The update published by the Faculty of Sexual and Reproductive Healthcare (FSRH) highlights the fact that there is no health benefit from the seven-day hormone-free interval.
It recommends that women can safely take fewer (or no) hormone-free intervals to avoid monthly bleeds, cramps and other symptoms.
In addition, if hormone-free intervals are taken, shortening it to four days could potentially reduce the risk of pregnancy if pills, patches or rings are missed, it states.
The updated guideline also states that consultations about combined hormonal contraception (CHC) do not necessarily have to be face-to-face, online CHC provision is possible, and that at first consultation, many women can safely be prescribed a one-year supply of CHC instead of the current three-month supply.
Women on the combined contraceptive pill have traditionally taken a seven-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.
However, the new NICE-accredited clinical guideline from the FSRH highlights that there is no health benefit from having this hormone-free interval. Women can avoid monthly bleeding and symptoms that come with it by running pill packets together so that they take fewer (or no) breaks.
Online provision of combined hormonal contraception can help women access these methods of contraception. The guideline reminds remote providers that all the same checks must be made and the same information provided to women as with a face-to-face consultation. To cut down the number of appointments required and make it easier for women to continue combined hormonal contraception, the guideline recommends that a year’s supply of the combined pill can safely be prescribed at the first consultation instead of the current three-month supply.
Commenting, Dr Diana Mansour, vice president for clinical quality of the Faculty of Sexual and Reproductive Healthcare, said: “Pill-taking often isn’t perfect; the riskiest time to miss pills is at the beginning and the end of a pill-free interval. The guideline suggests that by taking fewer hormone-free intervals - or shortening them to four days – it is possible that women could reduce the risk of getting pregnant on combined hormonal contraception.”
Dr Sarah Hardman, co-director of the clinical effectiveness unit of the Faculty of Sexual and Reproductive Healthcare, said: “If a woman wants to avoid periods on combined hormonal contraception she can run the packets together – we don’t need a regular monthly bleed to be healthy, and lots of women welcome the option of avoiding bleeding. But women need to know that there is a small increase in some health risks with combined hormonal contraception, so it isn’t suitable for everyone.”