What’s the Difference Between a Period and a Withdrawal Bleed?
A big misconception I see in practice is women thinking that their period is a true period, when really it’s just a withdrawal bleed. It’s an important distinction, especially if you are trying to understand your cycle, address PCOS, or support long-term hormone health.
Let’s break down what these two terms really mean.
What a True Period Is
A period is the shedding of the uterine lining (endometrium) that happens after ovulation when pregnancy does not occur. Here’s the sequence:
Your ovary releases an egg (ovulation).
After ovulation, your body makes progesterone from the corpus luteum (the structure left behind from the egg follicle).
If the egg is not fertilized, progesterone levels fall.
The uterine lining that was built up to prepare for a potential pregnancy is no longer supported, so it sheds.
This bleeding is a true period because it follows ovulation and a full hormone cycle of both estrogen and progesterone.
What a Withdrawal Bleed Is
A withdrawal bleed is different. It is bleeding that happens when hormone levels drop, but not because of ovulation.
This is most commonly seen when taking the birth control pill. The pill suppresses ovulation by keeping hormone levels steady. During the placebo week, when you stop taking active hormones, the sudden drop causes the lining to shed. That bleeding is a withdrawal bleed—it mimics a period in appearance but does not reflect an ovulatory cycle.
You might also experience a withdrawal bleed after you discontinue the use of birth control as hormones drop. This could happen right away, or within a few weeks after stopping.
Why the Difference Matters
If you are looking at your cycles for signs of health or fertility, knowing the difference is key. A true period means your body has gone through ovulation, which is an essential part of hormonal balance and reproductive health.
Many women assume that getting a withdrawal bleed on birth control means their hormones are “balanced.” In reality, that bleed is not a reflection of their natural cycle at all. It’s simply the body’s response to the drop in synthetic hormones during the placebo week.
This matters because a withdrawal bleed does not indicate that ovulation has happened or that your body is making progesterone on its own. It can give the illusion of a healthy cycle, but it is really just the pill controlling your hormones rather than your body running its natural rhythm.
How to Tell the Difference
Well, it’s pretty easy. Just depends on whether you are on birth control or not!
On hormonal birth control (or discontinuing/changing your birth control): Bleeding is almost always a withdrawal bleed. The pill prevents ovulation by design.
Off hormonal birth control: If your cycles are regular and roughly 25 to 35 days apart, it is more likely that you are ovulating and having true periods.
Bottom Line
A true period only comes after ovulation, while a withdrawal bleed is the result of a hormone drop without ovulation. Both look similar, but they mean very different things.
✨ If you’d like support in understanding what your body needs to restore a healthy rhythm, I work one-on-one with women with PCOS in their 20s to mid-40s to create a personalized plan for regular, predictable cycles. Book a discovery call to learn more!