Can long-term stress affect the lack of spotting from withdrawal?

There are opinions that stress can have some effect on the absence of withdrawal bleeding, but I have not found any reliable results that would allow to confirm this. The absence of withdrawal bleeding may mean pregnancy if the tablets were taken incorrectly or if there were any confounding factors (medications, gastric problems). If you exclude such a possibility, the blame can be placed on the tablets themselves. It is known what mechanism lies behind the lack of withdrawal bleeding in the absence of pregnancy. In the case of two-component contraception, especially with a lower estrogen content, the lining of the uterus becomes very thin. Sometimes, during the whole month, it is not possible to build a layer abundant enough to cause withdrawal bleeding through its exfoliation. According to the Vines documentation, in the section: "What to do if there is no withdrawal bleeding on the days of taking the placebo tablets: If all the tablets were taken correctly, there was no vomiting or severe diarrhea and no other medicines were taken, it is very unlikely that the woman was pregnant. If the expected bleeding does not occur twice consecutively, it may indicate pregnancy. Contact your doctor immediately. Do not start the next pack until you are sure that you are not pregnant." I enclose additional information: https://www.gdziepolek.pl/artykuly/jak-prawidlowo-stosowac-antykoncepcje https://www.gdziepolek.pl/artykuly/jak-prawidlowo-stosowac-antykoncepcje https://www.gdziepolek.pl/produkty/81748/vines-tabletki-powlekane/apteki/w-warszawie