New safe ways to take the combined pill (and bleed less often!)

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#1
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In the SH:24 offices this week we have been discussing ‘new ways’ to take the combined pill - (the one with two hormones - oestrogen and progestagen).

The original way to take the combined pill is take 21 pills and have a 7 day break. Then start the next pack of 21 days and have a 7 day break.

There has been some discussion in medical literature on this with some health professionals saying that alternative ways to take the pill are just as safe and effective as the original way, and everyone starting the pill should be made aware of them.

This makes sense to me. The only thing to note is that this is an ‘unlicensed’ use.
This means that when the pill was originally given a licence to be used as a contraceptive that licence specified that it should be used for 21 days and stopped for 7. Despite new evidence that taking it in different ways is still safe and effective, the licence has not changed. So doctors who prescribe it in this way may well tell you that this is an ‘unlicensed use’ of the pill.

So, what are these alternative ways of taking the pill?

The first is 'tricycling’
This is when you take the pill every day for 3 packets in a row without a break and then stop for a 7 day break. This means that you will only have a bleed every 3 months.


The second is 'extended use’
This is when you take the pill every day for at least the first 21 days without any breaks. Then keep taking it every day without stopping - just keep taking one packet straight after the next, one pill every day, until bleeding occurs for 4 days in a row. Don’t worry if you don’t get bleeding - not everyone does. But if you do, then stop the pill for 4 days in a row (you will probably continue to bleed during these days) and then re-start and keep taking it every day until you get bleeding for 4 days in a row again - this may be many months later.


To be honest, I have found this a little difficult to explain clearly in this post - the instructions are a little complicated. It would be great to have feedback on whether this explanation makes sense to you - and of course to hear from people who have tried this and want to share their experiences.

Paula


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#2

This is really great to know. On the rather rare advice of a temporary doctor I started taking it consistently until I noticed some spotting. I then stopped taking it for a week and had a bleed like before but it was extremely painful. I think stopping for only 4 days would make more sense.
This explanation made sense to me! Thanks for the advice :blush:


#3

My problem is remembering to take it! Have had to set an alarm on my phone!!


#4

I find it works if I tie taking the pill into something I do at the same time every day.

I put mine in my make up bag because I always have it with me and use it at the same time every day


#5

Going back to something I use every day also helps me remember - I usually leave it by my contact lens case, or next to my glasses on my bedside table.


#6

Good idea - i tried to squeeze them into my wallet but didn’t really fit, make up bag might work better…


#7

What would be the benefits of doing it this complicated way?


#8

Hi @flo - the main benefit is that you bleed less often. Of course some people really like to have a regular bleed on the pill. But others prefer to have fewer or no bleeds. Its a personal preference really.

Also, people are most at risk of pregnancy if they miss pills just before or just after their pill free week. So then if they don’t have a pill free week they are less likely to get pregnant if they miss a pill - does that make sense?

Thanks for the question.

Paula


#9

I use an app called Flo… You can monitor your flow, symptoms, when you’ve had sex drive and sexual encounter, protected, unprotected etc. And several other things can be monitored too.


#10

I used the tricycling method a lot when I was on microgynon for my painful periods, I used to get the occasional spotting and was worried about its effectiveness so I’m glad to hear that it doesn’t seem to have an affect :slightly_smiling_face:


#11

Thanks @Random. I just had a look at the Flo app and I agree it could be useful for monitoring contraceptive side effects. I will try suggesting it to people in clinic and see how they get on. Thanks for the tip.
Paula


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#12

What about shortening 7 day brake?instead of 7 day brake you stop taking the pill for 3 or 4 and then resume back?
Thank you!x


#13

I skipped a break last year as I was on holiday which was great but I found the next period was horrible and lasted longer than normal. My body just felt completely out of kilter and my boyfriend said I was horrible to deal with :joy:

I want to try the tricycle technique, perhaps practice makes perfect?


#14

Just updating this. The Faculty of Sexual and Reproductive Health have got new guidance out on this.

They say:

Taking combined pill packets back to back with out a break can reduce the hormone withdrawal symptoms that some women get in the break, but irregular bleeding is common.

Women should be given the choice of ‘extended pill use’ (see my post here New safe ways to take the combined pill (and bleed less often!) ) or taking a break every month.

Paula


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#15

Hi Dr Paula I asked you yesterday about having the iud as I’m currently on the implant but getting it taken out this week as it has been a nightmare as I bleed quite alot on it. So I’ve been reading all the different contraception options on here and I’m thinking of going back on the pill as that seems the best option for me but I want one that I can take every day with less periods and hopefully one that won’t cause mood swings. I have been on the pill before once on cilest and then microgynon. I’m just wondering which pill contains two hormones as that might be better for me.
Thank you


#16

Hi @Caroline_Loose

Sounds like you are moving forward with your decision making.

Both Cilest and Microgynon contain 2 hormones and can be taken in the new ‘extended regimes’ when you bleed less often.

They are slightly different. Although they both contain two types of hormone - an oestrogen and a progestagen, Cilest tends to have more of an ‘oestrogen’ dominant balance and microgynon tends to have a more ‘progestagen dominant’ balance.

Microgynon is the most tried and tested pill that we have and is the one that most people start with. So it could be a good idea to start with that, monitor your side effects and have Cilest as an alternative if the microgynon does not work out.

Does this make sense as a strategy?

Many thanks

Paula