- 20 Minutes conducted, in partnership with the Graduate School of Social Sciences (EHESS), a survey on the rules under the pill, in three parts and a podcast.
- The rules on the pill are false rules, which have no real medical utility, and one can just as easily take the pill continuously, say the doctors in unison. But then who invented them, these useless rules, and why? Is it dangerous to delete them? Why don't women do it more?
- In this second part, we look at what the science says about removing these false rules, and we want to know if it is a risky practice.
"I still find it strange to no longer have my period, I do not know if it is really healthy and safe," wonders Pauline, in the call for testimony that we launched for this investigation. "I'm not sure that this solution is good in the long term: the body expels every month, so let it expel, right? Asked Louise. “It is a comfort in everyday life, but it still generates little fears: Am I pregnant? How will the pill stop going? How long will it take for my body to resume its natural cycle? Asks Marine. Many of you have asked yourself these questions. Is it safe to suppress menstruation by hormonal contraception, by taking the pill continuously, an implant or a hormonal IUD?Or to put it more clearly: is continuous contraception more risky than a conventional pill, which triggers this bleeding which we often wrongly call "rules"?
The question is legitimate, since the continuous pill provides more hormones, for the same pill. For example, Seasonale has 23% more hormones than the same formula (Minidril) in cyclic use. But the Lybrel pill taken over 365 days brings less hormones than Minidril in cyclic use…
No more heart risks, infertility or thrombosis
Today, there is no very large study on the issue. It is also very difficult to make an overall judgment on "the pill continuously", because different types of pill can be taken continuously. These pills have different molecules and each carry specific risks. What can be said, on the other hand, is that the studies available on patients who have had their periods suppressed for several months have not revealed any particular health risks, compared to a conventional intake, with (false) rules. (Remember, as we said in the first article in this series, that the rules on the pill are not real rules, and that they have, with a few exceptions, no medical utility).
A scientific article synthesizing nearly 160 studies published between 1970 and 2014 on the subject concluded that there is no more risk of heart, infertility or thrombosis with the pill continuously, than with classic pills. "There is no impact on health by not having your period, and no impact on fertility," says Isabelle Yoldjian, head of the endocrinology department at the National Medicines Safety Agency , at 20 Minutes. and health products (ANSM).
Less risk of getting pregnant
However, these false rules have a well-known effect, already described in 2001 by the doctor and essayist Martin Winckler: they increase the risk of getting pregnant. This is also explained by Professors MacGregor and Guillebaud, in a study published in 2018, with the eloquent title: "The interval of 7 days without hormones should be relegated to the dustbin of history" (translated by us) . You should know that thanks to hormones, the pill blocks the production of follicles, which then produce ovulation. However, they write, "even in perfect use, the fall in hormone suppression during the standard seven-day cessation allows follicular development, with a risk that an egg will escape from it, near an exposed minority [of women] ”.
A report shared by Brigitte Letombe, professor at the Lille University Hospital and member of the orthogenics commission of the National Council of Gynecologists (CNGOF): "When you stop for seven days, you let the follicles take volume, after seven days you already have follicles that are 11 or 12 mm, and one of them can mature. So in the first week of packaging we have a lot of risks. When you take contraception continuously, you have much less risk. "
We must add to this that the pill is rarely taken perfectly, and that women precisely forget their pill most often just after this famous stop of seven days *, at the time when they are most at risk ... This is why all the laboratories which market contraceptive pills advise, if you forget during the third week, not to stop for seven days.
Less pain, but "spottings"
Continuous hormonal contraception has another definite benefit, and one that is also well documented: it reduces the symptoms associated with periods. Migraines, menstrual pain, ovarian cysts, genital itching and other miseries of the rules are eliminated, or reduced. Anemia due to heavy periods is less common. Women who suffer from endometriosis, a disease that can be debilitating, also experience an improvement in their condition. A study carried out in Germany in 2006-2007 with young girls even shows that school absenteeism has been reduced by 92% and the use of analgesics by 75%.
This is not to say that continuous hormonal contraception is harmless or that certain specific pills are safe. Some women report bloating, or increased breast tension. Slight weight gain can be seen in a tiny fraction of women.
It is also possible, even if it is not systematic, that some women who have continuous hormonal contraception have what are called "spottings", small patches of blood that appear suddenly. But these spots tend to disappear, for those who prolong the experience. At the end of the 13th brochure, they are only 21% to declare these small blood spots, according to a 2006 study (among other studies that we have consulted which go in the same direction).
Each woman will judge the pros and cons, whether or not the rules are a burden. “It's really a choice, the choice to have your period or not. We must respect the choice of patients. The right method is the one the patient chooses, ”comments Isabelle Yoldjian.
But one thing is certain: if you are already taking the pill, there is nothing to confirm, in the current state of knowledge, that adding a few tablets to suppress bleeding is dangerous, neither for your health, nor for your fertility. And suppressing your “rules” on the pill can also help you eliminate the pain and symptoms associated with it.
Making this observation, the British gynecology authorities have already updated their recommendations for women. The Faculty of Sexual and Reproductive Healthcare (FSRH), which trains gynecologists, says there is "no health benefit at the seven-day break without hormones." In France, the latest recommendations from the Conseil des gynécos are silent on the subject. And the laboratories are still massively recommending this seven-day halt .
* In a study of over 3,000 women in France, 23% said they forgot a pill at least once a month, and among them, 42% did so in the week immediately after the week of interruption.
To complete our dossier “What if we do without it? », Find two other articles in the EHESS PLACES project notebook.
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20 seconds of context
This series of articles is part of the PLACES project, initiated by the École des Hautes Études en Sciences sociales (EHESS) and coordinated by the OpenEdition Center, a collaborative research project between journalists and researchers. The ambition, according to Alessia Smaniotto, research engineer at EHESS and coordinator of the project, is "to offer a way out of the dead ends of a current situation, which positions the figures of the journalist and the researcher in two compartmentalized worlds".
To this end, three pilot projects have been selected in partnership with three media: research on young Alzheimer's patients, with Binge Audio, work on what migrations do in border towns with Café Babel and the survey of 20 Minutes on hormonal contraception, conducted with sociologist Julie Ancian, post-doctoral fellow at EHESS, today at Inserm. Through these three binomials, themselves observed during their work, the idea is to constitute a toolbox facilitating this type of collaboration, in order, ultimately, to create a larger platform for joint work.
The PLACES project is funded by the Ministry of Culture and Communication, coordinated by Pierre Mounier and Alessia Smaniotto, research engineer and study engineer respectively at EHESS. Alexandra Caria and Jonathan Chibois, post-doctoral researchers at EHESS for the PLACES project, studied communication and socio-professional practices as well as the digital uses of pairs of journalists and researchers, through observations and interviews.
- Blood
- Rules
- Contraceptive pill
- Contraception
- Health