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February 2019

No break necessary in hormonal contraception

Women can be advised that there is no need to have a hormone-free break when taking combined hormonal contraception, according to new guidance from the Faculty of Sexual and Reproductive Healthcare.

And there is no need to restrict supply to 3 months at the first prescription, the Faculty says – a year’s supply of the combined pill can safely be prescribed at the first consultation. However, it is still important that all the previously recommended checks are carried out before prescribing combined hormonal contraception.

Women on the combined contraceptive pill have traditionally taken a 7-day break at the end of each 21-pill packet. During this monthly break from pill-taking there is usually a bleed and some women have symptoms like period pain, headache and mood change. In the same way, women using combined contraceptive patches or rings have taken a seven-day break after every 21 days of use.

The updated FSRH guideline highlights that there is no health benefit from the seven-day hormone-free interval: women can safely take fewer (or no) breaks to avoid monthly bleeds, cramps and other symptoms. If a hormone-free interval is taken, shortening it to four days could potentially reduce the risk of pregnancy.