The connection between the Pope and contraceptive pills

By Dr. Ananya Mandal, MDJan 22 2019

Millions of women around the world use the combined hormonal oral contraceptive pill whcih has been around the past six decades. The usual method advised is a 21 day cycle of the pill followed by a 7 day break when the woman bleeds.

Oral contraceptive pill. Image Credit: Areeya Ann / Shutterstock

This system of a seven day break for a woman to bleed is something advocated by the Vatican which wanted a normal menstrual cycle each month for these women. Despite this however, the Pope Paul VI had forbidden the use of artificial contraception.

The convention of the pills developed in the 1950’s by Carl Djerassi (father of the pill) and John Rock, a Catholic gynaecologist, however remained and women still use the 21-day pill cycle followed by a seven day break perceiving it as a “period break”. During this “fake” period women are provided with placebo pills or sugar pills on the pack to aid them to keep count of the pills they take and maintain regularity.

Researchers have said that the 21-day pill cycle is more because of a cosmetic need for a period of bleeding rather than a scientific necessity. This seven day break from the pill can raise the risk of unplanned pregnancies say experts. They explain that the administration of the hormones helps keep the levels of estrogen and progesterone raised in the body that helps turn off ovulation or release of the egg or ovum from the ovary each cycle. The seven day break can allow the levels of estrogen to fall and turn on ovulation. If the pills are not resumed by day-9 of the break, the ovary would release an ovum (ovulation) which could be fertilized by a sperm resulting in a pregnancy.

According to experts, if a woman misses a pill mid-cycle, she is at risk of ovulation because of a drop in the levels of estrogen. A deliberate break of seven days each cycle thus can lower the levels of the hormone to such levels that ovulation may occur if further pills are missed. They suggest that the pill free interval should be shortened to four days each cycle and should be taken less number of times per year. This would reduce the risk of unwanted pregnancies.

These new guidelines come from the Faculty of Sexual And Reproductive Healthcare (FSRH). At present the clinicians are thus recommending extended or continuous pill regimens. This entails taking three or more packets of pills consecutively without a break followed by a pill-free interval of a week (7 days) or a shortened period of four days. The lack of the breaks reduce the risk of stimulation of the lining of the uterus leading to endometrial hyperplasia and also prevent spotting and “breakthrough bleeding” which can occur any time within the cycle if the womb lining is allowed to grow but not allowed to shed.

A large number of women however are in favour of a seven day break from the pills due to the misconception that the “dirty menstrual blood” needs to be shed each month in order to “cleanse” the body. This comes from the misconceptions about menstruation as well as the way hormonal contraceptives works. Many hormonal contraceptives cause spotting or minimal bleeding during the seven day break.

Dr Diana Mansour, vice president for clinical quality at FSRH said in a statement, “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.”

Taking a “tri-cycle” pill regimen with 30 microgram (standard dose) or 20 microgram (lower dose) of estrogen before a period break can also reduce side effects that are seen due to withdrawal of the pills. For example migraines are commonly seen among at-risk women who take the seven day break from pills each cycles. Continuous regimen helps reduce these side effects.

Using pills without a break at present is “off license”. This means that the prescriber becomes liable to the risks of such use and the manufacturer is free from legal responsibilities of the side effects caused by continued raised levels of the hormone. At present newer pill regimens are being manufactured which are meant to be used in a continuous fashion.