If you’re taking combination birth control pills, you may have noticed that some of your pills are a different color. You probably have 28 pills in a pack, separated out by weeks, with the last week standing out from the bunch. These are called placebo pills, and unlike your other pills, they don’t contain any hormones.
Placebo pills are completely safe, and — while they won’t affect your fertility status — it’s usually best not to skip them. They can help you stay on track with your pills, reduce side effects, and have several other benefits. Here are some of the reasons your pill pack has a placebo week and what it means for you.
Some people take the pill not only to prevent pregnancy, but to regulate their menstrual cycle. If you have irregular cycles, the predictable 28-day schedule can help you bleed on a more consistent basis. During the three weeks you take active pills, you likely won’t experience bleeding. Then, you may experience bleeding during the week you take placebo pills.
This type of cycle regulation may be helpful for people who experience very long or heavy periods. The combination pill can make bleeding much lighter, shorter, and less painful. Even if you aren’t sexually active, birth control can help you get relief from difficult periods. Brands like Sprintec are designed to control heavy or painful periods and can even prevent acne.
Taking the pill can give you even more control over your cycle. For example, if you want to skip or delay bleeding, you can simply skip your placebo week. Instead of taking those seven sugar pills in the pack, simply start a fresh pack of pills with an active hormone week. It’s safe to do, and convenient if you’re planning something like a beach vacation or a multi-day hike.
The easiest way to form a habit is to do it every day, for many weeks or months in a row. Habit formation is even more effective if you do the exact same thing at the same time every day. Most birth control pill users set a timer and take their contraceptives every day when it goes off. A week of placebo pills enables them not to break continuity in this schedule.
This week of placebo pills in your pack doesn’t actually influence your ability to get pregnant. But it can make it easier to remember to take your active pills when it’s time. If you stopped taking pills for a week every month, your birth control wouldn’t be any less effective. But you’d probably be more likely to forget to resume taking the active pills the following month.
Even with the placebo week, smartphone timers, and other reminder tools, some people struggle to remember their birth control. This is especially true for folks with ADHD and other diagnoses that involve executive dysfunction. Missing one — or all — of your placebo pills won’t make a difference. But if you tend to miss the pill a lot, use a backup method and consider an alternative form of birth control.
The “period” you have during your placebo week isn’t technically an actual period. It’s called withdrawal bleeding, and it happens when you briefly stop taking estrogen and progesterone, and your hormone levels dip. It’s not considered menstruation, because regularly taking these hormones has already stopped your body from ovulating, or producing an egg.
While it’s not actually medically necessary to have bleeding while on the pill, many people find it reassuring. When you’ve gotten used to having your period every month, the absence of this regular bleeding might feel a bit strange. This is especially true for people who are used to relying on their monthly period as reassurance that they haven’t gotten pregnant.
That said, when you’re on the pill, your monthly bleeding doesn’t really mean anything. The pill continues to provide pregnancy prevention whether you experience bleeding or not. To find out if you’re pregnant on the pill, check for other symptoms and get a pregnancy test. The pill won’t usually harm a fetus if you stop taking it early in pregnancy, should you decide to carry to term.
Some people who take hormonal birth control experience side effects that are similar to PMS or pregnancy symptoms. These side effects can include bloating, mood changes, breast tenderness, headaches, and nausea. Side effects from birth control can be especially intense when you first go on the pill or start a new brand or dosage.
The pills in your placebo week, unlike your other pills, don’t contain any hormones. They’re mostly made of sugar, starches, and other inactive ingredients. Because they don’t contain any estrogen or progesterone, they give your body a short break from these extra hormones. This brief period of time without hormones may ease some of the side effects listed above.
If you experience mood swings and other emotional changes while on the pill, the placebo week could provide some relief. But for some people, this hormone-free week can make mood changes even worse, or destabilizing. Mood changes can be dangerous, especially for people with comorbid mental health conditions. Always speak to a healthcare provider if you notice changes in your mental well-being.
Most people who take hormonal birth control are on combination pills. And most combination pill packs do contain a placebo week. But some combination pill brands are designed to be taken continuously without any hormone-free breaks. And some other birth control pills, like progestin-only pills, stop working as soon as you miss a single hormone dose.
That’s why, if you’re on the pill, it’s very important to know exactly what you’re taking. Don’t assume your fourth week of pills is necessarily a placebo week. If you’re just starting the pill, or switching brands, carefully read the insert that comes with your birth control. When in doubt, never skip any pills in your pack.