No Health Benefit From 7 Day Break From The Pill

Nicky Broyd

January 22, 2019

There is no health benefit from having a 7 day break from combined hormonal contraception (CHC) according to a new, NICE-accredited, clinical guideline from the Faculty of Sexual and Reproductive Healthcare (FSRH).

The new guideline for combined hormonal contraceptives based on the latest available scientific evidence covers the contraceptive pill, transdermal patch, and vaginal ring.

Dr Sarah Hardman, co-director of the FSRH clinical effectiveness unit, said in a media statement: "If a woman wants to avoid periods on combined hormonal contraception she can run the packets together – we don’t need a regular monthly bleed to be healthy, and lots of women welcome the option of avoiding bleeding.

"But women need to know that there is a small increase in some health risks with combined hormonal contraception, so it isn’t suitable for everyone. And if it isn’t used correctly there is a risk of pregnancy." 

New Guideline

As well as stating there is no health benefit from having a 7 day hormone-free interval after every 21 days of CHC use the FSHR contraception guideline says:

  • Women can, with safety, take fewer (or no) hormone-free intervals to avoid monthly bleeds, cramps, and other symptoms

  • If a hormone-free interval is taken, shortening it to 4 days could reduce the risk of pregnancy

  • Consultations about CHC do not have to be face-to-face and online provision is possible, although all the same checks must be made and the same information provided as at a face-to-face appointment

  • At the first consultation, many women can safely be prescribed a 1 year supply of CHC instead of the current 3 months

Risks

There may be no health benefit to having a 7 day hormone-free interval but the same risks that have been known for some time still exist - CHCs increase a woman’s risk of blood clot and breast cancer and shouldn't generally be used by women over 50.

Other contraceptives may be more suitable.

Dr Diana Mansour, FSRH vice president for clinical quality, said in a statement: "Pill-taking often isn’t perfect; the riskiest time to miss pills is at the beginning and the end of a pill-free interval. The guideline suggests that by taking fewer hormone-free intervals - or shortening them to 4 days – it is possible that women could reduce the risk of getting pregnant on combined hormonal contraception. 

"Women requesting combined hormonal contraception should be given information about its effectiveness and alternatives including long-acting reversible contraceptives (LARCs), the most effective methods of contraception."  
 

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