The way women are advised to take combined contraceptive pills for the past 60 years unnecessarily increases the likelihood of drinking it incorrectly, putting them at risk for unplanned pregnancies. And this, far from the ideal situation, is the result of the aesthetic peculiarities of pill design, based on a long and excessive historical context.
This is because standard combination oral contraceptive pills, such as Microgynon, Rigevidon, or Marvelon, are designed to be taken for 21 days, followed by a seven-day break, in which women do not take pills and experience vaginal bleeding. Therefore women who take pills have what seems to be a "period" every month.
But this "period" is far from necessary. Shortly before his death in 2015, I attended a conference by Carl Djerassi, "father of the pill". He noted that the seven-day termination, and cessation bleeding produced, was designed on pills in the late 1950s in an effort to persuade the Vatican to accept a new form of contraception, as an extension of the natural menstrual cycle. As is known, this was unsuccessful: Pope Paul VI forbade artificial contraception. Nevertheless, a seven-day break remains a component of combined oral contraceptive pills.
Read more: How the Catholic Church opposes birth control.
This is a problem. A seven day break is a danger that can increase the risk of pregnancy while taking pills. This is because the level of hormone contraception in the body is an important factor to stop ovulation, without which pregnancy cannot occur. About seven doses of daily contraceptive pills are needed to reach enough levels to kill the ovary. But a seven-day break allows these levels to fall again. If taking the pill is not continued on the ninth day after the disorder, ovulation will occur.
The occasional lack of pills is unlikely to cause hormone levels to drop to levels that could endanger ovulation. But taking a deliberate seven-day break reduces hormone levels to the point after another forgetting pill, either before or after a break, can allow ovulation to occur.
Some brands, like this, have placebo pills instead of pill-free breaks. Vitahima / Shutterstock.com
A seven-day break, therefore, is an inherent danger. Many women accidentally extend their week without forgetting pills to restart the next package on time, or lose the pill in the first or last week of the package. Reducing hormones in this situation can cause unexpected ovulation and, if you have sex, pregnancy. But by shortening the pillless interval (seven to four days) and reducing the number of times a year the woman is asked to have an interval without a pill, the risk of accidental ovulation decreases and, therefore, decreases unwanted pregnancies.
New pattern of taking pills.
As a result, many doctors now prefer an extended or continuous pill regimen in which three or more pill packages are taken sequentially and only then does a woman have a week without a pill or a four-day interval reduction without a pill. This less frequent tear is enough to avoid continuous stimulation of the uterine lining, which can cause excessive growth of unhealthy tissue (endometrial hyperplasia). They also prevent the inconvenience of "advanced" bleeding that eventually occurs if the coating is not allowed to escape.
Some women have taken 30 micrograms (standard dose) or 20 micrograms (lower dose) in this way, running two or three packets together before the break, often to reduce the side effects of hormone withdrawal, such as migraines. . But to take longer pills continuously, the use of low-dose pills containing 20 micrograms of estrogen is recommended to offset the increase in the annual estrogen dose when reducing rest periods. This is because the total estrogen dose over time can be associated with a small increase, but the risk of breast cancer is known.
The use of contraceptive pills prescribed in this way is "without a license", which means that the prescribers, not producers, will bear legal responsibility for damage caused by their use. However, prolonged or continuous use of pills, without licenses, is professionally accepted, and pharmaceutical companies are developing and authorizing new pills to take on the long term, with fewer pill-free intervals.
Mild or no bleeding
In addition to providing fewer opportunities for ovulation, this extended regimen also means that a woman has fewer bleeding days. A review found that the regimen was safe and effective.
But many women expressed concern that not bleeding every month can damage their health or fertility. The belief that menstrual blood "accumulates in" if bleeding does not occur or that the body needs to be "cleansed" every month is normal. This may be caused by a misunderstanding of why bleeding does not occur with some hormonal contraception.
In the natural menstrual cycle, the uterine lining accumulates during the first half of the menstrual cycle under the influence of estrogen, reaching its maximum thickness at the time of ovulation. Then it is maintained for 14 days with progesterone, after that, if the pregnancy does not occur, it is removed through the opening of blood vessels in the lining of the uterus, and the woman experiences menstruation.
Natural menstrual cycle. Design / Shutterstock.com
In most contraceptive methods that cause a lack of vaginal bleeding, a continuous supply of progesterone at low doses greatly reduces the thickening of the layer, so it does not need to be removed. In continuous long-acting methods such as IUS or contraceptive injection, women experience a significant reduction or absence of bleeding because this layer is largely inactive. With combined oral contraceptive pills, lighter bleeding is experienced because the thinner layer comes from the removal of hormones, not because of the need to remove the proliferation of the lining.
Many women and girls welcome a reduction in bleeding days and a decrease in social disturbances, and the absence of school and workday can cause menstrual periods. With the increasing recognition of "time poverty" and the problems that some women face to pay for menstrual protection, the days of reducing bleeding can also be financially beneficial for some people.
In the end, the decision to bleed or not bleed must be made by each woman, according to their lifestyle needs. Adherence to the pattern of taking pills 21/7, instituted for social and non-medical reasons, whether due to tradition or unfounded health reasons, should no longer be a standard position with regard to birth control pills.