Birth Control Mythbusting Sex Ed

Birth Control Beyond the Basics: Pill Power!

Today’s post is written by Annie, a dear friend of mine who knows a whole lot about sexual and reproductive health. This is part one out of three in her series, “Birth Control Beyond the Basics.” Enjoy! 

Birth control pills are the most commonly used method of contraception in the US, and are so ubiquitous that they’re probably the first thing that pops to mind when you hear the phrase “birth control.” There are actually a lot of other methods, most of which are actually easier to use than the pill, but the pill can be a really great method for those who don’t struggle with taking it every day at the same. (Yes, you really do need to be taking it at the same time for full efficacy.) Although it can come with negative side effects, the pill actually has some potential POSITIVE side effects as well. It reduces your risk of certain cancers, often reduces acne, and helps many people get relief from irregular, heavy or painful periods. The pill is often prescribed specifically to deal with these issues!

What you might not know, though, is that you actually don’t need to get your period AT ALL while taking the pill!

Image: white woman looking suspiciously over her sunglasses.

Say what?

What?! I know, right? No periods, unless you want them.

When I worked as a birth control counselor, the question I heard most often in response to this was, “Isn’t that unnatural? Isn’t that unsafe? Won’t your periods build up and need to be released eventually?”

The answer is, it’s not natural (the hormones in the pill accomplish it), but it is safe for people who can safely take the pill, and the periods you skip won’t build up to an ultimate uber-period.

That’s because when you take birth control pills, as with most hormonal methods, you don’t ovulate. That means your body doesn’t release an egg each month. As you may know, your period is the shedding of the lining that the uterus builds up in anticipation of a fertilized egg implanting. So, when your body isn’t releasing an egg, it won’t build up any uterine lining, and there’s no need for it to shed each month.

You might be wondering, if it’s not the uterine lining shedding, what exactly is the period you get when you’re on the pill?

It’s actually not really a period. It’s called “withdrawal bleeding” and occurs because you’re not taking the active, hormonal pills during that week. For most people, there is really no medical reason that you need to experience withdrawal bleeding every month, unless you like to be assured that you’re not pregnant.

Some people skip every other period, some skip two and then get the third, and some skip all of their periods. Or, you can skip it once in a while if your period falls during an inconvenient time, like a busy work event or your wedding.

For some people, especially those who skip all their periods, you might get a little bit of spotting, either occasionally or frequently. That’s because your body isn’t a computer. Even though it’s not building up a full uterine lining, you might get a little lining that does build up and eventually sheds. If this happens, try getting the next period you reach in your pill pack, and then if you want, you can try continuous cycling again.

If you want to skip your period with the pill, tell your doctor you’re interested in “continuous cycling.” Some birth control pills, like Seasonique, are designed to be used this way. They come in a hugantic mega-pack with 12 weeks of active hormonal pills and 1 week of placebo pills. But if you like the pill you’re using now, you can also do continuous cycling with any combined hormonal pill (that means a pill that contains estrogen—not the more rare progestin-only minipill). All you do is skip the placebo week! When you finish taking the third week of active pills, start the first active pill in your next pack the next day.

Animation: Lamb giving a thumbs-up.

Easy peasy.

Using the Nuvaring? You can do continuous cycling too! Just leave your ring in for four weeks, then remove it and replace it with a new one.

What’s the downside? Insurance companies. Even though there is generally no medical reason to get a period on the pill, some insurance companies disagree and won’t cover enough packs to get you through the year continuous cycling, or won’t cover specifically dedicated continuous cycling pills. In Maryland, where I was a birth control counselor, Medicaid doesn’t cover continuous cycling pills at all, which is frustrating because they fully cover every other birth control method. (Always call your insurance company or check the literature that came with your plan if you have questions about your coverage. Your doctor doesn’t always know what your insurance covers!)

It’s a shame that insurance companies aren’t always on board, because there is some evidence that continuous cycling makes it slightly less likely that you’ll get pregnant if you miss a pill. With that said, though, you should always follow the instructions in the package insert if you miss a pill.

Continuous cycling is a great option for people who are using birth control pills and want to escape the hassle and expense of periods. Personally, I did continuous cycling with several types of pills and Seasonique for about 3 years. Then I decided I wanted a break from hormones. If you’re with me on that, we’ll talk about hormone-free birth control options in the next edition of “Birth Control Beyond the Basics!”

Disclaimer: This information is not intended to simulate or replace the advice of a physician. Always talk to your doctor about your birth control options and how to best use them. Birth control pills containing estrogen are not safe for everyone; only your doctor can help you decide if they are right for you! Always take a test or contact your healthcare provider if you think you may be pregnant.

Annie spent a year working as a birth control counselor at a monolithic nonprofit women’s health clinic. She did the counseling, memorized the stats, and gazed into the vagina. She’s now a freelance writer and spends her free time obsessing about the Civil War to anyone who will listen. She writes the popular blog, Bras I Hate and Love, about tackling life with boobs you didn’t bargain for. She lives in Baltimore with her boyfriend and her cat, Gremlin.


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  2. Tex

    Will insurance companies budge if your doctor determines continuous use to be medically nessissary?

    For example with your period you also get debilitating cramps, nausea, and fevers causing a disruption in your normal ability to function?

    1. Noah Post author

      Hi, Tex! Unfortunately, it depends on the insurance company. Some insurance companies will cover continuous use, and others have a definite-no policy. You have a much better chance of getting insurance on-board if your doctor prescribes the birth control pill as treatment for specific conditions (such as your intense period symptoms), but if your company tends to not cover continuous cycling, it might take a lot of back-and-forth between you, your doctor, and your insurance company. It definitely helps to have your doctor on your side.

      Good luck! And let us know if you have any success so that we can offer advice to others in the same position.

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