The Truth About the ‘Pope Rule’ and the Seven Day Contraceptive Pill Gap

If you’re on the pill, you dread the week-long break. You try to plan your holidays, date nights and club outings around that immensely inconvenient seven days. But now (trumpet sounds), the Great Disruption could be no more. New guidelines from the Faculty of Sexual and Reproductive Healthcare (FSRH) confirm that there is no medical benefit to stopping your oral contraceptive for seven days. So why was it there in the first place?

Apparently, it’s because of the Pope. This Telegraph news story on the changes claims that women have been given misleading advice for decades in order to please the Catholic church, with a Catholic scientist who helped to develop the medication believing that the break might go down better with the anti-contraceptive religion, as it could be pitched as more “natural”. The women who fought for our right to control our own bodies would be appalled at the bio-politics at play here: Catholicism having a say over women’s reproductive rights? Again?

I wanted to know why it took over 50 years for this guidance to be scrapped and, of course, if the rule had anything to do with the Pope. To find out, I spoke to Jane Dickson, Vice President of the Faculty of Sexual and Reproductive Healthcare.

VICE: What led to this revelation about the “Pope Rule”?
Jane Dickson: Can we start off by not calling it a “Pope Rule”? Essentially, the background to the seven-day break with the pill is actually multi-factorial. There were many reasons, historically, why the pill had a seven-day break, not just because one of the inventors himself was a Catholic and wanted to appease the Catholic church – so I think that’s really important. It wasn’t just about appeasing the Catholic Church. I think there has been a lot taken out of context and sensationalised in the press; I need to clarify that first.

So: there were many reasons why there was a break when the pill was introduced. One of the most important reasons is that the pill that was used 60 years ago, some of the hormones that were in that pill were 100 times greater in dose than the pills we have now. Quite often, women actually felt quite dreadful when they took it. Part of the reason for the seven-day break was just a break from the massive amount of hormones. Also, it led to a period, even though we know now that that’s not a proper period, that’s just a withdrawal bleed. Because contraception was new at the time, there was a lot of anxiety about how it affected your body. One of the other reasons for the break was to reassure women that they weren’t pregnant.

What we have seen over the years is that pills have been modernised; we have much lower dose pills now, [and they are] much better tolerated. Research over the last ten years or so has demonstrated that there is actually no medical reason to have a break. We also know that many women are troubled by symptoms due to their break. There’s quite a lot of women who get rebound headaches and mood swings in the week that they’re not taking the pill. As well as that, they’re having to have a period, which, you know, let’s face it, if you could do without, quite a lot of women would prefer not to have. Basically, we’re trying to put women at the forefront and it’s not about any anti-Pope thing; it’s actually about the fact that it’s not medically necessary.

It’s a guidance for health professionals – it’s not a Department of Health ruling, or an NHS ruling. We’re a professional organisation that makes clinical recommendations to health professionals who provide contraception, so it’s just about the fact that we now have enough evidence to say that you don’t have to have that seven-day break. If you don’t want to have the seven-day break, you don’t have to have it.

Are there any other benefits to the break?
The other slight advantage is that women who take the pill because they’ve got symptoms – like maybe they’re taking it because they’ve got painful periods or a condition like endometriosis or PMT – and they’re taking the pill to suppress those conditions, those conditions are going to be better helped if you’re taking it continuously and you don’t need to have the break. The other advantage of that is that there’s potential [for] fewer pill failures. Even though the pill is a very popular method of contraception, it actually has a very high failure rate. In realistic terms, it has a failure rate of 9 percent. This is because people often miss pills, and if they miss pills around the time of their break, it means that they get more potential for their body to actually ovulate. There’s a likelihood that if you have fewer breaks, there is a lower chance of failure. So those are the reasons behind the recommendations.

Does that mean it’s possible that women could keep taking the pill for, say, a year straight, without getting their periods?
Absolutely, that would be fine. The only thing is that it would be unlikely that she wouldn’t get some spotting bleeding at some point.

Thanks for clearing up the Pope stuff. Why is it that everyone is misinterpreting this information to think that the Pope’s the main cause?
Basically, one of the inventors of the pill was a Catholic. He was concerned about how the Catholic church would respond to contraception. There is a theory that one of the reasons for the pill-free interval was to make it more acceptable to the Catholic church, because it mimicked the natural cycle. But as I told you, there were lots of other reasons for that break, other than just the Catholic church.

Why do you think it’s such a popular theory?
I think it’s a sensationalised story, because contraception isn’t very sexy. So, some sensationalising every now and then doesn’t go amiss. But, really, we view this as a positive change. It puts women at the centre of their care, to give them more power over their bodies.

What’s the main message here?
There’s all sorts of ways that we can empower women to take control over their hormones. That’s the far more important message than anything about the Catholic church. It’s about women having more reproductive control, [and] that there’s potential for it to be more reliable, less pill failures and health benefits, in terms of better control of conditions like endometriosis and PMT. I suppose we’re just trying to challenge the held belief that you have to have a period. It is just a withdrawal bleed.

How do you think this will this affect women taking the pill right now?
Basically, if women are established in their current regime, and they’re happy taking the pill, and with their standard three weeks on, one-week break, they don’t need to change to anything. This advice is really just for health professionals who are starting women or educating them on contraception. It just means that when women talk to their doctor or their nurse for contraception, we can go through with them that there are different ways of taking the pill that their patients might like to know about. There’s no need for people to panic, or change the ways we do anything. This is a guideline for health professionals. This will influence women, but it’s not aimed at them. It’s for doctors and nurses who are going to support these women and their contraceptive choices.

How long until these new guidelines reach the NHS?
Well, it’ll be influencing the NHS now.

So, just to clarify for anyone who scrolled through to read the end: there is no medical benefit to the break?
No.

Thanks, Jane!

@CorissaHollenb1