As far as contraceptive methods go, taking the pill is currently the most popular method of birth control in the UK, with 41 per cent of women taking it according to healthcare and pharmaceutical company Bayer . And yet, for 60 years we’ve been instructed to take a week-long pause in our combined contraceptive pill taking to allow for a “period” that’s not really a period at all and was originally devised to please the Pope. Never mind the fact that women’s health issues and pain have routinely not been acknowledged, studied or taken seriously , but we’ve designed an entire contraceptive method around appeasing the Catholic church by replicating women’s natural menstrual cycles according to Emeritus Professor of Family Planning and Reproductive Health at University College London Professor John Guillebaud.
Commenting on new guidelines issued by the Faculty of Sexual and Reproductive Healthcare (FSRH) that state that “there is no health benefit from the seven-day hormone-free interval”, Professor Guillebaud told The Telegraph that “the gynaecologist John Rock devised [the break] because he hoped that the Pope would accept the pill and make it acceptable for Catholics to use.” The Pope, as it happened, still wasn’t won over by this “natural” schedule, but women the world over have carried on taking the combined contraceptive pill in this 21 days on / 7 days off manner regardless because...a religious man might have liked it.
This isn’t the first time that Professor Guillebaud has spoken out about the previously outdated advice regarding the 21/7 pill taking system. In 2017 he told the Royal College of General Practitioners annual conference that the seven-day break routine “should be consigned to history” as it was “based arbitrarily on the calendar not on science.” Consultant gynaecologist at London Gynaecology Mr Narendra Pisal agrees, telling us that he’s been advising many women to skip the break routinely in his practice, because, aside from the Pope charming stuff, a seven-day dip in hormones can provoke detrimental effects:
“By taking the pill continuously you block a period completely and it also improves a lot of period-related symptoms such as heavy bleeding , pain and anaemia . Taking it continuously is also known to improve conditions such as endometriosis , adenomyosis and menorrhagia .”
“While taking the seven day break doesn't necessarily not make the adverse effects any worse or more common (such as headaches or sleep issues ) it’s known to cause cramping during periods and may also cause some mood swings when the hormones are withdrawn during a break.”
The new national NICE approved guidelines state that women can take fewer or no monthly hormone-free breaks to avoid such symptoms, which, as well as fundamentally improving many women’s quality of life, could also lessen the chance of pregnancy. As consultant in contraception and reproductive health Dr Tina Peers told Estée Lalonde’s On The Line podcast , “the pill actually has a high typical use failure rate of around 9 per cent.”, with Bayer reporting that a whopping 62 per cent of women have forgotten to take pills in the last six months. Anyone who’s taken the pill in the 21/7 fashion will know that the pill after the break is likely to be the most oft forgotten, and Dr Pisal underlines that this is an especially risky time regarding pregnancy:
“A lot of women may forget to restart the pill after the break and we know that forgetting the pill in the first half of the cycle is more likely to lead to failure of contraception. In theory, it will be a lot easier to keep taking the pill continuously.”
FSRH guidelines support this, saying that “if a hormone-free interval is taken, shortening it to four days could potentially reduce the risk of pregnancy if pills are missed.” But why take four days off at all?
Dr Pisal emphasises that, for some women, a hormone-free window might be preferable as “skipping the break can be associated with breakthrough bleeding, fear and anxiety regarding missing a pregnancy and theoretically higher risk of thromboembolism due to higher amount of hormones.” That said, these factors apply to a minority of women and an insistence on taking a seven-day break is as cultural in grounds as it is medical. As such, new guidelines suggest that “many women can safely be prescribed a one year supply, instead of the current three month supply at first consultation” and in a further modern-day update “consultations about do not necessarily have to be face-to-face; online provision
One glaringly obvious issue, however, is that many combined contraceptive pills are provided in packets of 21, or with a placebo pill week, thus the pill is likely to be prescribed as such for the foreseeable. Until new guidelines are implemented in a practical sense, Dr Pisal highlights that, while skipping the seven-day break will become more accepted, it’s technically “off-licence”:
“Continuous back to back use of the pill is outside its license terms and will continue to be off-license. The recent guidelines will make the back to back use more common but it will continue to be used in its conventional form for the majority of women. The pill has been ‘three weeks on – one week off’ for such a long time that it is unlikely to change but there will be some preparations in the future which will provide continuous combined pills without a break.”
Until then, sack off the Pope (where your contraceptive framework is concerned) and visit your GP to discuss what’s best for you, particularly if you’re experiencing any of the symptoms described above during your pill-free week. Dr Peers clarifies that even “taking two or three packets in a row followed by a four-day break could completely clear up these symptoms”, finishing by affirming that “there’s a lot of myths and misconceptions out there where the pill is concerned.” Don’t we know it.
Visit the FSRH website for more information