{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T20:44:34Z","timestamp":1781210674026,"version":"3.54.1"},"reference-count":50,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2018,5,4]]},"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>This review summarises the available data on the disadvantages of the 7-day contraceptive-free interval (CFI) of combined oral contraceptives (COCs), in contrast to shorter CFIs or continuous use \u2013 including flexible regimens \u2013 and provides recommendations for practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Relevant papers were identified by Medline and PubMed. The final reference list was generated on the basis of relevance to the review, with priority given to systematic reviews and randomised controlled trials.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There is considerable inter- and intra-individual variation in the absorption and metabolism of COCs. Even with perfect use, the loss of endocrine suppression during the standard 7-day CFI allows follicular development with the risk of escape ovulation in a vulnerable minority. This risk increases in typical users whenever the CFI is prolonged: late restarts are a common reason for pill omissions. Shortening or eliminating the CFI improves contraceptive efficacy using the lowest doses available, without evidence to date of compromised safety.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There is no scientific evidence to support a 7-day CFI and it should be replaced either by a continuous flexible regimen, or extended regimens with a shortened CFI, prescribed first-line. In women preferring a monthly \u2018bleed\u2019, a 4-day CFI similarly provides a greater safety margin when pills are omitted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2017-200036","type":"journal-article","created":{"date-parts":[[2018,6,26]],"date-time":"2018-06-26T12:25:23Z","timestamp":1530015923000},"page":"214-220","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["The 7-day contraceptive hormone-free interval should be consigned to history"],"prefix":"10.1136","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4116-9828","authenticated-orcid":false,"given":"E Anne","family":"MacGregor","sequence":"first","affiliation":[{"name":"Barts Health NHS Trust, London, UK"},{"name":"Barts and the London School of Medicine and Dentistry, Centre for Neuroscience & Trauma, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Guillebaud","sequence":"additional","affiliation":[{"name":"UCL EGA Institute for Women\u2019s Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,6,26]]},"reference":[{"key":"2025090221170436000_44.3.214.1","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/0002-9378(58)90722-1","article-title":"Fertility control with oral medication","volume":"75","author":"Pincus","year":"1958","journal-title":"Am J Obstet Gynecol"},{"key":"2025090221170436000_44.3.214.2","first-page":"CD003989","article-title":"20 microg versus >20 microg estrogen combined oral contraceptives for contraception","volume":"8","author":"Gallo","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025090221170436000_44.3.214.3","unstructured":"Trussell J . 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