This is a question many Family Practitioners are all too familiar with, yet there still seems to be a lot of confusion around the topic. Here we shall explore the options around taking a break from hormonal contraception. One of the difficulties is that there are many different brands of pill, however they mostly fall into two main categories – Combined (oestrogen + progestogen) and Progesterone only.
The Combined Oral Contraceptive Pill (COCP)
The COCP was designed to be taken in a 21 day cycle simply to mimic the natural menstrual cycle and not for any medical reason. Therefore you can continue to take the pill if it is monophasic (each pill contains the same amount of hormone e.g. microgynon or Femodene) without a break for 3 months. Continuing for longer increases the chances that some break through bleeding (spotting of blood) occurs, which can be inconvenient.
Some women wish to take a break from the COCP due to unpleasant side effects, which will vary depending on the individual. One of the most common complaints is weight gain which may be due to marginally increased appetite and water retention, both associated with the oestrogen component of the pill. It may help to switch to a brand with a relatively higher progestogen component and lower oestrogen. Brands such as Gedarel or Yaz also have a mild diuretic effect which can help with the bloating and retention. Family planning experts say that most minor side effects (breast tenderness, mood swings, headache) settle down after around 3 months. However if this is not the case you should always see your GP to discuss switching to another brand.
The Progesterone Only Pill (POP)
The POP does not contain Oestrogen and should be taken around the same time each day, with no break in-between packets. This requires a rather more consistent and disciplined regime, so may be reserved for those who are unable to take oestrogen because of associated health risks such as obesity and smoking.
Should I Take a Break Before Starting A Family?
There isn’t any evidence that it helps to be off the pill for a certain period of time before trying for a baby. Most doctors advise women to use another form of contraception until they’ve had one natural period simply because it helps them time the pregnancy and estimate the due date correctly.
Dr Martin Saweirs from the Women’s Wellness Centre says: ‘a lot of my patients share a common concern about the pill, mainly that taking the hormone for an extended period of time has a negative impact on their fertility, even after stopping it. It is very normal for there to be a delay between stopping the pill and normal periods returning. This can be anything from 1-2 months, up tp 9 months or so – there is unfortunately no way to tell or to predict this though. However, we do know that once normal periods resume, there is no negative impact upon fertility.’
Risks And Benefits Of The Pill
One side effect of the pill that has received a lot of media attention is that of deep vein thrombosis – when the blood clots and impacts blood flow through the veins, predominantly in the legs. However it is important to remember that pregnancy itself is a highly risky process and carries more than double the risk of thrombosis than the pill.
Therefore the risks and benefits must be put into context and will vary depending on individual health and lifestyle factors. These are things that will be considered during your initial consultation, as well as any risk of interaction with other medication such as anti-epileptics, herbal supplements and even grapefruit juice.
Dr Martin Saweirs expressed that: ‘some women worry that any unwanted side effects from a pill may persist after stopping it too. Examples include skin reactions, mood swings or changes in weight, and again there is no way of predicting which women will have which potential side effect with which particular pill. It’s an understandable concern that these may persist after stopping, however, once again, we know that this simply is not the case and that if there are any unwanted effects from a pill, they will gradually resolve after stopping it.’
What Other Options Are There?
There are a whole host of different options for you to choose from depending on your lifestyle needs and your local family planning clinic will be able to guide you through the process. Examples of other hormonal alternatives include the Intrauterine System (IUS) which can be fitted into the womb and left for around 3-5 years. There is also a hormone-free version known as the Intrauterine Device (IUD) which is made of copper. Hormonal Implants and Injections are also available and just as effective as the pill.
In summary, any medication should always be taken in the way that the manufacturer has recommended. In the long-term, there is no evidence to suggest that use of the pill has any effect on a woman’s fertility and if all is well, then there appears to be no medical benefit to taking a break from hormonal contraception. The choice comes down to personal preference, tolerance of any side effects, risk-benefit analysis, convenience and your family planning needs.