If you’re taking the combined contraceptive pill, you might be surprised to learn there is more than one safe and effective way to use it. While many people follow the traditional “21 days on, 7 days off” schedule, NHS guidance shows that alternative regimens, including extended use and continuous use, can be just as safe and may even reduce side effects.

This blog breaks down the four main ways to take the combined pill, how they work, and how to decide which method suits you best.

Table of Contents

What Is the Combined Pill?

The combined oral contraceptive pill contains oestrogen and progestogen. When taken correctly, it prevents pregnancy by:

Stopping ovulation
Thickening cervical mucus
Thinning the womb lining

It’s highly effective (over 99% with perfect use) and flexible, which is why alternative regimens are so useful.

The Traditional 21/7 Method

How the standard combined pill cycle works

The most common method is:

Take one active pill daily for 21 days
Have a 7-day pill-free break
Experience a withdrawal bleed during the break
Start a new pack on day 8

Who this method suits

✔ People who prefer a predictable monthly bleed
✔ Those new to the pill
✔ Anyone who wants a simple, easy-to-remember regimen

Pros

Predictable cycle
Familiar and widely taught

Cons

Symptoms may worsen during the 7-day break (headaches, mood swings, low energy)
Some accidental pregnancies could occur because some women can ovulate in the 7 day break

Shortened Break Method (21/4)

A shortened pill-free interval reduces the hormone-free time to 4 days instead of 7.

How it works

Take 21 active pills
Take a 4-day break
Start the next strip on day 5

Why some people prefer the 21/4 cycle

Reducing the hormone-free interval can:

Reduce withdrawal headaches
Improve mood stability
Decrease bleeding duration

Ideal for

✔ People who get migraines during the pill-free week
✔ Those with PMS-like symptoms during the break

Extended Use (Tricycling)

Extended or “back-to-back” use of the combined pill means taking more than one pack before a break.

How extended pill-taking works

Take three pill packs in a row (63 pills)
Have a break of 4–7 days
Restart the cycle

Benefits of extended pill use

Fewer bleeds (as few as 4 per year)
Reduced period pain
Improved endometriosis symptoms
Fewer mood swings linked to hormone withdrawal

Best for

✔ People who want fewer bleeds
✔ Those with painful or heavy withdrawal bleeds
✔ Anyone whose symptoms worsen during the break

Continuous Use (No Planned Breaks)

Continuous use means taking active pills every day with no scheduled breaks.

How continuous pill use works

Take pills continuously
If you experience 4+ days of bleeding and you’ve taken at least 21 days of pills, take a 4-day break
Resume continuous use

What to expect

Irregular spotting is common at first
Over time, bleeding often stops completely
Safe for long-term use

Benefits of continuous use

No planned periods
Reduced menstrual pain
Fewer PMS symptoms
Avoid bleeding during travel or important events

Is Continuous or Extended Pill Use Safe?

Yes. NHS guidance confirms:

No harmful build-up of the lining of the uterus
Continuous use is clinically safe
Fewer withdrawal bleeds may reduce symptoms like migraines, low mood, and fatigue

Many people assume they “need” a monthly bleed, but medically, this is not necessary when using hormonal contraception.

Which Method Is Best for Me?

Choosing the right method depends on your symptoms, lifestyle, and personal preferences.

You may benefit from flexible pill-taking if you:

Have heavy or painful withdrawal bleeds
Get headaches or low mood during the break
Want fewer periods
Prefer not to bleed at all
Experience PMS symptoms linked to the pill-free days

Stick with the traditional method if you:

Prefer a regular monthly cycle
Are new to the pill and want simplicity
Find breaks help you track cycles emotionally

A women’s health clinician can help you personalise your regimen.

Common Questions About Taking the Combined Pill

Is it safe to skip periods on the pill?

Yes. Skipping withdrawal bleeds is medically safe and does not affect fertility.

Does the womb lining build up without a monthly bleed?

No. The combined pill keeps the lining thin and stable.

Will I gain weight if I take the pill continuously?

There is no strong evidence linking continuous pill use to weight gain.

Can I switch between pill-taking methods?

Yes, but always speak to a clinician before changing your regimen.

Tips for Taking the Combined Pill Successfully

Take your pill at the same time every day
Keep a spare pack with you when travelling
Use reminders or apps to stay consistent
Expect some spotting during the first 3 months of a new regimen
If bleeding is persistent or heavy, speak to your doctor

Resources & Further Reading

Oxford Health NHS: Different Ways to Take the Combined Pill
https://www.oxfordhealth.nhs.uk/wp-content/uploads/2020/03/OH.087.20-patient-information-leaflet-for-different-ways-to-take-the-combined-pill.pdf
NHS: How to take the combined pill
https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/how-to-take-it/
NHS: Combined Pill Overview
https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/
FSRH: Combined Hormonal Contraception Guidelines
https://www.fsrh.org

What next?

Book an appointment with one of our clinic doctors and nurses to discuss the right pill taking rules for you. This isn’t a one-size-fits-all approach, so it’s worth taking the time to assess you needs and get bespoke solutions.

Speak soon,

Dr Nikki x