Since its creation in the 1960s, the pill has become the most widely used form of contraception in the UK; in an ONS survey undertaken in 2006, 35 percent of women aged 16-49 using contraception indicated that they use it.
The standard directions for the combined pill - three weeks on, one week off - have long been understood by many of those using it as the most effective and only way to take it.
Recently however, some experts have begun to challenge this accepted notion, and put forth the argument that continuous pill-taking with no 7-day break makes this method of contraception more convenient and effective.
In this post, we’ll explore this argument, and discuss:
- the current guidelines for taking the combined pill
- if the 7-day break is outdated
- what the proposed benefits of the no 7-day break method are
- and whether someone should adopt the 365/365 method
Current guidelines for taking the combined pill
Most combined contraceptive pills instruct users to take one pill each day for 21 days and to stop taking the pill for seven days before starting a new blister pack. This method is sometimes referred to as ‘21/7’.
During the pill-free break many women experience a period-like bleed, known as a hormone withdrawal bleed. If the pill has been taken correctly, contraceptive cover is still maintained during the seven pill-free days.
‘Perfect use’ of the combined contraceptive pill makes it an extremely effective method of contraception, with a theoretical effectiveness rate of over 99%, and ‘actual use’ is said to be around 91% effective.
‘Actual’ use takes into account some aspects of method failure, such as forgetting to take the pill at the correct time, or missing one or two pills throughout the month.
Why is there a seven day break on the pill?
The 21/7 method has been accepted practice since contraception became available in the 1960s. However, recently there has been some debate about whether this is still the most appropriate way of taking the pill.
Professor John Guillebaud, an expert in family planning and reproductive health at University College London, has argued that the seven day break is outdated.
This method, developed 60 years ago, he said was not based on scientifically optimising the effects of the drug, but more ‘arbitrarily’ on making the use of it practical (a uniform seven-day break at the end of each month is relatively easy for patients to remember and observe).
But one of the major drawbacks of this method, according to Guillebaud, is that towards the end of the break, a small amount of ovulatory function may begin to return.
In a study published in 1990, Guillebaud and colleagues suggested that extending the seven-day break could increase the chances of ovulation in 23% of the study population. Professor Guillebaud has stated that continuous pill taking would reduce the likelihood of this happening.
This has led him to adapt a patient leaflet with revised instructions on how to take the pill following the 365/365 method, which he has called ‘the 21st century way to take the pill’. According to the leaflet, the ‘period’ bleed experienced during the seven day break is of no benefit to the patient and can be completely avoided.
It is possible that some patients who adopt the 365/365 method may experience irregular bleeding (spotting) but it is expected this would lessen over time, and these women would experience either none or much less bleeding overall.
The authors of the leaflet argue that a 4-day break in pill-taking could be advised to those who experience ‘unacceptable bleeding’, and no extra precautions would need to be taken provided perfect use was observed in the previous seven days.
They also go on to say that the 365/365 method would enable lower doses to be more effective.
(It’s important at this stage to clarify that there are already some combined pills that are classed as everyday (ED) pills, such as Qlaira. A pill is taken every day but the pack contains ‘dummy’ or inactive pills. Therefore, if you use this type of combined oral contraceptive, it is important to follow the instructions correctly in order to maintain protection.)
What are the benefits of not having a pill break?
Some patients may prefer to take the pill continuously for a number of reasons.
Professor Guillebaud suggests that omitting the seven day pill break increases the contraceptive efficacy of the pill.
But taking the pill every day without a break may also mean that someone is more likely to adhere to ‘perfect use’ and not miss a pill through error.
Furthermore, regular menstrual or withdrawal bleeds can be an inconvenience and cause women to experience uncomfortable symptoms. Patients who adopt a 365/365 pill routine might find that premenstrual symptoms, such as headaches and abdominal pain, are reduced.
Lower doses may also be more effective when taken in this manner.
Can I adopt a 365/365 pill pattern?
You shouldn’t make a decision about the pill on your own. The best person to speak to is your own GP or a sexual health clinic. They will be able to discuss the benefits of various methods with you in detail.
In short, you should continue to take your pill as directed by the doctor or nurse who prescribed it for you. The 365/365 method of taking the pill is not yet official guidance and is classed as an ‘off license’ method of prescription, and it can only be applied to non-phasic 20 mcg oestrogen pills.
Some GPs may be comfortable prescribing the pill to patients in this manner.
But as it stands, most doctors are perhaps more likely to prescribe a combined contraceptive pill according to the traditional (and official) 21/7 guidelines.
If you are interested in finding out more about taking the pill without a seven day break, speak to your doctor or visit a sexual health clinic.