Understanding the 7-Day Break
Traditional combination birth control pill packs are designed to mimic a 28-day menstrual cycle. They typically contain 21 active pills with hormones (estrogen and progestin) followed by 7 inactive or placebo pills [1.2.4]. During the week of placebo pills, the drop in hormones causes a withdrawal bleed, which is similar to a period but not medically the same thing [1.2.2].
This 7-day break is not a medical necessity [1.2.2, 1.2.3]. The concept was introduced in the 1950s partly to mimic a 'natural' cycle, with some historical accounts suggesting it was to make the pill more acceptable to the Catholic Church [1.7.5, 1.7.7]. The withdrawal bleed provided reassurance against pregnancy, but it is not required for health [1.3.3]. The uterine lining does not build up when taking active pills, as the hormones keep it thin [1.2.6].
Is it Safe to Skip the Placebo Pills?
Yes, it is generally considered safe for most people to skip the placebo pills and start a new pack of active pills immediately [1.2.1, 1.2.5]. This practice, known as continuous or extended-cycle use, does not decrease the pill's effectiveness in preventing pregnancy [1.2.2]. In fact, some research suggests it may even increase efficacy by reducing the risk of forgetting to restart the next pack on time [1.2.8].
You can skip the break occasionally for a special event or do it every month [1.2.1]. There is no limit on how long you can continuously take active pills; some do so for years [1.3.3]. Fertility typically returns to its normal state soon after stopping the pills, even after long-term continuous use [1.2.7].
Benefits of Continuous Use
Skipping the hormone-free interval can provide several benefits beyond just preventing pregnancy and avoiding a monthly bleed [1.2.6]:
- Relief from Menstrual Symptoms: Continuous use can alleviate symptoms like hormonal headaches, bloating, breast tenderness, and mood swings associated with the hormone drop [1.2.2, 1.3.3].
- Management of Medical Conditions: Doctors have prescribed continuous cycles since the 1960s to help with conditions like endometriosis, premenstrual dysphoric disorder (PMDD), anemia, heavy menstrual bleeding, and period pain [1.2.2, 1.3.4].
- Increased Efficacy: By eliminating the break, the risk of 'ovary wake-up' is reduced, which can potentially make the pill more effective [1.2.8].
- Convenience: Many find it easier to remember to take a pill every single day rather than stopping and starting [1.2.8].
Potential Side Effects and Risks
The primary side effect of skipping the placebo week is breakthrough bleeding or spotting [1.2.4]. This is unexpected bleeding that can occur, especially during the first few months, as your body adjusts [1.5.1]. This spotting usually decreases over time for most people [1.2.2].
Factors that can increase the likelihood of breakthrough bleeding include:
- Missing a pill [1.5.4].
- Illness with vomiting or diarrhea [1.5.4].
- Starting new medications that may interfere with the pill, like certain antibiotics or St. John's wort [1.5.4].
- Smoking [1.5.4].
If breakthrough bleeding is persistent or heavy, a healthcare provider might suggest taking a short, 3- or 4-day break from the active pills to 'reset' the uterine lining before resuming continuous use [1.2.7, 1.5.4].
The long-term risks of continuous use are the same as those for traditional cycle use of combination pills. These risks are rare but can include an increased chance of blood clots, heart attack, and stroke, particularly for smokers over 35 and individuals with certain health conditions like uncontrolled high blood pressure [1.4.2, 1.4.5].
| Feature | Traditional 21/7 Cycle | Continuous/Extended Cycle |
|---|---|---|
| Schedule | 21 active pills, 7 placebo pills | Active pills taken continuously (e.g., for 3 months or a full year) [1.6.1] |
| Bleeding | Scheduled withdrawal bleed every month [1.2.2] | No scheduled bleeds, but potential for unscheduled breakthrough bleeding, especially initially [1.4.2, 1.5.1] |
| Efficacy | Highly effective when taken correctly | Equally or more effective, as it reduces the risk of missing the start of a new pack [1.2.8] |
| Symptom Relief | May experience PMS/PMDD symptoms during placebo week | Can reduce or eliminate hormone-drop symptoms like migraines and cramps [1.3.6] |
| Pill Types | Standard 28-day packs | Can use standard monophasic packs back-to-back or specially designed extended-cycle packs (e.g., Seasonale, Amethyst) [1.6.1, 1.6.3] |
How to Skip Your Period on the Pill
If you use a 28-day pack of monophasic pills (where each active pill has the same hormone dose), simply skip the last week of inactive/placebo pills (which are usually a different color) and immediately start the first active pill of a new pack [1.2.5, 1.2.8].
Some pills are specifically designed for extended use, providing active pills for 84 days followed by a 7-day break (resulting in four periods per year) or for 365 days with no breaks at all [1.6.1, 1.6.2].
It is important to note that this applies to combination pills (containing both estrogen and progestin). Progestin-only pills (the 'mini-pill') are typically taken continuously already and do not have a placebo week [1.3.3]. Triphasic pills, which have varying hormone levels, are generally not recommended for skipping periods as it can be more complicated [1.3.3].
Conclusion
For most individuals using combination birth control, it is medically safe and often beneficial to skip the 7-day break. There is no medical requirement to have a monthly withdrawal bleed, and continuous use does not harm your body or future fertility [1.2.2, 1.6.1]. The main drawback is the potential for breakthrough bleeding, which tends to diminish over time [1.5.4]. As always, it's best to discuss any changes to your medication regimen with a healthcare provider to ensure it's the right choice for your individual health profile and to get your prescription written in a way that allows for continuous refills [1.2.7].
For more information, you can visit Planned Parenthood for guidance on using birth control pills.
