Unscheduled bleeding is the commonest reason women abandon a continuous or extended combined pill regimen, and most of it can be managed without switching method. The first step is to exclude other causes: missed pills, vomiting or diarrhoea, interacting drugs such as enzyme inducers, pregnancy, chlamydia, and cervical pathology if bleeding is new or persistent.
If those are excluded and a woman has taken at least 21 consecutive active pills, a short hormone-free interval of up to four days usually settles the lining; she then restarts active pills. Tailored regimens built on this pattern are supported by UK sexual and reproductive health guidance.
- Check adherence, vomiting or diarrhoea, and enzyme-inducing drugs first
- Offer a pregnancy test and chlamydia screen when bleeding is new
- Examine the cervix if bleeding persists beyond three months or appears after a settled pattern
- After 21 or more consecutive active pills, a break of up to 4 days is a reasonable fix
- Never allow the hormone-free interval to exceed 7 days
Why it matters
Most women who stop continuous pills for bleeding could have been kept on them with one simple instruction.
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