Is it safe to skip the placebo pill?

One of the biggest issues people have with birth control pills is taking it on time every day. Each pill that you take gives you a dose of hormones ー progestin (if you’re on the mini-pill) or estrogen and progestin (if you’re on the combined pill). In order for your body to properly respond to the pill, you need to take it every day as directed. With the mini-pill, this is especially important since even taking it a couple of hours late can affect hormone levels in the body. This can reduce the effectiveness of the pill and increase your chance of pregnancy. 

Clearly, a tiny little pill, smaller than the size of a raindrop, can have such a profound impact on your body.

So, where does the placebo pill come into play?

For most people, the week of your placebo pill is when you get your period. If that’s the case, why do we even have the placebo pill? It’s basically there to mimic the 28-day menstrual cycle and help you get into a routine of taking the pill every day. 

Remembering to take the pill is hard in itself. But, what’s even harder is training yourself to take it for 3 weeks straight, taking a break for a week, and returning to taking it for three weeks straight. In order to train yourself into taking it everyday, doctors may give you a pill-pack that has a week of placebo pills, so you never get out of the habit of taking the pill. Technically speaking, if you have superhuman abilities, and you’re someone who never forgets their pill, then you don’t need to take the placebo pills. What this would look like is taking the active pill for three weeks, then taking a one week break with no pills, and then starting a new pack of birth control. But if you’re a creature of habit, then you probably want to stick with taking the three weeks of regular pills plus one week of inactive placebo pills!

Now that we’ve covered the basics, let’s talk about skipping the placebo pills altogether. Say, for example, you go from one pill pack straight to the next. What happens then? 

The most important thing is that it can make you skip your period altogether, and there are both pros and cons to this. 

Pro #1: Avoiding debilitating or uncomfortable period-related symptoms. 

If you’re someone who struggles from intense PMS symptoms like anxiety, depression, headaches, moodiness, bloating, or anything else, then you can eliminate those symptoms by not having a period at all. Some people suffer from intense period-related migraines which occur as a result of significant hormone fluctuations throughout their cycle. People who suffer from menstrual migraines are often prescribed the pill to regulate their hormone levels. In such cases, straying off the active pill for even a week can bring back menstrual migraines or make them worse. Choosing to skip the placebo pills will help alleviate those symptoms. 

Skipping your period can also help if you have been diagnosed with anemia. Having anemia means your blood lacks in red blood cells -- the cells that carry oxygen throughout your body. This means people with anemia tend to feel tired and lack energy. People who have intense periods with significant blood loss, medically termed menorrhagia, may be prone to being anemic. As blood is lost, red blood cells decrease in quantity. People who have a previous anemic diagnosis, unrelated to their period, can also have worsened symptoms during their period. If you’re someone who’s anemic, then skipping your period may be something that helps with your symptoms. 

Pro #2: Lowering the length or intensity of your period. 

If you struggle with long, uncomfortable periods, then skipping the placebo pills and continuously taking active pills may help skip your period all together to avoid all of these symptoms completely.

Pro #3: Avoiding the worry of getting your period on vacation or during a major event. 

Let’s be real, getting your period can be stressful enough in the comfort of your own home. But, getting it on your birthday or while you're on your beach vacay is probably 10x worse! If you know you have an upcoming event or trip planned, and you don’t want to worry about cramps, changing your pad, or having an unexpected leak (we’ve all been there), then you can skip the placebo pills altogether. The last thing you need is to have your period get in the way of having fun or enjoying yourself!

So far, we’ve touched on all the positives. But, it almost sounds too good to be true. Surely, there must be some consequences of skipping your period?

The main concern is breakthrough bleeding. Even if you were to take placebo pills, you would still be prone to breakthrough bleeding, but the chances increase as you go for long periods of time without a period. 

Another concern that’s often raised is what happens to all that uterine-lining? If it doesn’t get shed during your period, does it just build on itself every cycle? The short answer is no, that’s not how it works. 

When you’re on birth control, it’s important to know that you’re not getting a regular period to begin with. During a regular cycle, the uterine lining thickens to prepare for a potential pregnancy. If an egg gets fertilized, it needs to implant itself in the lining in order to grow and develop. If an egg isn’t fertilized, then the uterine lining and the unfertilized egg are shed in the form of your period. The hormones in the pill prevent the uterine lining from getting thick, or as thick as it normally would. The “period” that you get on birth control is actually just withdrawal bleeding ー withdrawal from the active pills. That’s why you typically get your period during the placebo pill week. So no, skipping the placebo pills doesn’t mean your uterine lining is getting thicker or “filling up your uterus” because on the pill, your uterine lining doesn’t get that thick to begin with. Skipping the placebo pill just maintains a consistent thin lining.

Another concern is infertility. There’s no current data to say that you’ll become infertile by completely skipping your period while taking birth control pills. But, when you’re not on hormonal birth control, your period tells you a lot about your health. So, skipping a natural period can indicate other health issues and may prevent you from getting those insights about your health, including fertility, that may be a concern later on. 

With all this being said, it is definitely important to consult with your doctor before choosing to skip your period, especially if your plan is to do it long-term. If you do plan to skip your period long-term, your doctor will also have to re-write your prescription to get more packages more frequently. You also never know what underlying health condition you may have. 

By joining the Aavia community, you can get feedback from other users who have been through this and our medical advisors. Not only that, but you can also track your period symptoms! If you realize that you are constantly logging really intense PMS symptoms that you’d like to skip the month of your vacation, then you can consider doing so!