Why do women on the pill have a monthly bleed

Most women want safe contraception and therefore use hormonal contraceptives like the pill, the ring, or patch. When the pill was developed in the 1960s, the researchers wanted to mimic the natural cycle of the woman, which averaged 28 days (although wide variations are frequent and normal).
The break for a monthly bleed is not based on a biological need, but was introduced by the inventors of the pill for marketing purposes to imitate a ‘natural’ cycle, and thereby increase women’s acceptance of the pill, as well as facilitate approval by the FDA, the American health authority. It was feared that the FDA and women would probably reject the new pill if women were neither pregnant nor menstruating. This rationale is described by the inventor of the pill, biochemist Gregory Pincus, in his biography:

The control of Fertility, 1965
Source: Gregory Pincus, The control of Fertility, 1965, www.muvs.org

Read the exciting story about the invention of the pill: A forgotten revolution: muvs.org
Video: de.muvs.org

Are monthly bleeds with the pill important or can I do without?

Today’s pills are based on this same 28-day cycle. For example, the most commonly used pills contain 21 tablets in a blister pack, with instructions to take a tablet each day for 21 days, followed by a 7-day break, the “intake-free interval”. (Cycle: 21 days + 7 days = 28 days). Some pill packets come with 24 days of tablets and a break of 4 days. Other packets contain 4 or 7 inactive tablets (a placebo), so that women can just take a tablet every single day.

Women in the 1960s and many today still consider monthly menstruation to be natural, so the 21 + 7-day scheme is still the most frequently used. Since the pills are designed to induce artificial monthly bleeding – i.e., not a natural menstruation – it’s also called withdrawal or break bleeding. The withdrawal causes hormones level to drop over the 7-day break. The uterine lining, which has built up over the 21 days of taking the pills, is expelled and bleeding occurs. However, the bleeding is usually weaker than a real period and less painful.

From a medical perspective, the monthly bleeding is not necessary. Research and development over the last few decades have significantly reduced the hormonal dosage of modern pills. The future trend for the pill will be to omit monthly bleeding entirely, which is perceived by many women today as bothersome and unnecessary.

After consulting with your doctor, you can take the pill (single-phase preparations) without a break using the long cycle. After 6 months maximum, you should take a break for 4-7 days. This may trigger bleeding to expel the built-up uterine lining, but probably not heavier than a normal period. The long cycle reduces bleeding to twice a year if you take the pill for 6 months, or four times a year if you take it for 3 months.

Ask your doctor.
Also read this article: Menstruation – is it necessary? Part 1  Menstruation – is it necessary? Part 2

The Long Cycle

The “long cycle” describes the use of the pill, contraceptive ring, or patch without interruption for longer than 21 days. The hormonal IUD is also suitable for the long cycle. After one year of use, light bleeding occurs only on 1-2 days per month. One user in five experiences no bleeding after one year of use.

Download the long cycle leaflet: Long Cycle Leaflet 

Further advantages of the long cycle:

Besides the advantage that bleeding does not occur every month, other beneficial side effects of the long cycle include:Discomfort due to suddenly declining hormone levels at the end of the cycle can be avoided or significantly reduced by taking the pill, including for example:
•    Abnormal pain
•    Migraines
•    Mood fluctuation
There are no known medical reasons against using the long cycle.

The New 3-month Pill

A 3-month pill has been available in the U.S. for many years, and is now available in Austria.

The 4-7-day break that causes bleeding occurs only after several months because this pill is used for two, three, or more months without interruption. After a maximum of 6 months, a 4-7 day break should be taken, causing a bleed.

The number of bleeds can be reduced in this way from the typical 13 in a year, to between two and four. For example, if four packets of pill, each containing 21 tablets, are used without taking the 7-day breaks, a bleed-free period of 12 weeks can be achieved.

Advantages:  With the long cycle, women can self-determine the timing and frequency of their menstruation. For many, this not only leads to an improved quality of life, e.g., when traveling or on holiday, but also enables them to maintain a state of well-being and comfort. In particular, women with heavy or painful periods benefit from the long cycle. Studies have shown that women on the long cycle have fewer headaches and less abdominal pain, and improved well-being compared to women using the normal regimen. Medically speaking, the long cycle is safe. After discontinuation, the normal cycle returns rapidly, as shown by studies of biopsies of the endometrium.

There are no effects on your health, or the effectiveness of the pill, if you take the pill for several cycles without interruption. Ask your doctor to prescribe the 3-month pill or a one-phase pill – this is the easiest way to start shifting the menstrual cycle, because all the pills in the packet contain the same amount of hormones and are the same colour. Instead of the 21-day cycle, take the pill for 180 days without interruption, and then take a 7-day break. As long as you take a pill each day, the pill’s ability to prevent pregnancy is not affected.

After a maximum of 6 months on the long cycle, you should take a 4-7 day break to trigger a bleed that will expel the mucous membrane in the uterus, and should be no heavier than a normal period. 
Source: diepille.info

Menstrual management with the pill

Postponing a period for a few days was an available treatment for women with painful periods during the first generation of the pill (in the 1960’s). If they saw their gynecologist in time before taking a trip, they could postpone a painful and unpleasant period to a less inconvenient date.

Today, women feel more confident about using the pill than in the 1960’s, and tend to see it as a useful tool rather than a medical intervention. Furthermore, most women want to decide not only the number and timing of their children, but also the frequency and timing of their periods. According to the Austrian Contraception Survey, almost 40 percent of women surveyed said they had self-managed their menstruation:  4 percent regularly took the pill over a longer period of time to avoid withdrawal bleeding, and 14 percent did so occasionally. In particular, young women between the ages of 21 and 29 manage their menstrual bleeding to a much greater extent than their mothers ever did.

After some delay, industry responded to the changed consumer behavior by developing a pill that can be taken without interruption for three months. This allows women to have periods only four times a year.


Verhütungsreport 2012, www.verhuetungsreport 2012

Further, this modern innovation of hormonal contraception is medically recommended: Women’s well-being increases measurably, headaches and abdominal pain decrease, and after discontinuing the long-cycle pill, the normal cycle returns quickly.