For decades, women taking the contraceptive pill have been advised to take a seven-day break each month to trigger a withdrawal bleed but in the UK, that's about to change. The Faculty of Sexual and Reproductive Healthcare (FSRH) have now updated their guidelines to reflect the fact that there is no known benefit to having this break – and no medical reason not to take the Pill every day of the month.
"It should be made clear to women that this bleed does not represent physiological menstruation and that it has no health benefit," the authors of the new guidelines state.
According to a survey conducted between 2010 and 2012, more than a third of British women aged 16 to 44 had used oral contraception in the last year. The majority use the combined oral contraception pill, which tends to come in packets of 21 active pills and seven sugar (placebo) pills to trigger a monthly withdrawal bleed. Less common but also available are brands like Seasonale that contain more active pills and fewer placebo pills, resulting in fewer withdrawal bleeds per year.
However, aside from a risk of breakthrough bleeding, which typically decreases with time, there isn't really a reason to have a withdrawal bleed, period.
"It’s not actually necessary to take a break from the contraceptive pill for a withdrawal bleed, it doesn’t do any harm to skip this break or take the combined oral contraceptive pill continually," Karin O’Sullivan, the Clinical Lead at FPA, a sexual health charity based in the UK, previously told IFLScience.
That seems to be the general consensus among gynecologists today and yet, medical guidelines have not changed to acknowledge this fact. Or the fact that one of the principal reasons it was added in the first place was to please a man – specifically, the Pope.
Indeed, while there is nothing wrong with having a withdrawal bleed as such, some women actually benefit from taking the active pills continuously, for example, if a health condition like endometriosis or dysmenorrhea is involved. Even those with milder menstrual symptoms may find it more comfortable to skip or shorten the monthly bleed. A 2014 study found that women who took the Pill continuously experienced fewer headaches and less fatigue, bloating, menstrual pain, and genital irritation than those who took breaks.
What's more, taking the Pill continuously or shortening the monthly break may improve its effectiveness as contraception. If taken "perfectly", the chances of pregnancy from the Pill should be close to zero but with "typical use", it is estimated that 9 percent of women experience unwanted pregnancies in the first year of use. According to the new guidelines, shortening this break can slash the likelihood of unwanted pregnancies by reducing the risk of 'escape' ovulation.
"The guideline suggests that by taking fewer hormone-free intervals – or shortening them to four days – it is possible that women could reduce the risk of getting pregnant on combined hormonal contraception," Diana Mansour, vice president for clinical quality at FSRH, told The Independent.
Of course, many women may continue the same pattern of 21 days on and seven days off. These new guidelines offer women that choice as well as the choice to shorten the withdrawal bleed or skip it altogether. Basically, it gives women more jurisdiction over their bodies – and that can only be a good thing.