FIRST available in the US in 1960 and introduced to Britain the year after, the combined oral contraceptive pill (COCP) is undoubtedly on of the greatest breakthroughs in modern medicine.

Since that time, the mantra “21 days on, 7 days off” has been held as gospel by many women and indeed by many prescribers.

However this is all about to change with the Faculty of Sexual and Reproductive Health stating that for some women the seven day pill-free interval could be dropped, with advice that it confers no health benefit, and that continuous use of the pill may even reduce the number of unwanted pregnancies.

It is thought that the 21/7 day cycle was designed to mimic a natural menstrual cycle, and hence appeal to religious leaders; which sadly it didn’t.

Indeed the natural cycle can be anywhere between 14-35 days, and some women may only have a period a handful of times per year. The withdrawal bleed, when contraception is stopped, is often anxiously anticipated as a demonstration that the user is not pregnant. Yet it is only a sign of the contraceptive hormones leaving the body.

There are advantages to taking the combined pill continuously. Firstly the lack of a period will appeal to many women who find their monthly bleed disruptive and often painful. In addition, the drop in hormone levels in the pill free break have often been blamed for side effects including mood disruption and headaches. But perhaps the greatest benefit from forgoing the seven-day break may be a reduction in the number of unwanted pregnancies.

The combined contraceptive pill is sited as being 99 per cent effective if instructions are followed to the letter. In the real world this is around 90 per cent. The riskiest time for missing a pill and falling pregnant is either at the start or end of this long hormone-free period.

Combined oral contraception, as the name suggests, involves two hormones, oestrogen and progesterone. It works in three ways. Firstly it prevents an egg being released from the ovaries every month. By thickening the composition of mucus at the neck of the womb, sperm are less able to swim into the womb itself. If despite the above measures a sperm and egg combine, the pill thins the lining of the womb, making implantation of the fertilised egg less likely.

The combined pill is one of the most commonly prescribed medications for young women first requiring contraception, and for many it will be entirely suitable long term, even up to the menopause. It offers both short and long-term benefits including alleviating the pain associated with periods, lightening the volume of blood loss, as well reducing the risk of some cancers. If you are on the combined pill using the traditional 21/7 method and would like to omit the break, it would be worth discussing this with your doctor.

Many will have experience of patients using three packs without a break, and some will have been advocating continuous use long before these new guidelines.

Ask Dr Zak

Question: I’ve tried over the counter treatments for fungal nail infections, and went to my GP hoping I’d be able to get a tablet to treat it, but he wanted me to give in some nail clippings first. Why? - Sandra, 54

Answer: While fungal nail infections can be unsightly and distressing, it makes sense to be sure that it is actually this and not dystrophic nails, where the nail appears damaged and often thickened, but where the cause is not fungal. For dystrophic nails, a review by a podiatrist would be of more benefit. Also oral antifungal medications for nail infection typically need to be taken for between 4-6 weeks and as they are metabolised by the liver, they can occasionally affect its function, hence the need to be entirely sure that this is the correct treatment.

Question: I am a reasonably fit man who has just turned 40. Most of my exercise revolves round our two young children. Recently I noticed an unpleasant sensation that I can only describe as a “flutter” in my chest, mostly when I’m sat doing nothing. Should I be worried? Ryan

Answer: The word “flutter” is often used to describe many situations, including increased awareness of your heart beat. If you don’t get the flutter, chest pain, a feeling like you are about to collapse or indeed collapse during exercise, it is less likely to be a serious issue. However you could be describing a transient abnormal heart rhythm or extra beats from the bottom two chambers of the heart. It would be worth booking in with your GP, who may advise an ECG (electrical reading of the heart) as well as blood tests. Sometimes an overactive thyroid can cause palpitations. If you get any funny sensations which are directly provoked by exercise or make you feel seriously unwell, please seek immediate medical help.

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Dr Uddin’s advice is provided in good faith and in accordance with currently accepted evidence. However, this content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of a GP, or other qualified health provider, regarding a medical condition.