Tricycling the contraceptive pill

Information for patients

Sexual Health

What is tricycling pill taking?

Tricycling means continuing to take your pills every day in a row (without the regular pill free 7 day break), or 'back to back' with no break until you’ve finished the box. When you have taken all of the pills in the box, take a 4 day break, before restarting the next box. 

This means you would have a bleed every 3 months (rather than every month). There is a lot of evidence that tricycling makes your pill much more reliable and national guidance supports this. We have known for some time that the break of 7 days when not taking the pill weakens the pill’s main effect of stopping your ovaries from releasing an egg.

It makes egg-release more likely when pills are missed which can then result in pregnancy. The added benefit of tricycling the pill is it will reduce the number of bleeds you have as there are less breaks in pill taking.

The instruction leaflet in the box with your contraceptives will usually suggest taking pills in the usual licensed way of 21 days followed by a 7-day break, but national medical advice says it is just as safe to choose tricycling. This is an 'off-licence' prescription because the pharmaceutical companies that make the pill have not applied for a licence for using the tricycling method as this is an expensive and time-consuming process.

What is an 'off licence' prescription?

All medicines have a product licence. The licence tells us under which conditions the medicine can be prescribed for patients. If expert medical opinion is that a medicine can be used in different ways or under different conditions, this is called prescribing 'off-licence'.

You may choose whether you prefer to take your pills in the usual licensed pattern, or the tricycling method.

We usually recommend a 20 to 30 microgram oestrogen pill for tricycling - your healthcare provider will be able to tell you about this.

What are the benefits of tricycling pills for me?

  • It makes the pill more reliable as a contraceptive
  • It may reduce problems such as period pain, PMT (pre-menstrual tension), migraine and other headaches
  • It’s convenient if you want to avoid monthly bleeding

How do I tricycle my pills?

Take one pill at the same time of the day, at a time that is easy for you to remember. 

Each box contains 3 strips of pills. Take all the pills in a strip and then start the next strip straightaway without a break. 

Keep taking the strips without a break, until you have finished all the strips in the box (three strips in total). 

After completing all 3 strips of pills in a box, take a 4 day break, during which time a bleed is likely to occur, before restarting your pills again. 

Restart the pill after 4 days even if you are still bleeding.

How long can I tricycle my pills for?

For as long as you like - until either you choose another contraceptive method, or your clinic advises you to stop.

Isn't it better for me to have 'periods' every month?

'Periods' are not needed. Women do not need to bleed every month to know that they are not pregnant or for any other health benefit. The womb lining does not build up because the pill keeps the lining of the womb thin. The 'period' on the pill is completely artificial and is just your womb’s response to stopping the pill (and therefore the hormones) for a few days. Tricycling stops you having that completely unnecessary monthly bleed.

What happens if I get bleeding while tricycling my pills?

Irregular bleeding and/or ’spotting’ during the first months of tricycling pill-taking can occur, but most women find this becomes acceptable and it often lessens over time. If the bleeding is troublesome for you and continues for more than a few days, or does not settle, seek medical attention.

How often should I come back for follow up?

Once you are settled on the pill you usually only need a yearly check for any changes to your medical history, family history, drug history or allergies. You will also have your blood pressure and weight checked yearly.

If at any other time you have a question, or problem, or want to switch methods, make an appointment with your clinic for review. 

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