Can you skip the sugar pills in your birth control pack?

Answer 1

Yes, it's fine to skip sugar tablets. Doing so does not increase your risk of pregnancy. This is true whether you're asking:

• Is it OK if I don't eat the sugar pills, but take a seven-day break (or a shorter one); and
• Is it OK if I start the new pack immediately after taking the last active pill, and throwing the rest of the last pack away.

While you can do this with any combination Birth Control pill, you can't do it with the mini-pill (also known as the progestin-only pill, with US brand names like Micronor or Errin). The minipill has no sugar pills, so you should take every pill in the pack.

Also, if you're on a triphasic pill (typically one that has more than two colors in the pack) you may find that you have more trouble with breakthrough bleeding or unscheduled spotting. Skipping is easier with monophasic pills. Examples of monophasics include Alesse, Brevicon, Demulen, Desogen, Genora, Levlen, Levlite, Loestrin, Lo/Ovral, ModiCon, Necon, Nordette, Norethin, Norinyl, Ortho-Cyclen, Ortho-Novum 1/35, Ovcon, Ovral, Portia and Zovia.

You don't actually have your "period" when you're on birth control because the pills work by changing your hormones and preventing the egg from being released. If you have a shorter break or no break, your lining doesn't build up more, so it doesn't lead to heavier periods during the next cycle.

Although it may be unhealthy to have no period if you're not on hormonal contraception, the risk of overgrowth of the uterine lining is prevented by the hormonal birth control pill, so it does not increase the risk of endometrial cancer (on the contrary, it lowers that risk).

There are many reasons why a woman may choose to skip the sugar pills. These include:

• Timing bleeding for increased convenience
• Avoiding menstrual migraine or premenstrual syndrome, which for many women recurs with the pill-free interval.
• Treatment of endometriosis
• Reducing menstrual cramping
• Avoiding menstural bleeding in women with cognitive disabilities or other conditions and who experience fear with their menstrual period.
• Increasing effectiveness against pregnancy (particularly with pills with very low estrogen content)

There are a few ways to skip periods:

• Skipping the placebos occasionally for convenience.
• Taking two or three packs of active pills (that is, six or nine weeks) without a break, then stopping for seven days or fewer to have a withdrawal bleed. (Seasonale and Seasonique are examples of pills in a special pack to facilitate this plan. They are not new or special medications; they have the same content as other pills already on the market. Their only difference is the packaging of 84 active pills and 7 inactive pills).
• Taking sugar pills as scheduled until the first day of bleeding, and then starting the next active pack on that day. (Women who experience menstrual migraine but still want monthly bleeding find this helpful.)
• Taking birth control pills continuously for months or years, without using any sugar pills. (Lybrel is a birth control pill packaged this way. Like Seasonale and Seasonique, it does not represent a new form of birth control pill, but only an alternative kind of packaging.)

Previous answers to these questions contained a great deal of misinformation:

• Myth: The pill has a placebo period built in because it's medically necessary. In fact, the placebo period was built in as a marketing device when the pill was first formulated; it was assumed that women would want to see monthly bleeding as evidence that the pill was working.
• Myth: It is dangerous to skip more than X periods in a row. In fact, Seasonale, Seasonique, and Lybrel are marketing responses to advice commonly offered to women by their health care providers: you can skip as many as you like.
• Myth: You should only skip placebos if you're on one of the above-mentioned pills that are built for this purpose. In fact, these pills contain the exact same ingredients in the exact same doses as other 21- or 28-day pills on the market.
• Myth: If you skip periods, the pill will be less effective. In fact, skipping placebos lowers the risk of pregnancy. Without the pill-free interval, your body has a lower risk of starting to ripen an egg. Bleeding on birth control pills is never a sign that the pill is working or not working.
• Myth: If you try to skip periods and then bleed, it means the pill is not preventing pregnancy. In fact, skipping placebos lowers the risk of pregnancy. Without the pill-free interval, your body has a lower risk of starting to ripen an egg. Bleeding on birth control pills is never a sign that the pill is working or not working.
• Myth: You should not try to skip periods if you are using triphasic or biphasic pills. In fact, there's no harm in trying, but if you experience breakthrough bleeding, you may want to ask your health care provider to change your prescription to a monophasic pill.
• Myth: You shouldn't skip placebo pills until you've been on the pill for a certain number of months. In fact, this recommendation has no basis in science, and the pills like Seasonale and Lybrel can be used by a woman who has never been on birth control before.
• Myth: If you don't take the placebo pills and shed the lining, your body can't "clean" itself. In fact, the lining doesn't build up much when on hormonal birth control, and there's no special need to "clean out." That's why hormonal birth control lowers, not raises, the risk of endometrial hyperplasia and endometrial cancer, even in those methods like Depo Provera or Mirena in which periods usually stop.

Bottom line: talk to your health care provider about the real risks and benefits of skipping placebos or shortening the pill-free interval. You can confirm the above information with your health care provider, pharmacist, or by checking respected sources such as Contraceptive Technology or the related links provided here.