Nine percent of women of reproductive age take the Pill worldwide. What most of them don’t know is that the seven placebo pills taken in the final week of the four-week cycle are unnecessary. That’s right – you do not have to have your period at all. Instead, you can take the Pill continuously for as long as you like. (Although it is always a good idea to check in with your health provider first.)
“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, told IFLScience. “In fact, many women already do this when they go on holiday or if they tricycle packs.”
"Providing it is safe for women to take the combined oral contraceptive pill and there are no medical contraindications then it is safe for women to use any of the pill taking regimes," O’Sullivan added, whether that is traditional (with regular breaks), tricycling (a break every three packs), extended (no breaks), or flexible (taking breaks but not falling into one of the previous categories). There is no biological evidence that "giving your body a break" makes any difference. There is no build-up of hormones and when you stop taking the Pill, the effects are immediately reversible.
Let’s get things straight. The period you get when you’re on the Pill is not really a period at all. It’s a withdrawal bleed. This is the body’s response to the sudden drop in hormones that occurs when you stop taking the active pills and switch to the placebo pills. The difference between the withdrawal bleed and a regular period is that when on the Pill, the uterine lining (endometrium) doesn’t have the chance to build up. It remains thin. This makes the bleed lighter than a regular period – and much less necessary.
“I sometimes describe that as the difference between shag rugs, and a normal period to indoor-outdoor rugs when you’re on the Pill,” Susan Wysocki, Editor in Chief of journal Woman's Health Care, former President and CEO of the National Association of Nurse Practitioners, and President of iWoman’s Health, told IFLScience.
However, even if you do decide to take the Pill continuously, you may experience what is called break-through bleeding – that is bleeding or spotting between periods. This is not harmful, O'Sullivan says, but some people may choose to take a break and then resume the Pill again after a few days (flexible regimen). If you decide to persevere, these symptoms may dissipate with time.
"Breakthrough bleeding typically decreases over time, however, as your body adjusts to the new regimen," the Mayo Clinic explains, before adding "If breakthrough bleeding becomes heavy or lasts more than seven days in a row, contact your doctor."
But back to the placebo pills. If they are unnecessary, why do we have them and where did the idea come from in the first place?