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The Pill: facts, myths, and history of the placebo week

February 13, 2019 Update:

Lauren MacIvor Thompson, a history lecturer at Georgia State University, and Samira K. Mehta, an assistant professor of religious studies at Albright College, write in a perspective piece for the Washington Post (2/7) that “many common brands of birth control instruct women to take one pill each day for 21 days, then finish the month with seven days of placebo pills, to still have their period (or, more accurately, withdrawal bleeding that mimics a period.” The pair add, however, that physicians and researchers have repeatedly said that that the seven-day “break” is unnecessary. Thompson and Mehta say the creators of the oral contraceptive tested the drug with a “break” to try to appease the Pope and to assuage fears that the pill was interrupting women’s natural cycles, and that the recent decision by the UK’s NHS to recommend “continuous hormonal pill prescriptions” with no break is a step towards better healthcare for women.

Our original post from September 28, 2017:

A fascinating article – The Man Behind the Pill Decided Women ‘Need’ to Have Periods, But They Don’t – about how the Pill was invented, about the placebo week that gives a false period (to appease the Catholic church!),  perceptions about the Pill, the safety of continuous use (no artificial period), and more.


  • If you’ve taken oral contraception, you’re probably familiar with the concept of placebo pills—a week’s worth of inactive tablets taken at the end of the month. Because these don’t contain hormones, taking them triggers what’s known as “withdrawal bleeding,” which mimics a period, along with fun menstruation-related symptoms like cramping and diarrhea. You have also probably wondered, at least once, whether or not you can just skip ahead to next week’s hormonal pills, staving off the bleeding in order to preserve the inviolability of your new sheets or looming beach vacation plans.
  • In fact, although the majority of oral contraception brands include inactive pills in their packages, there’s no actual medical justification for this—gynecologists have deemed withdrawal bleeding medically unnecessary for years now. For many women on hormonal birth control, this raises a very valid question: Why the hell am I bleeding every three weeks if I don’t have to be?
  • The scientists who helped develop the birth control pill, John Rock, was a devout Catholic. He was convinced, however naively, that the church would accept the pill as a form of “natural” contraception if it were presented in the right light. (Because the pill contains progestin—a hormone naturally released after ovulation, during the “safe period”—Rock considered it a sort of scientific extension of the rhythm method.)
  • This formula—three weeks of hormonal pills, followed by one withdrawal week, complete with the requisite bleeding—remained unchanged for over 40 years. Then, in 2003, the drug company Barr released Seasonale. This was the first oral contraceptive to give women the option of foregoing monthly withdrawal bleeding; it contained 84 hormone pills and seven placebo pills. Women using this method would experience withdrawal bleeding just four times a year—or once per season, as the drug name intimated. Four years later, the FDA approved Lybrel, the first oral contraceptive to offer continuous active pills with no breaks for withdrawal bleeding whatsoever.
  • The discrepancy in education and affordable access is telling: The normalization of placebo pills and subsequent withdrawal bleeding means that even in 2017, many women do not know that extended cycle pills exist, let alone that menstrual suppression is a safe option. Combined with the fact that the percentage of schools teaching students about contraception has declined drastically since 2000, this means that many women are likely to stay in the dark about their options when it comes to choosing whether or not they want to bleed once a month.

About The Author

vaginismus specialist Dr. Ditza Katz team member Women's Therapy Center

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