In the words of the colloquial female, “21/7” has been the unvaried handbook for the combined oral contraceptive pills (COCP) usage for over the past 60 years.
Since its introduction in the 1950s, women have been advised to take the pill for 21 days, followed by a seven-day break, during which the woman experiences a withdrawal bleed.
This traditional method of pill-taking was devised by catholic gynaecologist John Rock, who placed religious and social expectations before scientific or medical rationale.
Knowing that the Catholic church was at the helm of all decision-making, Dr Rock attempted to persuade the Vatican to accept the new form of contraception.
He included a seven-day break and resultant withdrawal bleed to imitate a natural menstrual cycle, therefore showing nature was still taking its course to some effect, according to VICE.
To no avail, Pope Paul VI prohibited artificial contraception. Yet, the seven-day break still holds an integral role in how women understand oral contraception.
New guidelines from the Faculty of Sexual and Reproductive Healthcare (FSRH) confirm that there is no medical benefit in a seven-day break, and that fewer or no monthly hormone-free breaks can be more effective at preventing pregnancy.
“It takes approximately seven daily doses of [the] contraceptive pill to reach sufficient levels to turn the ovaries off.”
“But, the seven-day break allows these levels to fall again..to a point after which further missed pills, either before or after the break, may allow ovulation to happen,” according to Susan Walker, Senior Lecturer in Sexual Health, Anglia Ruskin University.
Any advice existing outside the realm of the seven-day break is considered “unlicensed”, despite having the support of the World Health Organisation (WHO) and multiple medical authorities, according to the FSRH.
There is growing support among general practitioners to emphasise contraceptive choice among women, to highlight that contraception is not a “one size fits all” topic.
One such GP is Dr Doireann O’ Leary, who is positively cultivating a safe medical haven for female health on her online platforms (@dr.doireannoleary).
Dr O’ Leary recently addressed the outdated COCP’s guidelines, for standard brands such as Microlite, Rigevidon or Marvelon.
“You can still take a break if you wish but a four-day break is more effective at preventing pregnancy than a seven-day break..you don’t have to take a break at all though. A lot of women take three months back to back followed by a four to seven day break.” Dr O’ Leary said in a recent social media statement.
Irish pharmaceutical companies are yet to update prescribed COCP packets. Recommending a seven-day break on prescriptions is in retrograde to the new, unanimously supported pill guidelines, according to O’ Leary.
One loosely held supposition, and an assuming benefit to the seven-day break, is the presumption that a woman is not pregnant if she gets her “period” within this pill-free break.
Contrary to belief, this “period” is simply a withdrawal bleed; the body’s natural reaction to the withdrawal of hormones in the pill. This drop in hormone levels causes the lining of the uterus to shed.
These bleeds do not serve any medical benefit, and they cannot be taken as an indication that a woman is not pregnant, according to Devon Sexual Health.
“In fact women who become pregnant on the pill often still have a bleed in the pill free week and this can lull some women into a false sense of security.” Jonathan Shaw of Devon Sexual Health, said.
A 2017 interactive study carried out by Evoke, a female orientated media outlet, highlighted that 94 per cent of participants felt Irish women should be more open about discussing sexual health.
From contradictory pill guidelines to discrepancies in what a withdrawal bleed represents, it is obvious that there is a need for women to be placed on a higher platform to vocalise their sexual health queries and qualms.
Particularly in a dichotomous world where a devout Catholic devised the steps towards birth control, knowing the right personal contraceptive choice can be overwhelming.
Talking to your GP about the correct route for you is imperative, but being equipped with the necessary knowledge and knowing that there exists numerous possibilities outside of the seven-day break is even more important.
Image Credit: Reproductive Health Supplies Coalition