Is it time for women to come off the Pill?

After six decades of oral contraception, we should consider our options, says Radhika Sanghani

Since 1961, when the Pill was made widely available on the NHS (albeit to married women only), it has become Britain’s most popular contraceptive. Today, 44 per cent of women who access contraception through sexual health services still take oral contraceptives. But is the Pill still the best option?

In recent weeks, research has suggested that women who have been taking the Pill daily, many of them for decades, have been given incorrect information.

The Faculty of Sexual and Reproductive Health issued new guidelines saying that, contrary to advice given by GPS and instructions provided by Pill manufacturers, there is no need for women to take a seven-day break after taking the contraceptive for 21 days.

In fact, the Pill was always designed to be taken continuously; the seven-day break was only introduced by the Pill’s creator, American obstetrician John Rock, to help mimic a woman’s natural menstruation cycle, but also for a non-medical reason: to placate the Vatican.

Almost 60 years on, news that the seven-day break was medically superfluous angered women who had endured unnecessary bleeds and increased their risk of unwanted pregnancy. Prof John Guillebaud, emeritus professor of family planning and reproductive health at University College London, said at the time: “How could it be that for 60 years we have been taking the pill in a suboptimal way because of this desire to please the Pope?”

But there is also another piece of Pill-related news that, for many, has been just as hard to swallow – that the oral contraceptive makes women less able to read emotions in other people.

Dr Alexander Lischke, who led a German study published in the Frontiers of Neuroscience, said: “Cyclic variations of oestrogen and progesterone levels are known to affect women’s emotion recognition, and influence activity and connections in associated brain regions. Since oral contraceptives work by suppressing oestrogen and progesterone levels, it makes sense that oral contraceptives also affect women’s emotion recognition.”

Prof Anne Macgregor, women’s health specialist and co-author of the report against seven-day breaks, says that all of this news about the combination pill is coming out now because women are finally demanding answers about contraception.

“Women are generally, and quite rightly, much more concerned about what goes in their bodies than they used to be,” she says. “It’s then really important they’re given correct information and offered choice when it comes to contraceptive methods.”

And when it comes to the Pill, there are still a number of pervasive myths. Many believe that it’s important to give their body a break from the Pill, and come off it for several months before restarting again. But Prof Macgregor says that actually increases a risk of blood clotting, and it’s much safer to take the Pill continuously. “Also, remember the benefit that taking the combined pill acts to protect you against ovarian and endometrial cancer. We have to think: what is the point of a break?”

But the Pill isn’t the only option available to women. According to Prof Guillebaud, “the Pill is last century’s method. We should be moving away from it. The bottom line is that long-acting reversible contraceptives (Larcs) such as intrauterine devices (IUDS), hormonal intrauterine devices (IUSS) and subdermal implants are best.” Prof Guillebaud believes that taking a daily pill – either the combined pill and the progestogen-only Pill, also known as the mini-pill – is based on the “wrong model”. “You have to take your tablets to remove your fertility and if you neglect to do that consistently – especially when it’s taken the suboptimal, old-fashioned way, with the seven-day interval – women, typically, get pregnant. With something like the IUD or IUS, you can fit and forget. When you want your fertility, you can get it back – rather than it always being there and you trying to get rid of it by taking a pill every day.” One of his biggest issues with the Pill isn’t just the model, but the fact that it can have side effects such as depression and nausea, as well as an increased risk of thrombosis.

“It is a very low risk, but not absent. The Pill, by being a drug that goes into its system, has an inbuilt likelihood of causing side effects that you can avoid by using methods that are more targeted. I’m not against the Pill, I just think it should take its place in the cafeteria range and not be displayed at the front.”

For women who are taking contraceptives in their 40s and 50s, he urges that they consider the Mirena IUS, a hormonal coil that only needs to be replaced every five years, or the mini-pill, which has a lower dosage and no oestrogen, making it particularly appropriate for women with declining fertility, and has no thrombosis risk. “You don’t get many side effects from these,” he says. “But they do mask the menopause, so you can’t easily tell when you’ve reached it.”

He suggests women could either keep taking these contraceptives until the age of 55, when fertility will be virtually all gone, or after 50, have a follicle stimulating hormone (FSH) test; FSH levels rise in women as egg production declines. The combined pill can be taken for women in their 40s, even up to age 50, but risk of thrombosis does increase with age – and so it should only be used by women without the well-known risk factors, such as having diabetes or smoking. Prof Macgregor suggests women speak to their doctors about their options.

While women should be able to rely on their GPS for accurate information around contraception, the reality isn’t always that simple. A 2015 Telegraph survey found that just one in four GPS discussed all 15 contraceptive options with female patients seeking their advice, while family doctors said they hadn’t be given enough training around contraception.

“It’s not ideal if GPS just tell women which contraceptive to use,” says Prof Guillebaud. “The model they should follow is: ‘You tell me what you want.’ The user should be the chooser, and an informed chooser.” He suggests women look at the Family Planning Association website for information and research their options, rather than just opting for the combined pill without much more thought.

With contraception, there are 15 choices – not to mention the endless different brands for the combined and mini-pill, all of which can have different effects on users. It means that women need to research multiple options – and not give up immediately if something isn’t working.

“With the Pill, there’s a view in people’s minds that there is just one Pill,” says Prof Macgregor. “But there are so many different types. We’re not statistics, we’re individuals, and we can all respond to those in different ways. It’s important for people to talk to their GPS about any side effects and keep going to find the right method for them. There’s such a broad spectrum available that can suit different people at different stages in their lives. It comes down to choice.”

‘The Pill is the last century’s method – and we should be moving away from it’