FSRH press release: Updated FSRH guidance on combined hormonal contraception (CHC) highlights new recommendations – and reminds us of important messages about safety and effectiveness

Posted 21 January 2019

Date: 21 Jan 2019

Type: FSRH Press Releases and Statements

The updated FSRH guideline highlights that there is no health benefit from the seven-day hormone-free interval

What is new in this guideline?

  • The updated FSRH guideline highlights that there is no health benefit from the seven-day hormone-free interval
  • Women can safely take fewer (or no) hormone-free intervals to avoid monthly bleeds, cramps and other symptoms
  • If a hormone-free interval is taken, shortening it to four days could potentially reduce the risk of pregnancy if pills, patches or rings are missed
  • Consultations about CHC do not necessarily have to be face-to-face; online CHC provision is possible 
  • At the first consultation, many women can safely be prescribed a one year supply of CHC instead of the current three month supply

Women on the combined contraceptive pill have traditionally taken a seven day break at the end of each 21-pill packet. During this monthly break from pill-taking there is usually a bleed and some women have symptoms like period pain, headache and mood change. In the same way, women using combined contraceptive patches or rings have taken a seven-day break after every 21 days of use.

However, a new NICE-accredited clinical guideline from the Faculty of Sexual and Reproductive Healthcare (FSRH) highlights that there is no health benefit from having this hormone-free interval. Women can avoid monthly bleeding and symptoms that come with it by running pill packets together so that they take fewer (or no) breaks.

Online provision of combined hormonal contraception can help women access these methods of contraception. The guideline reminds remote providers that all the same checks must be made and the same information provided to women as with a face-to-face consultation. To cut down the number of appointments required and make it easier for women to continue combined hormonal contraception, the guideline recommends that a year’s supply of the combined pill can safely be prescribed at the first consultation instead of the current three-month supply.

What is not new, but is still very important?

  • It’s important to use combined hormonal contraception correctly: if used perfectly, it is over 99% effective; however, with typical use, about 9% of users become pregnant in the first year of use
  • There are some health risks with combined hormonal contraception: use increases a woman’s risk of having a blood clot or breast cancer (although the risk remains small)
  • Combined hormonal contraception should not generally be used by women over 50
  • Combined hormonal contraception has some important benefits in addition to contraception: it can help with heavy or painful periods, acne and PMS, and it reduces the risk of some cancers

Dr Diana Mansour, Vice President for Clinical Quality of the Faculty of Sexual and Reproductive Healthcare, said:

“Pill-taking often isn’t perfect; the riskiest time to miss pills is at the beginning and the end of a pill-free interval. The guideline suggests that by taking fewer hormone-free intervals - or shortening them to four days – it is possible that women could reduce the risk of getting pregnant on combined hormonal contraception.

Women requesting combined hormonal contraception should be given information about its effectiveness and alternatives including long-acting reversible contraceptives (LARCs), the most effective methods of contraception. 

If the combined pill is the woman’s preferred option and it is deemed safe for her, clinicians can prescribe a year’s supply at the first consultation, with recommended annual follow-up”

Dr Sarah Hardman, Co-Director of the Clinical Effectiveness Unit of the Faculty of Sexual and Reproductive Healthcare, said:

“We are all different: there isn’t any one method of contraception that is the ‘best’ method for every woman, so it’s really important that women have choice.

Combined hormonal contraception can allow women to have a regular monthly bleed, whereas bleeding can be unpredictable with some other contraceptives. It can make periods lighter and less painful too. If a woman wants to avoid periods on combined hormonal contraception she can run the packets together – we don’t need a regular monthly bleed to be healthy, and lots of women welcome the option of avoiding bleeding.

But women need to know that there is a small increase in some health risks with combined hormonal contraception, so it isn’t suitable for everyone. And if it isn’t used correctly there is a risk of pregnancy. Women in the UK are really fortunate that - free of charge - they can choose combined hormonal contraception if it’s right for them, or a safer, or more effective alternative.”


 Notes to editors:

  • Combined hormonal contraception (CHC) includes the combined contraceptive pill, transdermal patch and vaginal ring.
  • Contraindications to use of combined hormonal contraception are unchanged in this guideline, in line with United Kingdom Medical Eligibility Criteria (UKMEC) 2016. Women aged over 50 years should generally use safer alternative contraception.
  • The FSRH guidelines offer support for clinicians to inform women as to how to take combined hormonal contraception, what to do if they don’t use it correctly and symptoms that should prompt women to seek medical advice. The updated FSRH Guideline Combined Hormonal Contraception can be found here.
  • You can read the interim guidance on incorrect use of combined hormonal contraception, launched together with the updated guidelines, here
  • The Faculty of Sexual and Reproductive Healthcare (FSRH) is the largest UK professional membership organisation working at the heart of sexual and reproductive health (SRH), supporting healthcare professionals to deliver high quality care. It works with its 15,000 members, to shape sexual reproductive health for all. It produces evidence-based clinical guidance, standards, training, qualifications and research into SRH. It also delivers conferences and publishes the journal BMJ Sexual & Reproductive Health in partnership with the BMJ. You can read more about FSRH here: https://www.fsrh.org/home/

For further information please contact:
Camila Azevedo
FSRH External Affairs & Standards Manager
Email: externalaffairmanager@fsrh.org
Telephone: 02037945309