Women Don’t Need to ‘Take a Break’ From the Pill Every Couple of Years

Originally published on The Conversation

More than half of 18 to 19-year-old women in a recent survey agreed that “women should ‘take a break’ from oral contraceptive pills every couple of years”.

You may be surprised to know there is no biological evidence for “giving your body a break” and, in fact, it could do your health more harm than good.

There are many different types of contraceptive pills, most commonly containing both oestrogen and progestogen (called combined oral contraceptive pills).

Doctors use detailed medical eligibility criteria to assess whether a method of contraception is suitable for you on the basis of your medical history. The pill is not suitable for some people. Others may start taking it but find that it doesn’t suit them.

But for many women the pill provides a convenient, easily accessible method of contraception. In fact, it’s the most popular form of contraception for women under the age of 30.

Studies in the United States and Australia have found that many women worry about overdosing or having a build-up of hormones in their body if they use hormonal contraception. These types of misconceptions about the way the pill works fuel the erroneous idea that it’s good to take a break from the pill.

For some people, the pill can be associated with unpleasant side effects such as breast tenderness, bloating, headaches and nausea.

But rather than being an effect of the hormones themselves, these unpleasant side effects are most commonly associated with the hormone-free interval which allows a “withdrawal” bleed to occur, mimicking a natural menstrual cycle.

These side effects may be lessened by new pills or pill regimes with reduced or no hormone-free intervals (and therefore fewer or no withdrawal bleeds).

Once a doctor prescribes the pill for you, it’s generally recommended that you keep taking it for at least three months to allow any unpleasant side effects to resolve themselves.

Whether or not a particular pill is problematic for a woman does not change with the duration of use. In fact, any initial side effects you had on starting will be experienced again after a break. For these reasons, it’s best to find a pill that suits you and stick with it.

Of course, as you age your contraceptive needs will change, so it’s important to review your contraception periodically. Research shows that Australian women reduce their reliance on the oral contraceptive pill over time as they try to conceive, have children, complete their families, and move towards menopause.

Like all medicines, there is a small risk of serious health effects associated with the pill. The risk of serious adverse side effects is highest in the first few months of starting the pill, or when restarting after a break. So it may be more risky to start and stop the pill than it is to use the pill over many years.

Despite the very low risk of health complications associated with the pill, people’s fears are exacerbated by “pill scares” – misrepresented studies reported in the media – which are usually not based on an accurate understanding of the risks.

One of the most serious adverse health effects associated with the pill is thrombotic complications such as stroke, myocardial infarction, and venous thromboembolism (VTE) – in other words, blood clots in the brain, heart, legs, arms and groin. This is why the pill may not be suitable for older women, particularly those who smoke.

Although potentially very serious, the absolute risk of blood clots is very low. This risk is marginally higher than for women not taking the pill, but is lower than the risk associated with pregnancy, delivery and the postpartum period.

Some people may be concerned about the risk of cancer associated with long-term use of the pill. There is a slightly increased risk of cervical cancer but a reduced risk of ovarian and endometrial cancer. The findings about the risk of breast cancer are not conclusive.