Birth Control Pills and Your Period

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Jan 25, 2024.

When should I expect my period when using birth control pills?

Many women using birth control pills will find that over time their periods may become more regular, lighter, and less painful. In fact, many women use birth control pills to help regulate their periods and ease cramping and premenstrual syndrome (PMS). You can even use the pill to safely skip your period altogether if you prefer. But sometimes breakthrough bleeding or spotting can still occur.

Combination Birth Control Pills

If a combination birth control pill (estrogen + progestin pills in a 21- or 28-day pack) is started for the first time on the Sunday after your period begins, your period should occur about 25 days later.

Ask your healthcare provider which day is the best to start your specific pill pack. If your period begins on a Sunday, you can start the pill pack on that Sunday.

• In general, about 3 days after finishing all of the 21 active tablets in a 28-pill pack, most women will start their period. If you use a 28-pill pack, you'll get your period during the week you take the reminder (hormone-free) pills.
• If you use a 21-day pill pack, you'll still get your period the week you do not take any pills. Remember that the 21-day pack has no reminder pills.
• Use a reminder (like your smart phone or a calendar) to help you stay on track.

Extended-Cycle or Continuous Cycle Combination Birth Control Pills

If you take extended cycle (i.e., Seasonale, Seasonique) birth control pills you will only have four periods per year. If you take continuous dose birth control pills (i.e., Amethyst) you will eliminate your periods completely. However, breakthrough bleeding or spotting may occur with extended- and continuous-dose birth control pills. Spotting may last for up to 3 to 6 months, but will usually subside over time.

• Extended cycle pills like Seasonique typically have 12 weeks of active combined hormone pills (an estrogen and progestin) that you take continuously for 12 weeks, followed up by 1 week of reminder pills (91 pills total).
  • You take one pill each day. You’ll only have your period once every three months.
  • You are protected from pregnancy even the week that you take the reminder (inactive) pills. Your reminder pills may contain iron or other supplements.
• Continuous cycle pills like Amethyst usually contain 28 days of active combined hormonal pills (an estrogen and progestin).
  • You take one pill each day for 28 days in a row; there are no inactive (reminder) pills.
  • As soon as you finish one pack, you start the next pack the following day. You do not take a break in-between packs. Your periods will most likely stop, but you may have spotting. Do not stop taking your pills if you have spotting.

Progestin-Only Birth Control Pills ("Mini-Pills")

With progestin-only pills, all 28 pills have a progestin-only hormone (contain no estrogen) and come in a 4-week (28-day) pack. Progestins include drugs like norethindrone.

The new over-the-counter (OTC) birth control pill Opill is also "mini-pill" progestin-only pill. In July 2023 the U.S. Food and Drug Administration approved Opill, the first nonprescription, over-the-counter (OTC) birth control pill. Opill is available OTC, stocked on pharmacy shelves, and available online without a prescription in March of 2024. Check with your pharmacy.

Learn more: What is Opill, where can I get it and how much does it cost?

Take one pill every day in the progestin-only pack to be protected from pregnancy. You must take progestin-only pills within the same three hour time period every day to be protected from pregnancy. This is very important. Missing this timeframe can increase your chances for pregnancy.

• For example, if you normally take your pill at 8 PM, taking it after 11 PM the next night may put you at higher risk for pregnancy.
• Take every progestin-only pill in a pack to be protected from pregnancy — there is no hormone-free week or reminder pills.
• You may get a period in the 4th week, off-and-on bleeding or spotting throughout the month, or no period at all.

If you are concerned about spotting, irregular bleeding or an irregular cycle, contact your healthcare provider for further advice.

See also

• Birth Control Pills (Oral Contraceptives)
• Birth Control Pills: Benefits, Risks & Side Effects
• Birth Control Pills: Why do I get breakthrough bleeding?
• Emergency Contraception
• Emergency Contraceptives Available in the U.S.
• Grapefruit and Birth Control Pills: Your Questions Answered
• Hormonal Birth Control (Non-Pill Options)
• Missed your birth control pill? Here's what to do
• Non-hormonal Methods of Birth Control
• Permanent Birth Control

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer