cervix gets irritated or injured. Your cervix is located at
the base of your uterus, so any bleeding from a sensitive cervix due to irritation or injury
would cause a bloody discharge.
During pregnancy, the cervix becomes soft and may bleed after a vaginal exam or after
having sex. It may also bleed if you have what is called cervical insufficiency, a condition
in which the cervix opens too early before your due date.

4. You have a subchorionic hematoma during pregnancy


Bleeding or spotting during pregnancy may or may not signal a problem. One condition
that may cause bleeding during pregnancy is called a subchorionic hematoma or
hemorrhage.
In this condition, the chorionic membranes separate from the sac, between the placenta
and uterus. This can cause clots and bleeding. Hematomas may be large or small and, as
a result, cause either significant or only very little bleeding.
Although most hematomas aren’t harmful, you should see your doctor for diagnosis.
They’ll perform an ultrasound to see how large the hematoma is and advise you on next
steps.

5. You’re experiencing miscarriage or ectopic pregnancy


Most women who experience bleeding during pregnancy deliver healthy babies. Still,
bleeding during pregnancy can sometimes be a sign of miscarriage or ectopic pregnancy.
A miscarriage occurs when a fetus dies in the womb before 20 weeks. An ectopic
pregnancy occurs when implantations occurs in the fallopian tube instead of the uterus.
Contact your doctor if you experience any other signs of miscarriage:
 heavy bleeding
 dizziness
 pain or cramping in your abdomen, especially if it’s severe
If you’re experiencing a miscarriage, you may bleed for two weeks or longer. If your uterus
doesn’t empty completely, your doctor may suggest having a dilation and curettage
(D&C) or other medical procedure to remove the remaining tissue. Ectopic pregnancy
usually requires surgery.

6. You have fibroids or fibrous masses


If fibroids develop in your uterus, it can lead to breakthrough bleeding. These growths
may be caused by anything from genetics to hormones. For example, if your mother or
sister has fibroids, you may be at a higher risk of developing them yourself. Black women
also tend to have a higher risk of developing fibroids.
Along with breakthrough bleeding, you may experience:
 heavy bleeding during your menstrual period
 periods lasting more than one week
 pain or pressure in your pelvis
 frequent urination
 trouble emptying your bladder
 constipation
 backache or pain in your legs

Is it breakthrough bleeding or implantation bleeding?


It’s difficult to tell if the bleeding you’re experiencing between cycles is breakthrough
bleeding or implantation bleeding. Implantation bleeding is any bleeding or spotting you
experience 10 to 14 days after conception. Some women experience this, and others may
not.
Both may happen between normal menstrual cycles. Both may be light enough to not
require a tampon or pad. That said, breakthrough bleeding can occur at any time, and
implantation bleeding only happens a few days before a missed period.
The best way to tell if you’re experiencing implantation bleeding is to either take a home
pregnancy test or visit your doctor for a blood test.

Tips for management


You may or may not be able to prevent bleeding between periods. It all depends on what’s
causing your bleeding.
Whether or not you should wear a tampon or pad depends on the reason for your
bleeding. For example, if you believe your bleeding is a result of hormonal birth control,
it’s likely fine to wear a tampon. If your bleeding may be the result of an impending
miscarriage, it’s better to use pads.
It’s best to consult with your doctor for guidance on how to manage your bleeding. If it’s
happening frequently, you should make an appointment with your doctor. Your doctor
can help identify the cause of the bleeding and treat your symptoms.

When to see your doctor


Breakthrough bleeding isn’t necessarily a reason for concern. For example, you may
experience bleeding outside of your normal menstrual period due to the birth control
you’re taking or irritation to your cervix. In these cases, the bleeding will likely go away on
its own without treatment.
If you suspect you have an STI, fibroids, or other medical issue, take note of any other
symptoms you’re experiencing and call your doctor. In general, you should see your
doctor if the bleeding is heavy or accompanied by pain or other severe symptoms.
Women who have reached menopause should also pay close attention. If you haven’t had
a period in 12 months and start noticing abnormal bleeding, it’s important to tell your
doctor. Bleeding after menopause may be a symptom of anything from infection
to hypothyroidism.
Withdrawal bleeding merupakan pendarahan palsu yang disebabkan oleh konsumsi pil KB. Disebut
sebagai pendarahan palsu karena pendarahan tersebut mirip dengan haid, padahal Anda mungkin
sedang tidak dalam periode menstruasi.

Kapan withdrawal bleeding terjadi?


Pada saat Anda mengonsumsi pil KB hormonal, maka Anda berpotensi mengalami withdrawal
bleeding ini. Pada umumnya pendarahan ini terjadi pada minggu keempat setelah Anda memulai
konsumsi pil KB. Semua jenis pil KB yang mengandung hormon sangat berpotensi untuk
menyebabkan pendarahan pasca seseorang mengonsumsi pil KB.

Penyebab withdrawal bleeding


Mengapa bisa keluar darah setelah minum pil KB? Singkatnya, pendarahan ini akan terjadi pada
minggu terakhir Anda mengonsumsi pil KB karena terjadi perubahan hormon di dalam tubuh Anda.
Ketika Anda tidak mendapatkan asupan hormon pada minggu terakhir, maka lapisan rahim melemah
sehingga menyebabkan pendarahan.
Perlu Anda ketahui bahwa pendarahan yang terjadi setelah mengonsumsi pil KB pada minggu
keempat ini bukan periode menstruasi yang sebenarnya meskipun sama-sama berasal dari vagina.
Selain mengonsumsi pil KB, terapi progesteron juga dapat berpotensi menyebabkan pendarahan
seperti withdrawal bleeding.

Mengapa wanita mengalami withdrawal bleeding


Sebelum Anda mencari cara mengatasi pendarahan akibat pil KB, sebaiknya Anda mengenali terlebih
dahulu beberapa faktor risiko penyebab seorang wanita mengalami pendarahan. Setiap wanita tentu
ingin sekali mendapatkan haid teratur setiap satu bulan sekali. Oleh karena itu, pil KB hormon
menirukan siklus menstruasi normal yang biasa dialami oleh wanita.
Sebagian besar pil KB berisi 28 butir, di mana 21 butir merupakan pil aktif yang mengandung hormon.
Pada saat memasuki minggu keempat, pil KB yang Anda minum tidak bersifat hormonal. Maka tidak
heran jika pada umumnya pendarahan terjadi pada saat Anda mengonsumsi pil KB yang tdak
mengandung hormon ini.

Perbedaan antara menstruasi dan withdrawal bleeding


Sekilas, withdrawal bleeding memang serupa dengan menstruasi. Bila Anda merupakan seseorang
yang kerap kali menghitung siklus menstruasi Anda setiap bulan, maka tidak sulit
membedakan withdrawal bleeding dan menstruasi.
Faktor utama keluar darah setelah minum pil KB adalah fluktuasi, di mana kadar hormon
menyebabkan perubahan pada lapisan rahim. Jika kadar hormon tidak berfluktuasi maka lapisan
rahim tidak akan menebal. Perubahan lapisan rahim ini untuk mempersiapkan rahim terhadap
kemungkinan kehamilan.
Ketika Anda mengonsumsi pil KB, kadar hormon di dalam tubuh Anda tetap rendah dan lapisan rahim
akan tetap tipis. Saat lapisan rahim tidak mengalami penebalan, maka Anda tidak akan mengalami
menstruasi. Sebenarnya, pil KB hormonal akan menghentikan pendarahan menstruasi Anda
sebenarnya dan menggantinya dengan withdrawal bleeding ini.
Adakah cara mengatasi pendarahan akibat pil KB? Tidak ada solusi untuk mengatasi masalah ini.
Satu-satunya solusi untuk mengatasi pendarahan karena pil KB adalah menghentikan konsumsi
kontrasepsi hormonal ini. Jika Anda menghentikan konsumsi pil KB, maka siklus haid kembali normal,
tetapi risiko kehamilan tentu lebih besar.

Withdrawal bleeding, also known as a hormonal period or fake period, is the monthly bleeding
women experience while using a hormonal birth control method, such as the Pill, the patch, or
the NuvaRing. During the placebo week of these methods, women will typically have
withdrawal bleeding, which often feels like a regular period. Monthly withdrawal bleeding is not
the same thing, though, as having a real menstrual period.

When Does Withdrawal Bleeding Occur?

If you use combination hormonal contraception, you should be expecting your withdrawal
bleeding to come when you are not taking any hormones from your birth control method. This is
usually during the fourth week of your cycle:

 Combination Pill Users: Expect your withdrawal bleeding to take place during week 4 (your
placebo week) if you are using a 28-day pill pack brand.
 Patch Users: You should be expecting your withdrawal bleeding during the week you keep your
patch off (week 4).
 NuvaRing Users: Expect your withdrawal bleeding to occur during the week when you take out
your NuvaRing (week 4).
 Extended Cycle Pill Users: If you are you a 91-day extended cycle pill (like Seasonique), don't be
expecting your withdrawal bleeding for three months. It should come sometime during week 13.
 Progestin-Only Pill Users: Things are a little different for you since you do not have a placebo
week. If you start your pills on the first day of your actual period, you can expect your monthly
withdrawal bleed sometime during the first week of your next pack.

 21-Day Birth Control Pill Pack Users: Some of you use pill brands that only contain 21 pills
(like Loestrin 1/20 or Loestrin 1.5/30), so when should you expect your withdrawal bleeding?
Well, take all 21 pills (Weeks 1-3). Then, during week 4 when you don't take any pills, you can
expect your withdrawal bleeding.

What Causes Withdrawal Bleeding?

Withdrawal bleeding usually takes place during the last week of your birth control cycle because
there is a change in the hormone dosage that your body is used to. Not having any hormones
during week 4 can cause the lining of your uterus to weaken just enough to allow for some
bleeding to occur. It is important to point out that withdrawal bleeding is due to the change in
hormone levels and is not a true period. A withdrawal bleed can also occur after a course of
progesterone therapy.

If It's Not Real, Why Have Withdrawal Bleeding?

When you use hormonal birth control, you are "overriding" your natural menstrual cycle. In a
way, these methods make your body think that it's pregnant. Back when Margaret Sanger,
Katharine McCormick, John Rock, and Gregory Pincus first developed the pill, they felt that
women may not like the idea of not have a monthly period, especially since women usually rely
on their regular period as "proof" that they are not pregnant. There's no biological or medical
reason to have this period. But again, the pill developers thought that women would feel more
comfortable still having a monthly withdrawal bleed, and they also thought that since the pill
mimicked a woman's natural cycle, then perhaps there would be less religious objection to pill
use.

So the pill developers made the decision to build a withdrawal bleed into the pill. How did they
do this? Well, they designed the pill to only have 3 weeks ( 21 days of active, hormone pills).
Then, in week 4, they included a hormone-free interval of seven days by using only placebo
pills. The hormone decline that takes place during this pill-free/patch-free/NuvaRing-free
interval results in your withdrawal bleeding.

So How Does Withdrawal Bleeding Differ From a Real Period?

Withdrawal bleeding is a somewhat similar to your menstrual period (and is often referred to as
being on your period). But, you need to remember that it is not the same thing as having a true
menstrual period.

To understand why these are different, we need to take a quick look inside your body to
understand what causes you to have a period. In real simple terms:

 Fluctuations (changes) in hormone levels can cause changes in your uterine lining.
 If your hormone levels don't fluctuate, then the lining of your uterus will not thicken.
 Because it is not thick, it does not need to shed off, which is what happens during a regular
period.
 The only biological reason for these changes in your uterine lining is to prepare the uterus for a
possible pregnancy.

But, when you use the Pill, the Patch, or NuvaRing, your body hormone levels stay low, and they
don't seesaw—they actually stay fairly steady. Not having hormone fluctuations will keep your
uterus lining thin. This is important to point out, it doesn't just stay thin for the three weeks you
are using hormone contraception, it is still thin during week 4, and will continue to stay thin for
all the time you are using this method.

 This thinness means that there is no tissue building up in your uterine lining.
 No thickening of the lining means that there is no build-up that needs to be shed off.
 No shedding means that you do not need to have a regular menstrual period.

This is how these hormonal methods stop you from having a "real" monthly period. Instead, each
month you have withdrawal bleeding (or a "fake" period). Not adding hormones to your system
during week 4, basically softens your thin uterine lining just enough to cause some bleeding.
This bleeding is your withdrawal bleeding. Because your uterine lining hasn't been thickened,
withdrawal bleeding tends to be shorter and lighter than a regular period.
Withdrawal Bleeding and Sex

Last, but certainly not least, you may be wondering about having sex during week 4, and whether
or not the pill, patch, or NuvaRing still offers pregnancy protection during the placebo week. The
answer is "yes"! Even though you are not taking any hormones during week 4 (or week 13 for
extended cycle pill users) and even if you are having withdrawal bleeding, your hormonal birth
control has got you covered

Withdrawal bleeding, also called a “fake period”, is the bleeding you experience in the
placebo pill week of a conventional course of birth control pills. It also occurs with other
forms of hormonal birth control that affect a menstrual cycle, like contraceptive patches
or vaginal rings. To understand why this happens, it might help to consider how birth
control pills work.

Hormonal birth controls dose you up commonly with estrogen and progesterone. This
stops you from ovulating (releasing eggs), and prevents any further thickening of the
uterine lining.

However, when you take the dummy pills, those hormone levels drop down. The bleeding
you experience is just the uterus’ way of responding to the decrease in estrogen and
progesterone.

Though it may look like a period, what you get in a withdrawal bleed is a little different.
What you shed naturally in a period is the thickened uterine lining, but when you take birth
control pills, this lining stays thin. Withdrawal bleeding may look and feel like a period, but
it’s just a response to a drop in hormones.

Withdrawal bleeding is also different from “breakthrough bleeding”, which refers to the
unscheduled period-like blood and spotting you may experience as your body is still
getting used to the hormones in the pill.

If you’re taking birth control, there’s no physiological reason you need to have withdrawal
bleeding every month. There’s no evidence that going longer than a month without
withdrawal bleeding has any negative impact on your health.

However, it’s been included in most hormonal birth control methods for a psychological
reason. For starters, many of us rely on getting periods as a sign that we’re not pregnant,
so a withdrawal bleeding provides some much-needed reassurance.

On the other hand, there are many reasons someone may want to “skip” their period from
time to time. With this in mind, some extended cycle formulations of birth control let you
go longer between withdrawal bleedings. Instead of having 12 fake periods each year,
you only have 4 per year with these methods.

Assuming that you’re taking all your pills correctly as directed, you haven’t had any
vomiting or diarrhea that could interfere with absorption, and you’re not taking any other
drugs that could interfere with them? Then no. You’re not at any increased risk of getting
pregnant during the placebo week when withdrawal bleeding occurs.

This is because the days of “active pills” have already prevented your body from releasing
an egg, or from thickening the uterine lining. Just make sure you take all your pills as
directed, and you can have confidence that you’re not putting yourself at risk of an
unplanned pregnancy.

However, if you go more than a week without active pills – as could happen, say, if you
got the stomach flu, or skipped a few doses and then moved straight onto the placebo
week – there is a chance your body could restart the ovulation process. Play it safe and
use condoms if you’re not sure.

Whether you’re using to prevent pregnancy, get on top of a painful menstrual cycle, or
both, hormonal birth control can often make life a bit easier. Withdrawal bleeding is a
quirk of the dosing schedule of many hormonal birth control methods – not a “real” period.

But just as with regular menstrual periods, if your withdrawal bleeding is painful or
interfering with your daily life, you don’t need to put up with it. Speak to your doctor about
your options for avoiding excessive withdrawal bleeding, or improving the symptoms.

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