Pin It
Contraceptive Pill and the Pope Rule

Here’s the real story behind the ‘Pope rule’ and the contraceptive pill gap

A 59-year-old Catholic ideology influences how we take contraception, proving we still have more to do in reclaiming our menstrual cycle

You’d think that by now, women would be pretty clued up on ‘the pill’. We’ve spent years discussing it – from hushed school changing room chats to pre-drinks or quad vod-induced complaints while sharing a tube of Mac Ruby Woo in the club loo. Did you put on weight? Has it cleared up your spots? Which one are you popping and all its ups and downs is as much social-appropriate chat as “where’s that jacket from?”. After all, over 3.5 million women in the UK are making the most of the contraceptive pill that’s been available for over half a century.

But there’s something pretty crucial that many pill users don’t know – the standard three weeks of pill-taking and a seven-day break, a cycle as ingrained as reaching for the Colgate each morning – is actually pretty pointless medically, more risky for pregnancy and inspired by conservative religious beliefs.  

New guidelines from the Faculty of Sexual and Reproductive Healthcare (FSRH), set to be rolled out across the NHS, caused shock last week, as they state explicitly for the first time that women can safely take the pill every day of the month continuously without a break for as long as they wish. Meaning, importantly, no regular bleeds.

So, where did the rigid three-weeks-on-one-week-off formation come from? One reason – which has caused most of the recent discussion – is what has been nicknamed by some as the ‘Pope rule’, though not because the head of the Catholic church had anything to do with its inception back in 1957. It was invented in the United States by John Rock, a devout Catholic gynaecologist, and biologist Gregory Goodwin Pincus, who designed the radical new contraception to mimic a monthly period so that it would be accepted by the church and other religious institutions. Naturally, our Twitter TLs blew up with people outraged that they had been regularly bleeding for what seemed like no reason other than to keep religious types happy.

However, Dr Jane Dickson, vice president of the FSRH, tells Dazed that while the desire to appease religion may have played a part, there are two further reasons the pill had a built-in break. One was that it used to contain a much higher dose of hormones – a single pill, when it was first created, equated to seven today, which made women quite sick – and the other was the belief (shilled of course by men dominating the medical field) that anxious women themselves would panic about not having a regular bleed.

“Society was a very different place back then,” says Dr Ulrike Sauer, a consultant in sexual and reproductive health. Pre-pill, the major methods of contraception consisted of reusable condoms, the diaphragm (a little rubber saucer placed up your vagina) and… pot-luck. There were no readily available pregnancy tests like there are now either. “We’re now a lot more open about periods and sex – back then it was a different story.”

It is unclear what part maintaining ‘menstrual normality’ played in the pill ultimately getting the FDA approval it needed to be rolled out in the US – in 1957 it was first introduced as pain relief, and then in 1960 as a contraceptive – subsequently becoming available on the NHS in 1961.

The fact it revolutionised our sex lives certainly distracted everyone for a long time from questioning whether the military manner of pill-taking, taught by doctors generation after generation, was really the best one. Even when the high doses were lowered by the 1980s, there was a growing realisation that the seven-day break meant you were actually much more likely to accidentally fall pregnant.

“It takes a week of taking the pill to fully send your ovaries to sleep, so an egg isn’t released,” explains Dr Dickson. “And then it takes a week for them to wake up. So every time we have a seven-day break we’re potentially risking that ovary being switched on again.” Recent figures have shown that one in 10 women become pregnant while using the pill. Having a four-day break or none – both suggested by the new guidelines – will reduce this risk.

But in a wellness-obsessed world where living ‘naturally’ is both cool and associated with optimum health, many women have become attached to the monthly bleed in their pill breaks.

“This is often because they believe it confirms they’re not pregnant,” says Dr Dickson. “That’s a complete misconception. The bleed is simply a response to you not having a hormone in your body for those seven days. If a woman falls pregnant while taking the pill, and then has a break, she could actually experience a bleed and be pregnant. It could be falsely reassuring.”

“The fact that (the pill) revolutionised our sex lives certainly distracted everyone for a long time from questioning whether the military manner of pill-taking, taught by doctors generation after generation, was really the best one”

The other perpetuating myth is that, without a regular bleed, menstrual blood will build up inside you. “A lot of women get really worried about where all the blood goes,” continues Dr Dickson. “But because the womb lining isn’t growing, because you’re taking the pill, there isn’t any blood to shed.”

So, if a bleed on the pill neither warns against pregnancy, is actually ‘fake’ and makes sex a lot less safe, why are we still scheduling them in? Dr Dickson explains that while doctors in the US first started exploring the idea of alternative ways to take the pill over a decade ago – and the idea of running pill packs together for holidays has been around for a while – it has taken time for there to be enough build up of evidence through research to show conclusively that there is no medical benefit to having a break.

Then, there’s the issue of getting doctors to actually tell patients it’s alright. “Contraception is very badly covered on the medical school curriculum, and then time pressures in clinics mean doctors may not have the opportunity to pass on the message to patients,” she explains, adding that she hopes that the new guidelines should mean this changes.

And I bloody well do too. Over 10 years ago, at the age of 15, I started taking the pill to help with very heavy, painful periods that made it difficult to stand and left me in constant fear I was going to leak through my school uniform. Fortunately, a relative who happened to be a doctor specialising in sexual and reproductive health, taught me that it was OK to run my packs together - with a four-day break when some spotting inevitably arrives – and I had two periods a year for a long time. I truly believe that without limiting my bleeds, I wouldn’t have seen half as much of the world or be half as productive.

“Contraception is very badly covered on the medical school curriculum”

And before you say “but it’s not natural”, what if I told you that regular monthly periods are a relatively modern phenomenon? Women today have four times as many periods in their lifetime as our ancestors. “We used to have much fewer bleeds because we’d be constantly pregnant or breastfeeding,” explains Dr Sauer.

Indeed, in an age when feminism has never felt stronger and #MeToo is making us reevaluate all the ways the patriarchy continues to hold on tight, putting up with our bleeds month after month while on the pill feels increasingly less aspirational.

Period pain is responsible for 2.1 million hours of missed education for school girls in the UK, according to a recent survey, while Italian researchers found that the wage and promotion gap would be 15 per cent smaller between men and women at work if menstrual symptoms and period-related absenteeism weren’t factors. Indeed, the latter accounts for five million sick days in the UK a year. Running pill packs together can help you skip mood swings, migraines, bloating and cramps, which a leading doctor recently said were comparable to a heart attack.

Having a period is in many ways a financial privilege, too. It is estimated to cost a woman £20,000 in their lifetime (those tampons and ibuprofen all add up), and last year there were heartbreaking reports of UK teachers having to buy pupils sanitary products because they couldn’t afford to buy them themselves and were resorting to socks and tissue paper. ‘Period poverty’ affects one in 10 females aged between 14 and 21.

But times are changing. Unlike in 1957, women in the UK are definitely OK with not having a bleed. The uptake of the continuous progesterone-only pill increased by 1.5 million between 2005 and 2015, and those asking for long-acting reversible contraceptives (like the injection, implant or the ‘coil’) rose from 21 per cent in 2007 to 39 per cent in 2017.

As per the new guidelines, here’s how you can take your contraceptive pill safely and effectively: take it like you have been – continuously for three weeks with a seven-day break, take it for continuously for three weeks with a four-day break (this reduces the pregnancy risk), take it continuously for three months (usually the number of sachets in the pack) and have a break, or take them back to back continuously. “Eventually you will have a bleed because a bit of womb lining will build up,” explains Dr Dickson. If you see spotting for three days, have a four-day break before restarting.

“We want to empower women to make the decision that best suits them when it comes to contraception,” says Dr Dickson of the changing guidelines. And for many people who have periods, feeling comfortable running their packs together will empower them in a different way too.