Sisters doing it for themselves.

©FSRH J Fam Plann Reprod Health Care 2009: 35(2) Background We have come a long way since John Rock and his coworkers felt it necessary to build in a monthly bleed for women on the combined oral contraceptive (COC) pill.1 They were trying to offset potential objections from the Catholic church, and were aware of the fact that women were psychologically reliant on monthly bleeds for reassurance they were not pregnant. This was especially important with the early high-dose COCs, since the side effects in the early months of use were very similar to those of early pregnancy: nausea, breast tenderness and some bleeding. The 7-day pill-free interval (PFI) was chosen to ensure that the majority of women would start to bleed before they were due to start their next packet. The high doses used (100 μg ethinylestradiol) meant that it took several days before the hormone levels fell sufficiently to cause the bleed. Nowadays, with much lower doses of hormones being used, the 7-day pill-free week is clearly too long, with increasing evidence of follicular activity and even ovulation despite accurate pill taking.2,3 In addition, over the years, awareness has increased regarding problems specifically related to the PFI, such as premenstrual symptoms, headaches and painful bleeds.4