What’s New with the Combined Oral Contraceptive Pill?

Well over 100 million women around the world rely on the Combined Oral Contraceptive Pill a.k.a., ‘the Pill’.  Did you know that the earliest version of the Pill, called Enovid, was released in 1961? This was followed shortly by (surprise, surprise!) – The Sexual Revolution. And that’s a blog all by itself.

Since then, the combinations of oestrogen and progesterone in the Pill has undergone a number of re-formulations.

The Faculty of Sexual & Reproductive Health Care

In January 2019, The Faculty of Sexual & Reproductive Healthcare released their updated guidelines on Combined Hormonal Contraception. The guidelines discuss the risks and benefits of the Pill, the combined contraceptive patch (sadly, not available in Australia) and the contraceptive ring. Just 93 pages of light reading.

What is particularly exciting is the information coming to light about the increased reliability and safety of taking the Pill with a much shorter break, or pill free period.

Most Pill packets have 21 days of active or hormone pills and 7 sugar or placebo pills (no active component). It is during the sugar pills that women have a ‘period’ or withdrawal bleed.

What’s the Pope got to do with it?

The 21/7 design was more about trying to convince Pope Paul VI that being on the Pill was ‘natural’ and just like the normal period cycle. Fertility Awareness or Natural Family Planning Methods had been approved by the previous Pope in 1951. Unfortunately, this strategy failed and Pope Paul VI would not approve the use of hormonal contraception for Catholics.

Today, this leaves women with a method of taking the Pill that potentially compromises its reliability; many women’s own hormones kick into gear when the levels of hormones drop for so long…and they ovulate (release an egg from the ovary)…therefore increasing the risk of pregnancy.

It is particularly important that women remember to restart the Pill on time, and not accidentally extend the hormone free pill interval beyond 7 days. The 21/7 day packet also makes missed pill rules more complicated, further compromising reliability.

Can we fix the Pill? Yes, we can!

Prof John Guillebard from the UK has been campaigning for changes to the Pill packet design for years. He advocates ultra-low dose (i.e.10 mcg of oestrogen instead of the standard 30 mcg) oestrogen pills with 4 or less placebo tablets in each 28 day packet.1

Pills such as Yaz, Qlaira and Zoely have this packet design. Seasonique has a 7 day break every three months, but these 7 pills contain a very low dose of oestrogen. None of these Pills are available on the Pharmaceutical Benefits Scheme (PBS) making them more costly – about $30 per month.

The other option, one that women have been using for years, is to ‘tricycle’ the Pill; taking the hormone pills back-to-back with a break every 3-4 months. Ovarian activity is much lower in women tricycling the Pill than in women taking the standard 21/7 regimens. Whether this translates into a truly lower risk of pregnancy has not confirmed by research so far.

Is it safe to tricycle the Pill?

What the research does confirm for us however, is that this is a very safe way of taking the Pill. There is no biological need to have a period every month – as long as the body is receiving oestrogen and progesterone (the two hormones in the Pill). There is no increased risk of problems such as endometrial cancer.

Women are advised to have a period, or take a 4 day break from continuous pill taking if they experience ‘break thru’ bleeding or spotting. There are a number of clever period smart phone apps that help women to plan a scheduled withdrawal bleed and avoid pregnancy.

Many women notice that cyclical symptoms such as moodiness, headaches, bloating and acne are reduced by taking the Pill continuously. And that can only be a good thing!


Dr Tonia Mezzini has been helping women to chose the best method of contraception for many years.  If you would like expert advice on contraception, make an appointment to see Dr Tonia Mezzini today.

Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with:


  1. Guillebard, J & MacGregor A. Contraception: Your Questions Answered. 7th Ed, 2017. London:Elsevier.