- The combined oral contraceptive pill (COCP) contains a synthetic oestrogen and progesterone. There are numerous different combinations and doses with over 20 different COCP’s currently on the UK market.

- It works by stopping ovulation. No ovulation = no egg released = no pregnancy

- It is traditionally taken in 21/7 fashion: one pill per day for 21 days and then a 7-day break. You will bleed during this break due to the withdrawal of your hormones during this time.

- The bleed you have on the Pill is not a ‘period’ as such. It’s still your womb lining falling away, but it didn’t happen due to your own natural hormone production, it’s because the body is ‘withdrawing’ from the lack of COCP. I previously did a post on ‘fake periods’ so check it out here.

- The Pill also keeps the lining of the womb relatively thin which is why the bleeds you have on the Pill are often lighter than without.

- The riskiest time for missing a pill is at the end or the start of the Pill pack (ie. having an 8 day break instead of 7, or missing Day 2 for example) because you can get something called ‘escape ovulation’, where the lack of hormones for longer than designed allows your ovaries to jump back into business and pop out an egg, which could then result in pregnancy. This is especially true for the modern COCP’s with their relatively low doses of hormones that don’t suppress the ovary as strongly as the older, higher dose versions.

So why the break?

- When the Pill was first designed and introduced back in the 1960’s the amount of oestrogen in the Pills was up to 10x higher than in our currently available pills. This caused a lot of side effects including bloating, breast tenderness, mood swings. The 7-day break was designed to give women relief from these side effects

- It was thought that giving women a bleed every month would be seen as a reassuring sign that they were not pregnant.

Time to take a break from the break?

- There is now sufficient evidence to show there are no health risks or benefits associated with taking a 7-day break.

- The benefit is skipping one or several periods, include less bleeding, less period pain, fewer headaches for some women who experience oestrogen-withdrawal headaches and less PMS. It’s commonly done to reduce the symptoms of endometriosis and reduce recurrence after surgery.

- Studies have shown there is no increased risk in endometrial hyperplasia (where the womb lining thickens and can become abnormal) or in risk of blood clots when you don’t take a break

- Fertility is also not adversely affected by using an extended regime.

Why have I not been told this before?