Period after birth control

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Periods and the pill

The menopause is the time when your periods permanently stop. In the UK the average age at menopause is 52. The years before the menopause, when symptoms may begin to develop, are known as the perimenopause.

If you’re having sex and want to avoid pregnancy, contraception is necessary until you reach the menopause.

It is also sensible to use a barrier method of contraception, such as condoms, to avoid getting sexually transmitted infections (STIs), even after the menopause.

It’s advised you use contraception until you’ve not had a period or any bleeding for two years if you’re under 50, or one year if you are over 50.

Taking the combined contraceptive pill may mask the menopause by controlling menopausal symptoms, such as hot flushes and night sweats. It may therefore be difficult to tell when you are no longer fertile.

Hormone test for the menopause

There is no test that can absolutely define when the menopause has occurred. Your doctor can arrange a test to measure your levels of a hormone called follicle stimulating hormone (FSH). This blood test should be taken on the last day of the pill-free interval.

However, the test is usually only used in women over 50 who are using the progestogen-only pill. It is not a reliable indicator that ovulation has stopped in women using the combined contraceptive pill.

If you are taking the combined contraceptive pill, it does not change the time of your menopause, but you will continue to have period-type bleeds during the seven-day pill-free intervals for as long as you take the pill.

The combined pill can be taken until the menopause if you are healthy and a non-smoker. However, it shouldn’t be taken if you are 35 or over and smoke.

The progestogen-only pill (POP) can be taken until the menopause if you are a smoker. As the progestogen-only pill does not contain oestrogen, it will not control or mask any menopausal symptoms such as hot flushes.

7 Reasons for a Missed Period After Stopping Birth Control

On the other hand, if you had an underlying medical condition that was causing irregular cycles, like PCOS, hypothyroidism, or endometriosis, you can be sure that those conditions will rear their ugly heads again as soon as you stop taking birth control.

“Using a hormonal method of birth control to regulate irregular periods doesn’t solve an underlying hormonal imbalance,” says Dr. Camaryn Chrisman Robbins with Washington University Women & Infants Center. “But it can lead to improved quality of life by regulating cycles and promoting endometrial health. When someone stops using hormonal medication, it is likely those original symptoms will resume.”

  • RELATED: How Does Endometriosis Affect Pregnancy and Fertility?

Moy agrees, saying, “the underlying condition, or root cause, is still present, and will express itself when a woman goes off birth control. Many women believe that since they have a period on birth control, that they have achieved a normal cycle, but that is not the case. It is a mock cycle as the natural hormonal process is being suppressed by creating an imbalance.”

But that doesn’t mean birth control doesn’t help with some of these conditions. Robbins says, “hormonal contraceptives that contain both estrogen and progesterone are often used to treat symptoms of endometriosis and PCOS, like acne and excess hair growth.”

Sum this up to say that if you’re missing your period after getting off birth control, there is a reason behind it—you just have to find it. Here are the most common things that might be causing your cycle to be off track so you and your doctor can address them.

Stress

Small, daily stressors like missing the bus or getting the kids to school late shouldn’t wreak havoc on your monthly cycle. But if you’re experiencing significant stress from major life events, or you’re finding yourself stressed out of your mind from your daily grind, your cycles may become less regular over time. That’s because stress can affect your hormone balance, which plays a crucial role in maintaining a regular cycle where an egg is produced and the uterine lining is shed if the egg isn’t fertilized.

  • RELATED: 9 Reasons Why You’re Not Getting Pregnant

Low body weight

Dramatic weight gain or loss, regardless of your starting BMI, can always impact your cycle. But if your BMI is less than 18, you may experience what’s called secondary amenorrhea. That’s when your period, which started normally when you were a young teenager, stops altogether. Unless you are a competitive athlete, this is typically a good indicator that it’s time to check your diet and lifestyle and ensure you’re making healthy choices to get on the road to a higher body weight.

Obesity

On the flip side, having a BMI of 35 or higher is linked to a host of medical issues, including diabetes, heart disease, and of course, menstrual irregularities. Studies have found an exceptionally high correlation between obesity and missed periods. Similar to being drastically underweight, having a high level of adipose tissue in the body causes disruptions in normal hormone levels like insulin and sex hormone-binding globulin.

Polycystic Ovary Syndrome (PCOS)

One of the most common causes of irregular cycles is polycystic ovary syndrome, which is caused by increased levels of the male hormone androgen. Interestingly, obesity often seems to go hand-in-hand with PCOS, with some studies indicating that nearly 80% of patients with PCOS also have a very high BMI. While PCOS is not a curable condition, there are treatments that can help regulate your menstrual cycle and increase your chance of successfully getting pregnant.

  • RELATED: 4 Things You Need to Know About PCOS

Uterine polyps and fibroids

If you’re experiencing irregular cycles or spotting along with symptoms like pain during intercourse and lower back pain, it’s possible the root cause of your missed period is uterine polyps or fibroids. Both sound scary, but they’re actually pretty harmless; polyps are simply small overgrowths in the lining of your uterus called the endometrium.

Typically symptomless, polyps can cause disruptions to your monthly cycle and spotting between periods. Fibroids are growths found in or on the uterus that can cause painful, heavy periods. Why can polyps and fibroids cause you to miss your period? Because both occur in response to fluctuations in hormones that also regulate your cycle.

Thyroid Imbalance

Who knew your thyroid played such a huge role in your menstrual cycle? It seems strange, but it’s true. Your thyroid hormones directly impact your periods, and too much or too little (as in the cases of hyperthyroidism and hypothyroidism, respectively) can cause your cycles to become irregular or stop altogether.

  • RELATED: Will Thyroid Disease Affect My Baby?

Breastfeeding

Considering that nearly 50% of moms in the US breastfeed for 6 months or more after baby is born, it’s important to understand how breastfeeding affects menstruation. Numerous studies have shown that exclusive breastfeeding leads to a few months of amenorrhea (not having a period) immediately following birth. But there’s no definitive guidance on how long that lasts, and often, there aren’t any indications that your cycle is gearing up again. This can lead to an unplanned pregnancy if no other method of birth control is used.

To prevent this, many women turn to a “mini pill,” which is a progesterone-only birth control pill. According to Dr. Robbins, “A progesterone-only oral contraceptive pill is excellent for parents who are breastfeeding because progesterone pills do not interfere with milk supply. Estrogen has been shown to decrease the volume of milk, especially in early lactation. Many methods of contraception are safe to start any time after giving birth, and women can resume an estrogen-containing contraceptive after they stop lactating.”

Once your period does return after giving birth, it’s not unusual for it to be a bit irregular if you’re still nursing. But if your baby has been weaned for months and your period still hasn’t regulated, it’s worth a trip to your doctor to have your hormone levels checked.

  • RELATED: Could a Hormonal Imbalance Be Affecting Your Fertility? Here’s What You Need to Know

Weight gain after stopping birth control

Some women gain weight after stopping birth control, although this isn’t common. If you gain weight when you stop taking birth control, a healthy diet and exercise can help you get back to your previous weight.

Bleeding after stopping birth control

If you go off birth control pills in the middle of your cycle, you may experience bleeding slight spotting or bleeding before your next period. However, irregular bleeding after stopping birth control is a temporary phenomenon and should go away after a few months.

Cramps after stopping birth control

If you stop taking birth control pills midway through your cycle, you may experience cramping. For many, birth control pills minimize cramps. Once you stop taking the pill, you may feel cramping even when you don’t have your period for a while, and if you had cramps before you were on the pill, they may come back.

When will you get your first period after stopping birth control?

Most women will get their first period around two to four weeks after coming off the pill if they stop taking it in the middle of a pack. However, this can vary depending on what your monthly cycle is like. Weight, stress, health, exercise, and conditions such as polycystic ovary syndrome (PCOS) can also all affect your cycle.

Ovulation after stopping birth control

For many people, ovulation will start within a few weeks of quitting birth control pills. However, this can take longer, especially if you were using the shot for birth control.

Your health, the type of birth control you were taking, and how long you were taking it can all affect the amount of time it will take to restore hormonal balance, regular menstruation, and fertility.

You can track symptoms of ovulation, such as cervical fluid and basal body temperature, in the Flo app to get a more accurate prediction of when or if you’re ovulating.

Birth control pills can help women control their own fertility by preventing unwanted pregnancies. If you would like to stop taking birth control for whatever reason, it’s possible that you may experience irregular periods, cramps, and bleeding. The good news is these side effects are temporary and should go away once your body gets used to new levels of hormones.

What Happens to Your Period When You Stop Taking the Pill?

Coming Off of the Pill

Most women’s bodies will go back to normal hormone production after coming off the pill. In fact, it’s possible to become pregnant just a few days after you stop taking oral contraceptives. On the other hand, it could also take a few months for your body to begin ovulating and menstruating on its own schedule again — some women will experience a delay before their normal menstrual cycles returns, especially those who had irregular periods before taking oral contraceptives.

If you began taking a birth control pill to help regulate your period, your menstrual cycle may return to its original irregular behavior, or you may now have a more consistent pattern. If you’re waiting for a normal cycle to return but still don’t want to become pregnant, you’ll need to be vigilant about using another form of contraception, like condoms.

What if Your Menstrual Cycle Doesn’t Return to Normal?

If your menstrual cycle hasn’t returned to normal after a few months, your doctor will test your hormone levels, including human chorionic gonadotropin (HCG), to check for pregnancy. Testing other hormone levels can tell if there’s a problem with other endocrine glands such as the pituitary gland, for example.

Besides pregnancy, conditions that may prevent normal menstruation from returning include:

  • Ovarian dysfunction, including premature menopause
  • High levels of stress
  • Chronic anxiety
  • Extreme changes in weight

No matter what your reason for deciding to come off the pill — from wanting to become pregnant to choosing an alternative method of contraception — talk to your doctor first. Every type, dose, and brand of birth control pill works differently. Meeting with your doctor can help you get answers to any questions or concerns you have about what will happen to your body, especially your reproductive system. This visit will also give you the opportunity to discuss other forms of contraception if you don’t wish to become pregnant.

What to expect when going off birth control

About five years ago, I decided to stop taking the hormonal birth control I’d been on for a decade. I’d taken many different pills — from Ortho Tri-Cyclen to Apri (which I dubbed the “monster pill” for my wacko mood swings) and finally to Tri-Sprintec. I’d done my fair share of experimentation and I wanted to know: What does my body feel like on its own, without the birth control? How’s my mood? My sex drive? What’s my period like? My cramps?

I tried to think back to life before the pill — what were my periods like then? But the truth was, I had no idea. I’d been on birth control for about as long as I’d had a period. And that’s true for a lot of us, as the pill is often prescribed to us before we know our bodies well. It’s prescribed for pregnancy prevention, cramps, acne, mood swings, and headaches. According to the Guttmacher Institute, four out of five sexually active women have used the pill at some point in their lifetimes.

I spoke with Celia, 29, who transitioned from oral contraceptives to the ParaGard (a non-hormonal copper IUD): “It took awhile for my period to become regular on a 28-day cycle, but eventually it did. A few things I noticed pretty quickly were an increased sex drive (yay) and fewer mood swings. Oh, and my boobs shrank a cup size.”

Whether you’d like to stop taking hormonal birth control because it’s not working for your body, you’re sick of the side effects, you’re curious about trying a natural approach, or you’re planning to start trying for a family, there may be an adjustment period (no pun intended).

So, gather round, and let’s talk about transitioning off of the pill, hormonal IUD, vaginal ring, patch, or whatever your current hormonal BC of choice might be.

What is hormonal birth control, anyway?

When we say hormonal birth control, we’re talking about contraceptive pills, IUDs, the patch, ring, and Depo-Provera shot. Hormonal birth control uses synthetic hormones to mimic the estrogens and progesterones naturally produced in a woman’s body during pregnancy. (So, other birth control methods like condoms and spermicide wouldn’t fall into this category.)

Let’s talk about pills and IUDs specifically, since they’re two of the most popular methods:

  • Pills prevent pregnancy by preventing ovulation (the release of an egg during your menstrual cycle) so that there’s no egg available to be fertilized.
  • Hormonal IUDs prevent pregnancy by creating a thick wall of mucus around your cervix. The thick mucus acts like a plug to the cervix, making it very difficult for the sperm to get through and fertilize an egg.

Why women quit taking birth control

Aside from trying to get pregnant, some women stop taking hormonal contraception because of how it makes them feel.

One of the biggest side effects — and most talked about — is hormonal birth control’s effect on libido (for examplle, the pill decreases production of androgens, the hormone in charge of your sex drive).

Another side effect commonly cited is on hormonal birth control’s effect on mood, anxiety and depression. Anxiety and depression have been shown to fluctuate when women take hormonal birth control (for some women it makes symptoms better, for some, worse). But it’s difficult to say whether all those changes are due birth control, or whether they’re due to all of the other external factors that might impact your mental health (work, relationships, family, etc).

If you’re experiencing any of these side effects, quitting hormonal birth control might provide relief.

What happens when you quit birth control

We spoke with Kara Earthman, a women’s health nurse practitioner (WHNP) from Nashville, to get the scoop on going off all types of hormonal birth control. Earthman said that side effects will vary from person to person. If your initial reason for going on birth control was to deal with menstrual cramps, heavy flows, acne, or to shorten your period, “these original problems will likely resume after stopping birth control” — and if you were using an IUD, your period will immediately resume.

Those who struggled with PMS or estrogen-withdrawal headaches in the past may see symptoms come back (the “sugar pill week” included in some birth control packs have a small amount of estrogen that keeps headaches at bay). Earthman added that anyone who experienced breast changes after starting birth control might see another shift after going off it. “Basically, expect your pre-pill body to come back in full force.”

Some birth control pills have a small amount of estrogen in the “sugar pill week” (AKA the week of placebo pills), keeping these headaches at bay. But if you didn’t have headaches before starting the pill, you probably won’t suddenly get them after stopping.

Then there’s the twinge of pelvic pain some women experience on their periods. According to Earthman, “When on pills, ovulation is suppressed. Not all women can feel when they ovulate, but some do, and once off the pill, your ovaries resume business as usual.”

After quitting birth control, there’s also an increased risk for hair loss. One study showed that hormonal contraceptives change the rate at which your hair goes from the growing phase to the resting phase, and keeps it in rest mode for longer (although it’s important to note that this study is from 1970s). Hair loss can be hereditary, but it may be exacerbated by taking birth control and then stopping.

As for gaining or losing weight post-transition? According to Earthman, the only expected change would come after stopping the Depo-Provera shot, which is sometimes linked to increased appetite.

Luckily, some women might not notice anything different after going off birth control. One thing to keep in mind, though, is that for all birth control methods, excluding the Depo-Provera shot, fertility picks right back up. “So, it’s possible to get pregnant right away,” Earthman told me. But if you’re transitioning off of the Depo-Provera shot, “it may take up to a year before your fertility (read: ovulation) is back to normal.”

And now…the benefits of quitting birth control

On the plus side, Earthman said, “If there were any aspects of your birth control that you didn’t like (mood changes, decreased libido), you may see these problems resolved.”

Going from synthetic hormones to the real stuff: how to transition off of the birth control pill or an IUD

You can stop taking the pill safely at any point in your cycle, though it can be helpful to finish a pack so you can predict your next ovulation or period if you’re looking to plan or prevent pregnancy. As for an IUD, it can also be removed at any point, though removing it during your period when the cervix is naturally softer could be a bit easier.

Your body is really resilient—once you stop taking the pill, remove the patch, or an IUD, you’ll likely get back to normal fast. Cue the sighs of relief: “There typically isn’t much of an adjustment period where your hormones are concerned. The only exception is with the Depo-Provera shot, as the progesterone will impact your hormones for at least three months following your last injection,” Earthman said.

Recommendations from the expert

Earthman has a few tips for anyone looking to mitigate the side effects after quitting hormonal contraception. If you notice acne making its triumphant return, she suggests going to the dermatologist: “There may be other tricks to keeping your skin flawless aside from birth control pills.”

If you experience painful cramping and heavy cycles, 800mg of ibuprofen will become your new best friend. According to Earthman, if you take ibuprofen every eight hours for a couple days at the onset of your period, it can reduce pain and lighten your flow. Just a friendly reminder: “This is only applicable to women who are medically able to take ibuprofen.” In those cases, Earthman recommends decreasing your intake of refined sugars and fried foods, and looking to the practice of meditation and mindfulness to help with PMS symptoms. Sometimes, she said, SSRIs (selective serotonin reuptake inhibitors) can also have a powerful effect. Exercise has also been shown to be effective for cramping.

When it’s time to call the doctor

If your period doesn’t come back after two to three months after coming off birth control (diagnosed as amenorrhea), schedule a visit with your OB-GYN. For most women, though, regulation will happen within a month.

The exception here? If you were using the Depo-Provera shot, getting back to your normal cycle might take up to a year, according to Earthman.

Alternative non-hormonal contraception

For anyone looking to prevent pregnancy without taking hormonal contraceptives, you’ve got plenty of options. There’s, of course, the classic condom method, though you’ll have to remember to use one each time you have sex and it has a 15% failure rate. Similarly, you can use a diaphragm, cervical cap, or sponge whenever you want to reduce the chances of conception. If you’re hoping for another one-and-done contraceptive, the copper IUD might be the best choice for you (it’s also the most effective!).

So, if you’re ditching your pill or removing your patch, know that your body is likely to transition back to its “before” state over your next few cycles. And if you’re not feeling great, enlist your primary care provider (PCP), OB/GYN, dermatologist, some ibuprofen, or a trusty heating pad for support.

This article was medically reviewed by Dr. Jane van Dis, MD, FACOG. Dr. van Dis is an OB-GYN, co-founder and CEO of Equity Quotient, and Medical Director for Ob Hospitalist Group.

When will my periods come back after I stop taking the pill?


Your contraception guide

It can take a while for your periods to come back after you stop taking the pill.

Most women will have a period around 2 to 4 weeks after stopping the pill, but this depends on you and what your cycle is normally like.

Weight, health, stress, exercise and conditions such as polycystic ovary syndrome (PCOS) can all influence your cycle.

Your periods may be irregular when you first come off the pill, and you should allow up to 3 months for your natural menstrual cycle to fully re-establish itself.

This is because the pill contains the hormones that stop the release of an egg (ovulation) each month.

The first period after stopping the pill is known as a “withdrawal bleed”. The next one after this is your first natural period.

It’s unlikely that the time you’ve been on the pill will cause fertility problems. Some women conceive immediately after they stop taking it.

However, while the pill does not cause fertility problems, it can mask underlying problems you may already have, such as irregular periods.

You can get pregnant as soon as you come off the pill, so it’s important to use another form of contraception, such as condoms, straight away.

If you’re trying to get pregnant, it’s a good idea to wait until after you’ve had a natural period. This gives you time to make sure you’re in the best physical health for pregnancy – for example, by taking folic acid supplements, giving up smoking and giving up alcohol. It also helps your GP or midwife predict your due date more accurately.

Find out more about getting pregnant.

5 Things That Could Happen to Your Period When You Go Off the Pill

If you’re on the Pill, you likely don’t give your period all that much thought. Steady doses of hormones (often both progesterone and estrogen) in oral contraceptives help regulate your cycle, meaning you know just when to expect from your period every single month.

But when you go off the Pill? You might start to wonder not only when you’re actually going to get your “real” period back, but also what it’ll be like after being controlled for all of those years. Wonder no more. Here, ob-gyns outline what you can expect from your period when you stop taking birth control pills.

You may bleed a few days after stopping

When you stop taking a combination hormonal birth control pill—which has both estrogen, which builds up tissue in the lining of the uterus, and another hormone called progesterone—some tissue sheds off, which can cause a light bleed, explains Alyssa Dweck, MD, an ob-gyn and author of The Complete A to Z for Your V. This is also why you get a “fake” period on the Pill during the week you take the placebo pills, she explains. “A withdrawal bleed, by definition, is progesterone is being withdrawn and the bleeding that occurs,” says Dr. Dweck. “A withdrawal bleed is not technically, by definition, a period because it is not a result of ovulation.” So basically: After your withdrawal bleed, you still have to wait for your real period to come.

…and it could take a few months for that to happen

Think that because you’ve been on the Pill for 10 years it’s going to take *forever* to get your period back? That might not be the case: “Generally, the side effects of the pill and the impact on suppressing the hormone pathways are rapidly reversible,” says Samantha Kempner, MD, an ob-gyn and an assistant professor at the University of Michigan Medical School. “Even with long-term use of the combination birth control pill, most women can expect to resume ‘normal periods’ quickly.”

Still no period after three months? See your doc—they may want to check for issues like a thyroid condition or hormonal imbalances that could be keeping your period MIA.

Once you do get your period, it will likely go back to what it was like before you were taking the pill

Think back: Why’d you go on the Pill in the first place? Maybe it was because you were starting to have sex. But many women start taking oral contraceptives to help regulate an otherwise irregular period or control a condition like Polycystic ovary syndrome (PCOS), which causes infrequent ovulation and an erratic cycle.

When coming off the Pill, Dr. Dweck says, your period will usually return to what it was pre-hormones. Did it come like clockwork every 28 days? Was it super irregular? You can likely expect that to return off the Pill, she tells us.

But there’s also a chance your period could be totally different

The other side of that: If you’ve been on the Pill for years, your age, medical issues, stress levels, diet patterns, or exercise habits—all of which can impact your period—may have changed over time and could impact what your period looks like when you come off the Pill, says Dr. Dweck.

Say, for example, that you developed a thyroid abnormality while you were on the Pill. You might notice your period is more irregular than you remember because of that. “Your period may be different when you come off the Pill than it was before you went on, but that’s completely unrelated to the Pill itself,” she says.

You can get pregnant before you even get your period again

When your body realizes you’ve stopped taking the Pill (which Dr. Dweck says is basically immediately after you finish your pack), sometimes your brain thinks it’s time to ovulate, which means you can get pregnant right away, she says.

No period in sight? Says Dr. Dweck: “Number one, two, and three on the list of why someone isn’t getting their period after coming off the Pill for a while is pregnancy, pregnancy, pregnancy.”

Normal Periods
Birth Control and Your Period

Most women will use some form of birth control at some point in their lives. Find out how different types of birth control affect your period.

Many forms of birth control use progestin and/or estrogen hormones to prevent ovulation and/or implantation. These hormones also affect the uterine lining, and can lead to some spotting in between periods, and they do reduce your menstrual bleeding.

Explore Birth Control and Your Period:

How will my birth control affect my bleeding?
When should I see my doctor about irregular bleeding associated with birth control?
Side effects of hormonal birth control

How will my birth control affect my bleeding?

Birth control methods such as the pill, patch, vaginal ring, shot and IUD can all impact your menstrual bleeding. Some birth control methods can increase bleeding, and some can decrease it. Many aspects of bleeding can be affected, and these effects can change over time. Periods can be longer, shorter, heavier, or lighter, depending on the method of birth control. Spotting and irregular bleeding are common side effects of most methods of hormonal birth control, especially in the first few months of use.

Birth control pills

Birth control pills were originally only packaged as 28 pills – 21 pills containing the hormone(s) required to suppress ovulation, and 7 placebo pills (no active ingredients). The 7 days of placebo were designed to allow menstruation to occur. Today there are a variety of regimens available, such as 24 days of active-ingredient pills and 4 days of placebo, and extended-cycle regimens that can be taken for up to a year to stop all menstrual bleeding.

No matter which birth control pill you are taking, you may experience irregular spotting or bleeding during the first few months of taking the birth control pill. This is more common when you are taking progestin-only pills (the ‘mini-pill’), compared to combination pills that contain estrogen and progestin. It is also more common to have spotting when taking a ‘monophasic’ pill (same dose of hormones every day), compared to a ‘triphasic’ pill (different dosages over the cycle). Spotting can also result from forgetting to take a pill, or taking it late. Taking your pill even a few hours later than normal can cause spotting, especially with the progestin-only pill.

Injected and implanted contraceptives

Irregular, unpredictable bleeding is very common in women using long-acting, progestin-based birth control methods (e.g., Depo Provera®, Implanon®). After a year of use, about half of women will have no periods.

Intrauterine devices

There are two types of IUDs available, the copper IUD and the progestin IUD. With the copper IUD, spotting between periods and heavier, longer, and more painful periods are common in the first three to six months. Most women find this improves over time, and normal or near-normal periods resume after a few months.

With a progestin IUD, spotting between periods and irregular periods are common in the first three to six months. Usually this improves over time and many women ultimately have light or absent periods with the progestin IUD. The progestin IUD can be effective for many years (a new one is reinserted after 5 years). A smaller mini-IUD is also available, and may be preferable for women who have not had a child.

Vaginal ring

This small, flexible ring is inserted high in the vagina, and releases estrogen and progestin, which prevent ovulation. The vaginal ring is usually left in for three weeks, and then removed for a week to allow menstruation to occur but it can be used continuously or in an extended fashion with a new ring every month. Spotting between periods may happen, particularly in the first three months.

Emergency contraceptives

The ‘morning after’ pill may affect the length of your menstrual cycle, causing your period to come earlier or later than you were expecting it to. If you take emergency contraceptive pills in the first three weeks of your cycle, your period is likely to come early. Your period may also last longer than normal. In most cases, the earlier you are in your cycle, the sooner your period will come. If you took emergency contraception in the later part of your cycle (after ovulation), your period may be delayed. Some women also experience spotting between periods after taking emergency contraception. Your next menstrual cycle may also be slightly longer than normal, but if your next period is more than a couple of days late, it is a good idea to use a pregnancy test.

Emergency contraception is not to be used as a regular method of birth control but, if needed, it can help prevent unplanned pregnancies.

When should I see my doctor about irregular bleeding?

Since every woman’s body reacts differently to these birth control methods, it can be hard to know when irregular bleeding is abnormal. You should see your doctor if you experience abnormal bleeding:

  • And are pregnant
  • And have a lot of pain during your period
  • After intercourse
  • And you have been using the same method of birth control for more than three months
  • That is unexpected
  • And you are younger than 8 years old or have no other signs of puberty and have vaginal bleeding

You should also see your doctor if you are taking a combined contraceptive pill and your periods have stopped completely during the week of placebo pills, although in many cases this can be normal.

There are treatments available for irregular bleeding (e.g., ibuprofen, supplemental estrogen) that can help, or your doctor may recommend changes to your birth control method.

Side effects of hormonal birth control

You may experience side effects when using any type of hormonal birth control. These vary a little depending on which type of birth control you are using. Tell your doctor about any side effects that are bothering you.

Although it is rare, hormonal birth control methods, especially those that contain estrogen, increase your risk of developing a blood clot in your leg (deep vein thrombosis). Seek medical help immediately if you have trouble breathing, which can happen if a clot moves into your lung (pulmonary embolism). A pulmonary embolism is a medical emergency.

For more information on contraception options, including their advantages and disadvantages, .

Photo-Illustration: by Preeti Kinha; Photos: Getty

Every day since I was 15 years old, I have taken “the Pill,” a pale-pink tablet containing a combination of levonorgestrel and ethinyl estradiol, two chemicals that trick my body into thinking it’s pregnant so I can’t actually get pregnant. Since it came on the market in 1960, the Pill — a catchall term for a variety of oral contraceptives containing differing combinations of synthetic hormones — has been the most common form of birth control used in the United States, utilized at some point by four out of five sexually active women. While there are a number of other popular hormonal-birth-control methods, such as the IUD and the NuvaRing, none enjoy the popularity and cultural significance of the Pill.

In high school in Toronto in the early-aughts, it seemed like every girl I knew was put on it, for some reason or another, whether or not she was sexually active. This could be because, as science historian Elizabeth Siegel Watkins notes, marketing around the Pill began to change in the 1990s, with oral contraceptives being promoted not just as a birth-control method but as a “lifestyle” drug with a host of benefits, like treating acne or diminishing menstrual pain. Many of us went on the Pill and then stayed on it through young adulthood, without giving much consideration to the question of what long-term hormone usage might be doing; I took the Pill every day for 13 years without knowing much about it.

Until three months ago, when I quit. In a development that the Pill’s earliest advocates would likely find strange — and concerning, given the increasingly tenuous status of Roe v. Wade under a conservative Supreme Court — many women I know are beginning to question hormonal contraception, particularly its effects on mood and behavior. I wanted to know what was causing us to suddenly doubt something we had been swallowing for years without much thought at all, and how we feel now that we’ve stopped.

The current scientific consensus is that the majority of women do not experience adverse side effects from the Pill. Even so, Dr. Erika Banks, director of gynecology at New York’s Jack D. Weiler Hospital, said she’s noticed an increase in patients coming in with vague concerns about long-term hormone use. “I’m not really sure where they’re getting that information,” she said.

And yet there’s less conclusive data about the subtler ways the Pill might affect us when it comes to mood or sex drive or overall quality of life, all of which are harder to quantify. Some women who’ve quit the Pill told me they’ve seen a reduction in anxiety or depression; some have seen an increased libido. For others, the effects were more nebulous: I heard phrases like “more alive,” “more clear,” “more myself,” and “like a fog had lifted.” The more I spoke to people, the more obsessed I became with the idea that one little tweak to my hormonal network could be affecting everything I take for granted about myself. What might hormonal contraception be doing to our minds, our moods, our behavior? And if science hasn’t yet found a clear answer, how much does that matter?

It feels precarious to even be asking these questions right now, given the fact that women’s access to abortion and contraception in the U.S. is under siege. Nine states have passed legislation to ban abortion early on in pregnancy, though they are likely to get blocked in the courts; Ohio’s bill contains language that reproductive-rights advocates say could eliminate health-insurance coverage for contraception, including birth-control pills. Meanwhile, the Trump administration inches closer to defunding Planned Parenthood. The pro-choice climate that allowed our current wave of Pill skepticism to flourish is beginning to look like a thing of the past, and women’s ability to question their contraceptive choices feels increasingly like a luxury. As attacks on women’s bodily autonomy continue, quitting the Pill remains the purview of privileged women in liberal enclaves who have the time and resources to use things like non-hormonal IUDs and cycle-tracking apps — not to mention health care and therapists and access to abortions and morning-after pills when such methods fail. The Pill is still, for a great many women, the best and easiest option. Speaking about “influencers” who advise quitting the Pill without addressing the consequences of a lack of abortion care, Dr. Jen Gunter, a writer and ob-gyn, said, “I would say maybe these women should see what it’s like when people have to cross picket lines to get the kind of health care they need.”

Is it anti-feminist to question the Pill? It’s true that right now we need effective, accessible birth control more than ever. It’s also true that much of our current wave of Pill skepticism lives in that nebulous realm where fear of the medical Establishment and “wellness” trutherism intersect, one that — much like the anti-vaxx movement — easily veers into the realm of paranoia and pseudoscience. On the other hand, questioning the Pill can be viewed as stemming from the same feminist instinct that engendered the Pill’s rise: a desire to ask good questions and make informed decisions about one’s own reproductive future. It’s just that there never seems to be a good time to ask these questions. The daily onslaught against women’s reproductive rights makes it feel like expressing dissatisfaction with the status quo is an act of naïve privilege, even if it’s a status quo many women were not happy with.

Even though the Pill has given us freedom, it’s also the result of a culture that expects women to bear the costs — financial and otherwise — of preventing pregnancy. It’s also true that it comes with side effects that women have been expected to quietly accept. In 2016, a clinical trial of a promising hormonal contraceptive pill for men was halted for safety reasons. (Headlines at the time focused on the fact that a number of the men complained of adverse side effects, many of which may sound familiar, including acne and mood swings.) Maybe now, in this moment of exploding feminist rage, women have simply had it up to here with having to bear all these potential ill effects alone. It’s something Regan, 29, considered when she stopped taking the Pill — and when she persuaded her sisters and a lot of her closest friends to do the same. She lives in Toronto, where abortions remain relatively easy to access (for now). Now she says she uses condoms. “I really just had a moment of like, Okay, I’m doing this just so I can have unprotected sex — and at what cost to me?”

What is the cost to women like me and Regan? Hannah, a 25-year-old Brooklyn-based writer and illustrator, went on the Pill to manage PCOS in her late teens. Soon after, she started fantasizing about walking into traffic. When she brought up her concerns with her doctor, she received a “weird amount” of resistance, so she went off the Pill on her own. Indeed, many of the women I spoke to say that health-care professionals failed to listen to their concerns about the ways the Pill was affecting them. It’s a valid concern. Women’s health — particularly mental health — has long been an understudied area. As Maya Dusenbery writes in Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick, women suffer from both a trust and knowledge gap; doctors know less about how women’s bodies work than men’s, and women’s subjective stories are less often believed. Yet going off the Pill without professional guidance can be risky. Various health issues that existed prior to starting the Pill can recur. The biggest risk, of course, is that you could get pregnant. Most of the women I spoke to have replaced the Pill with other methods of birth control: condoms, other hormonal methods like the IUD (which could also have psychological effects), cycle-tracking apps, and the pullout method. These are of varying efficacy; the latter two, in particular, have high failure rates.

“Everyone has a different risk-benefit ratio,” says Gunter. “What if you were somebody with really difficult-to-treat depression and you decided to stop the Pill because of what you saw on social media, and then you had an unplanned pregnancy and were living somewhere where you couldn’t get an abortion? Definitely if you’re having depression, you should talk with your provider about whether contraception could be part of the picture. But it’s also important to remember that if you are at risk of getting pregnant, what’s going to be the plan? Because an accidental pregnancy is also not going to be good for your depression.”

In Hannah’s case, the psychological benefits of quitting the Pill outweighed any potential risks. Now she uses the Liletta IUD, which she got after extensive personal research, and conversations with her ob-gyn about how the hormones in the IUD differ from those of the Pill. “Within a few weeks of stopping the Pill, color returned to the world,” she told me. “It felt so cliché — like the episode of The Simpsons where Lisa goes on antidepressants and everything was all smiles. Within a few weeks the world was totally manageable, and I was like, Why did I wanna get hit by a bus so bad?”

When it comes to the Pill’s effect on women’s mental health, we still hold only a handful of the pieces to what could end up being a many-thousand-piece puzzle. “Most of the research women hear about is all from the neck down — increased risk of this or that health problem — but they don’t really talk about what it does to the brain,” said Dr. Sarah Hill, a professor of psychology at Texas Christian University and the author of the popular-science book This Is Your Brain on Birth Control, which will be out this fall. The book is inspired by her research, but also by her own experience of quitting the Pill about ten years ago after being on it for a decade. “I feel like I climbed out of a black-and-white drawing into the real world,” she told me. “I had felt flat and one-dimensional, and suddenly I felt so much more vibrant and alive. It was like waking up.” Hill had been studying women’s mental health for over 15 years, yet it had never really occurred to her that the little pill she took every day might be affecting her psychology in dramatic ways. “I realized like, Oh yeah, that’s right, hormones influence the brain, and if you change hormones you’re going to change what women’s brains do.” She laughs. “It was a pretty embarrassing epiphany to have as a psychologist.”

One reason for the dearth of research on the Pill’s mental-health effects is that doing research on women is more complicated and expensive than on men, as a result of the need to take into account participants’ unique hormonal cycles. A 2012 review of the research noted that “surprisingly little” is still known about adverse-mood effects from oral contraceptives. Based on the studies we do have, about 4 to 10 percent of women report deterioration in mood (although it’s likely that not all of these are caused by the Pill). Then again, a similar fraction of women see improvements in mood on the Pill, particularly those who suffer from PMS or premenstrual dysphoric disorder.

In recent years, there have been new developments, though nothing conclusive. A much-publicized 2016 Danish study found a correlation between depression and hormonal-birth-control usage, noting that women on the Pill were 23 percent more likely to go on antidepressants. A 2017 Swedish study, on the other hand, found no increase in depression, but did find a general decrease in quality of life (mood, energy levels, etc.) in women who took the Pill for three months.

Without much scientific data to go on, it’s tempting to be swayed by anecdotal evidence like Hannah’s story, and the rise of social media makes sharing stories like these easier than ever. While Gunter says women have had concerns about being on long-term hormones for as long as she has been in practice and that they have traded scary stories about the Pill’s side effects for as long as it has been on the market, she sees social media as amplifying the conversation about its “harmful” effects. She points to “the illusory truth effect,” where the more you hear something, the more you believe it to be true. While she doesn’t discount women’s experiences, she notes that it can be hard to tease out cause and effect. “There’s a huge placebo effect if you think you’re going to feel better,” she said. “There’s also the nocebo effect. If I tell you the Pill is going to give you side effects, you’re more likely to have them.”

While there’s little risk in listening to friends or influencers when it comes to, say, the benefits of meditation or yoga, choosing a method of contraception based on word of mouth can be risky, particularly because the internet is rife with misinformation. In many ways, this proliferation of questionable science represents the dark undercurrent not just of social media but of our current wellness boom. Thus far, many of the outspoken anti-Pill advocates don’t have the most pro-science track record. Like anti-vaxx rhetoric, much anti-Pill literature is rooted in a deep distrust of pharmaceutical companies and mainstream medicine.

In her anti-Pill polemic Sweetening the Pill, soon to be a documentary, writer Holly Grigg-Spall argues that hormonal contraceptives are “tools for a patriarchal society to have a ‘hold’ over women’s bodies.” Suppressing our natural periods makes us more like men, she hypotheses — “docile bodies” less prone to the volatile swings of our “natural” female hormones, and more effective cogs in the patriarchal capitalist machine. (Grigg-Spall’s book was panned in Slate and The New Inquiry for being unscientific and cherry-picking evidence to fit her claims.) And then there’s Kelly Brogan, a “holistic psychiatrist” who has spoken at Gwyneth Paltrow’s Goop summit, who advises her patients to quit birth control. Brogan also doesn’t believe in psych meds, has expressed skepticism about the efficacy of vaccines, and believes HIV doesn’t cause AIDS. On a 2017 episode of the Joe Rogan podcast, she described birth control as “the ultimate tool for oppression of the modern woman” — an idea that is not only patently absurd but dangerous.

But while anti-Pillers like Brogan and Grigg-Spall think the Pill is bad for all women, most clinicians advocate instead for the importance of each woman’s taking an individualized approach. A lot of women who went on the Pill as teenagers say that, in hindsight, they didn’t feel they were given all the information. “I think part of the disservice that the medical community has done to women in this area is that they have not explored the complexity of individual differences in responses from some women,” said Dr. Tory Eisenlohr-Moul, an assistant professor and scientist at the University of Illinois at Chicago, who uses experiments to understand how hormones impact mood in women. Levels of estrogen and progesterone naturally fluctuate at different points in our cycles, which can affect mood in some women. The Pill makes it so the levels of these hormones are more stable throughout the month. While one woman may report feeling like a “zombie” on the Pill, disconnected from her emotions, another may report feeling more stable, calm, and happy. Eisenlour-Moul advises her patients to listen to their bodies, because we’re all different and we shouldn’t presume what worked for another woman will work for us. “The goal is to be a little more thoughtful about giving your body what it needs to thrive instead of just assuming that what has been true for someone else is sure for you or making the logical fallacy that natural is better. Give yourself more credit for being the unique brain and body that you are.”

Hill was in the former camp, and after she went off the Pill, she started to dig into the research. What she found is that there might be solid biochemical evidence for what you could call a “lack of vibrancy,” the general dullness or lifelessness that some women report. “Pill-takers have lower levels of estrogen and unbound cortisol than non-Pill-takers,” she told me. “And these hormones are part of the signalizing machinery that make us feel like ‘us.’ For example, we know that estrogen increases a woman’s attunement to courtship cues and flirtatiousness. And we know that cortisol is something that plays a role in helping our brains absorb meaning from our environments. Having lower levels of these hormones may make Pill-taking women’s brains less excitable and less able to absorb all of the depth of their experiences than non-Pill-taking brains. It may make life feel more flat.”

While only a small percentage of women suffer from severe depression on the Pill, Hill thinks that the number of women who have some negative psychological side effects is probably much higher. “Lack of vibrancy” may not be up there with unwanted pregnancy or major depressive disorder, but it’s certainly a big deal to the women who experience it. “I think the only time that doctors consider something a psychological side effect is when somebody goes into a full-blown clinical depression,” said Hill. “It’s pathetic that our mental health doesn’t get taken very seriously unless it’s the absolute rock bottom of the barrel.”

Hill’s book looks at how hormones can influence things like mood, sexual attraction, stress response, and a whole range of other things, and calls for more research into the effects of long-term hormonal contraceptives on both an individual and societal level. “This book is sort of making women aware of how their hormones work and how they’re really a key part of who we are,” she said. “You can’t change women’s hormones without changing women, and I think we’re just hitting the tip of the iceberg now in terms of how it can influence how we experience the world.” In rare cases, she said, women have gone off the Pill and found that things they’d felt certain of — like their work-life balance or their choice of partner—suddenly felt wrong. “There are women who built their whole lives when they were on the Pill, and they go off it and don’t know what to do because they feel like they don’t recognize it — they built a life that they don’t want anymore.”

Some women say the Pill drains their libido, and a number of studies have found evidence to support that (although, according to Psychology Today, less than half of 1 percent of the published research on the Pill has been on libido). But decreased sex drive is not just a side effect listed on a pamphlet. While it used to be enough of a miracle benefit simply to be able to have sex without getting pregnant, today sexual fulfillment is intrinsic to being a modern woman.

Of course, many women go off the Pill and feel worse, suddenly finding themselves in the grip of unexpected physical symptoms and tumultuous mood swings. As for me: I have been off the Pill for three months now. So far I have been using condoms, though it doesn’t feel like a long-term solution (they are awkward and I hate them). Yet I can’t deny that I feel better. I’m less anxious. It feels like a sharp edge has been removed; like I’m not vibrating at quite the same neurotic frequency that I’m used to. As great as this change is, it’s also difficult to process. If the Pill really has been increasing my anxiety, then could much of the past 13 years of emotional turbulence have been avoided simply by switching my birth control? It’s hard not to look back and wonder. It’s also hard to imagine any other birth-control method that would have provided the same ease and peace of mind about unwanted pregnancy throughout a tumultuous period of my life.

To be a woman in the world is often to be content with choosing from a buffet of unappetizing alternatives. I don’t know how hormonal birth control might have changed me, because no one does. At least now we’re starting to ask these questions — even if a satisfying answer still seems a long way off.

As a 14-year-old in Los Gatos, California, going on the birth control pill was a no-brainer. I was in my first serious relationship and it seemed like all my peers were going on it. Some to regulate outrageously heavy periods, some for acne and others because they were having sex, plain and simple.

Sure, there might have been an underlying fear of teenage pregnancy coming down from our parents and pediatricians. But who could blame them? This was the ‘00s (or the “noughties?”). The decade that brought us shows like “Teen Mom” and “16 and Pregnant.” What a hell of a time to hit puberty.

It was also a high time for prescription drug use in minors and a general pathologization of puberty. Almost everyone I knew had a prescription for something in grade school. Think birth control, Adderall, Accutane… whatever it took to avoid being an awkward, scatterbrained adolescent.

When I say going on birth control was a “no-brainer,” I mean it. There wasn’t a lot of thought involved. There was no debate or grand discussion. No moral dilemma whatsoever. Choosing to go on birth control was a non-event. I don’t remember if it was my own choice or if my mom suggested it. I might have asked for it to “regulate my cycle,” but it was definitely for birth control. My period was light and relatively painless before going on the pill.

Thinking back, I don’t even remember getting my first pack. I don’t remember my doctor’s name or what she looked like. I don’t remember feeling any different on the pill.

I do remember failing to take it for days at a time, doubling doses and skipping periods altogether by starting a new pack early (my doctor said it was totally safe to do so, and I took full advantage).

Freshman year of high school. The year I went on the pill.

I was on the pill throughout high school and college with no problems. I was healthy and didn’t get pregnant. Achievement unlocked.

Ten years later. 24 years old. Still on the pill. But, no longer in the U.S.

I moved to Berlin to work for Clue in May 2015 (#bestjobever #downloaditnow #yesimonthemarketingteam) and with that, I started learning a lot about my own reproductive system.

I had no idea that I wasn’t even ovulating on the pill. I had no idea that my period was withdrawal bleeding and not a real period at all. I had no idea how short the fertile window is for people not taking hormonal birth control (up to 7 days depending on sperm strength, by the way). I had a vague understanding of ovulation from high school biology class, but if you asked me what it was, I probably would have froze.

I didn’t have to think about my reproductive system on the pill. I knew when my periods were coming, they didn’t faze me and I could even plan when to have them.

The health risks of the pill never reallllly crossed my mind.

Except when all those legal ads started airing on TV about pill-induced blood clots, heart attacks and strokes. Those were pretty alarming because at any given point I was on Yaz, Yasmin AND Ocella. And Zarah. And maybe Nikki. This is starting to sound like a Petey Pablo song.

Working at Clue naturally coincided with more tracking and awareness of my own cycle. I started to wonder:

Is it okay that I’ve been taking artificial hormones for over ten years?

What would happen to my body if I went off the pill?

What about my emotional stability?

I started to wonder if I should go off the pill, but I was concerned about the drop in estrogen levels and what that would mean for my mind and body.

When I was 22, my doctor recommended swapping my prescription with a lower dose pill. She said the pill I was on could cause blood clots. Like a good patient, or any regular person who doesn’t want blood clots, I made the switch right away.

But the lower hormone dose made me go totally berserk. My mood was all over the place, so I re-upped my dosage to restore a level head.

This little snafu didn’t exactly motivate me to lower my dose again, let alone go off the pill, but I was still curious to see what would happen if I quit cold turkey.

After three months in Berlin, my CVS prescription was dwindling, so it felt like the opportune moment. I stopped the daily pill popping in July 2015 and started to track what happened.

How fun! Well, not really. After three months off the pill, I felt like an ogre. It was bad. I experienced:

My periods were excruciating and my cycles were short. I was getting my period nearly every two weeks. I was in so much pain that some days I had to miss work (like many other women around the world).

Oh, and declining self-confidence DOES NOT pair well with increased sex drive.

My Clue calendar. Two periods per month.

Everyone told me it would take a while for my body to adjust, so I rationed for a few shitty months. But it didn’t get better. Not even after six months. I felt disconnected from my body.

And this is when shit hit the fan. The first days of each period were debilitating. I was going through tampons every 30 minutes. Before and during my period I would cry for no reason. I never woke rested. I was sleeping in late and had no energy (for someone who’s been a spastically energetic morning bird my whole life, this was telling). Even when I wasn’t on my period, I was uncomfortably wet. I was breaking out worse than I had when I hit peak puberty. I hated who I saw in the mirror.

I lost myself. And you know the saying, “if you don’t love yourself, who will?” Well, yeah, that’s true. It was hard to maintain a romantic relationship during this transition.

Pro-tip: Don’t make any radical changes to your prescriptions during a big life transition or move. Being on a new continent likely amplified my symptoms and made the whole chemical imbalance more overwhelming.

I decided to take action. I was done feeling like crap. I was sick of hearing how terrible the pill was when it helped me so much. On top of that, I was done feeling judged for my choice of birth control. Since coming to Europe last summer, I noticed people over here are generally more skeptical of the pill and more keen on natural family planning (fertility awareness). Because of this, I felt impure and slightly judged by people when I told them I was on the pill.

Before running straight back to estrogen and progestin, I wanted to see if there were any alternative treatments, so I went to a new gynecologist in Berlin.

Like most German doctors I’ve seen so far, the appointment was quick and to the point. She asked me what was wrong and firmly said: “The pill is the only option.” I pleaded with her and said, “there’s got to be another option — is there any treatment for heavy and irregular periods without hormones?”

“Nein.”

Then she proceeded to write a prescription without asking me if I wanted it. Within five minutes, I was walking back down Adalbertstrasse, and I was mad. Why is this my only option?

I didn’t want to cave in so easily, so I didn’t go to the pharmacy and fill the prescription. I wanted to keep my experiment going a little bit longer. Plus, I refused to believe that I needed the pill.

So on my next trip to California, I saw a doctor at the trusted Palo Alto Medical Foundation.

My American doctor said I was experiencing heightened levels of male hormones and recommended an antiandrogen. So I tried out spironolactone, which was primarily for hormonal acne, but seemed to be promising for my other symptoms as well.

I didn’t feel much better after a few weeks on spironolactone. And I didn’t like having to take two pills a day, morning and night. This is when I decided to go back on the pill.

New German prescription

So after eight months pill-free, I’m on MAYRA now. And yes, that’s a fiery redhead on the box. Pill branding is terrible in Germany too.

Since starting again, I’ve literally taken back control of my hormones and my body. And most of the annoying symptoms diminished within the first cycle.

My period isn’t an issue any more. The emotional window before my period is less intense. Little things that really irked me during PMS are less dire now. I’m able to move on. The painful cramps are gone. My skin is clearing up. I’m waking up early again, and with energy. I’m happier.

Sure, the pill is not for everyone and I’m definitely not trying to convince anyone to go or stay on the pill. Everyone is different. Our genetic makeup, lifestyle and environment play a huge role. For some people, being ON the pill has just as irritating side effects.

There is no one-size-fits-all treatment. Do what feels best for you. I know that might seem painfully obvious, but it’s not as easy as it seems. Especially without understanding the ins and outs of your own system.

We’re lucky to be living in a time when people are becoming more and more aware of their bodies. Being a part of the progress at Clue gives me hope that my daughter won’t ever be rushing down the street, frustrated and torn over what to do to achieve hormonal harmony. She’ll never feel out of control of her body. And hopefully, she’ll have a few more options.

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