You Might Want to Give Up on Placebo Week If You Take Birth Control Pills

Most packages of combination birth control pills contain 21 active pills and 7 placebo pills.
But how important is it for women to use those placebo pills or take a break from active pills each month?
According to updated guidelines released in the UK by the Faculty of Sexual and Reproductive Healthcare (FSRH), it’s just as safe and effective for women to skip the placebo interval and take combination birth control pills on an extended or continuous basis.
The conventional 21/7 cyclic regimen was designed to mimic a natural menstrual cycle. During the placebo interval, women experience a withdrawal bleed that’s similar to a natural period.
But there are no health benefits associated with a monthly placebo interval or withdrawal bleed.
For many women, there may even be benefits to skipping it.
“I think a lot of people get scared that you have to have a period every month, but when you’re on pills, that’s just not the case,” Dr. Kimberly Gecsi, an obstetrician-gynecologist at University Hospitals Cleveland Medical Center, told Healthline.
“Are you someone who feels more comfortable if you have regular bleeding or would you prefer to not have a period? Both are totally normal and healthy and fine to do when you’re on [combination birth control] pills,” she said.
There are multiple options to choose from
Rather than using a 21/7 cyclic regimen of combination birth control pills, some women follow a 24/4 cyclic regimen. In this approach, the placebo interval is shortened to four days.
Other women prefer an extended-cycle regimen, in which they skip the placebo interval and withdrawal bleed for multiple months.
One common approach is to take three months’ worth of active pills, followed by seven days of placebo pills.
Other women choose to follow a continuous regimen, in which they take active pills on an ongoing basis, with no placebo intervals or withdrawal bleeds.
All of these regimens reduce the risk of pregnancy, but certain approaches may appeal more to some women than others.
“The best contraceptive for a woman is one that she feels comfortable with and one she’s going to use,” Gecsi said.
“If you really want to have a monthly bleed, then a cyclic regimen might be better for you,” she continued. “If you don’t want to have a monthly bleed, then an extended-cycle or continuous regimen might be better.”
There are benefits to an extended-cycle or continuous regimen
If you take combination birth control pills, there are potential benefits to skipping the placebo interval and taking active pills on an extended or continuous basis.
For instance, the withdrawal bleeds that occur during placebo intervals can be heavy or painful.
In some cases, the drop in hormones during a placebo interval can also trigger or worsen symptoms of pain or mood disorders.
For example, some women experience menstrual migraines or symptoms of depression when they stop taking active pills.
To limit these symptoms, women can follow an extended-cycle or continuous regimen of combination birth control pills rather than a cyclic one.
In addition to these potential health benefits, many women find it more convenient to forgo the monthly withdrawal bleed that occurs on a cyclic regimen.
“It can be very helpful to be able to time your periods around a major event, a vacation, an athletic competition, a big exam, or things like that,” Dr. Paula Bednarek, an associate professor of obstetrics and gynecology at Oregon Health & Science University (OHSU), told Healthline.
“So there’s some ways in which it can really benefit a person at important times of their life,” she continued, “and it can also be much simpler, more convenient, and more pleasant.”