Illustration by Marta Pucci
How every method of hormonal contraception affects your period
Top things to know
For all hormonal methods, irregular bleeding and spotting are more common in the first months of use and usually get better over time.
With combination pills, the patch, and the ring, users generally experience monthly withdrawal bleeding that mimics a period (unless used continuously).
With the hormonal IUD, the shot, and the implant, it is possible to have no monthly bleeding at all.
The IUD may be the best hormonal contraception for managing heavy menstrual bleeding.
All hormonal contraceptives are associated with changes in menstrual bleeding patterns. When beginning a new hormonal contraception method, some people may experience irregular bleeding or spotting. Others may notice changes in the length or heaviness of bleeding, and some may stop bleeding entirely.
Let’s go over how different hormonal methods may affect your bleeding, based on current research evidence. (For reference, people who are not using hormonal contraception experience an average 6 to 7 bleeding or spotting days per month (1).)
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The combination pill
About 20% of users may experience breakthrough bleeding or spotting during their first cycle, and about 10% of users may still have these symptoms in the third cycle (2).
In the first three months of this method, users average 3 to 7 total days of bleeding or spotting (including expected withdrawal bleeding). Bleeding days may decrease to about 3 to 5 within the first year of use (3).
Between 12% and 77% of people with heavy menstrual bleeding experience “normal” flow after 6 months of using combination pills (4).
In one study, about 1 in 10 users stopped this method because of irregular bleeding within the first six months of use (5).
The patch
About 20% of users experience breakthrough bleeding or spotting during their first cycle with the patch, and about 10% experience these bleeding irregularities in the third cycle (6).
In one small study, fewer than 1 in 10 users stop using the patch because of bleeding and spotting (7).
The ring
Fewer than 1 in 10 users may experience breakthrough bleeding or spotting during their first cycle with the ring (8).
After about a year of use, users experience about 3 total bleeding and spotting days per month (9).
Within the first year of use, less than 1 in 10 users stop using this method because of irregular bleeding (10).
The progestin-only pill
In the first three months of use, users experience an average of 6 to 12 total bleeding and spotting days. After the first year of use, bleeding and spotting days decrease to between 4 to 9 (3).
After about a year of use, about 20% of users taking pills made with the progestin desogestrel (not available in the United States) may stop bleeding completely–this is less common for other types of progestin-only pills (11).
Between 10 and 50% of users will stop this method because of bleeding irregularities (12).
The hormonal IUD
In the first three months of using a lower dose IUD containing less than 20 mg levonorgestrel, between 37% and 56% of users may have bleeding or spotting that lasts for more than 14 days in a row. About 20 to 25% may have more than one bleeding episode per month (13,14).
One study determined that after about a year of using the hormonal IUD containing 52 mg levonorgestrel, as many as half of users may stop bleeding completely, and users experience an average of 4 bleeding and spotting days per month (15,16).
Research suggests that this method is the most effective hormonal contraception for managing heavy menstrual bleeding, with many studies reporting that bleeding decreases by more than 90% over the course of a year (17)!
In the first year of use, fewer than 1 in 10 users discontinue the method because of irregular bleeding patterns (15).
The 3-month shot
In the first six months of use, about 10% of users experience bleeding that lasted for more than 21 days (18).
12% of users may not bleed at all in the first three months of use, and the average number of bleeding and spotting days per month during this period may be 7 (1).
After about a year, nearly half of users do not bleed at all, and users overall experience an average of 3 bleeding and spotting days per month (1).
Some research shows that about 20% of users stop using this method because of irregular bleeding patterns, including no bleeding or unexpected bleeding (19).
The implant
Over the first three months of use, between 15 and 20% of users experience bleeding that lasts for more than 14 days and about 5% may have frequent bleeding (20).
11% users may not bleed at all in the first three months of use. On average, users tend to bleed or spot for 7 days per month over the first three months of use (1).
A user’s average bleeding pattern after a year of use is similar to their pattern in the first three months (1,21).
Within the first year of use, about 1 in 10 users discontinue this method because of irregular bleeding patterns (22).
