Contraception 2014;89:28–3

Skipping the pill-free interval: data from a Dutch national sample

Charles Picavet et al


A monthly pill-free interval is unnecessary and many women prefer to have fewer bleeding episodes.

Methods: Eight hundred and eighteen oral contraceptive pill (OCP) users reported frequency of skipping the pill-free interval in the online 2011 Sexual Health in the Netherlands Survey. Demographics of women who skipped pill-free intervals regularly were compared to those of women who rarely skipped intervals.

Results: 73% of the women have ever skipped pill-free intervals and 38% do so regularly. Women of Dutch or Western origin and non-religious women skip intervals more frequently, but differences are small. 

Discussion: Skipping pill-free intervals is common, even when it is not actively promoted.

Implications: Women who use OCPs can and do skip pill-free intervals, either with or without consulting a physician. If bleeding preferences were structurally discussed with patients, the number of women who skip intervals may increase even further.

Comment: This small and elegant study shows that many women, who do not want to have withdrawal bleedings, skip the pill-free interval. In my experience these women continue their pill, or vaginal rings, until they have some spotting or breakthrough bleeding. This practice appears to be acceptable, however, it can only be done with monophasic products, without placebo pills. (Hans Vemer)