Dosing

• Monophasic combined oral contraceptives are usually taken continuously for 21 days followed by a seven-day hormone-free interval (this is usually referred to as “standard use”). However, this interval can be truncated to four days (known as “shortened hormone-free interval”) and active pills taken for three cycles before a four- or seven-day interval (“extended use” or “tri-cycling”). Unbroken use of active pills is also possible (“continuous use”), with some patients opting to take a four-day break if they experience breakthrough bleeding that lasts three to four days (“flexible extended use”). In all cases, active pills should be taken at the same time each day, starting on day 15 of the menstrual cycle with no need for additional precautions
• Monophasic, phasic (where packs contain different coloured pills containing a different amount of hormone) and everyday pills (packs contain 21 active and seven dummy pills) should be taken at the same time every day, starting as detailed for monophasic pills, although there are some exceptions, so individual SPCs should be checked.

Patients should be advised that use of tailored regimens is outside the manufacturer’s licence but is supported by The Faculty of Sexual and Reproductive Health (FSRH).