For decades, millions of women have been taking birth control pills as a form of contraception. It is one of the most popular options for family planning available and works by manipulating hormones.

How birth control pills work is by stopping ovulation through using hormones, namely estrogen and progestin. Some options contain a combination of both while others only contain progestin. When taken properly, they can effectively prevent pregnancy.

If you’ve taken them, then you are aware that the pills commonly come in 21-day or 28-day packs. The 28-day packs include one week of inactive pills – called placebos – that are hormone-free. During that last week on the placebos, women can typically expect to have a period or “withdrawal bleeding”.

It is an easy way to stay on a 28-day schedule because there are 7 days of sugar pills automatically built in at the end. But that too is a choice.

Some women take the full week’s worth of placebos, some skip it and start a new pack immediately, and some break from the placebos mid-week and start a new pack. Depending on the brand, any of those methods can be done as can following the manufacturer’s instructions to a “T”.

With those 21-day packs, in general, there are no placebo pills, but women can give themselves a 7-day break before starting a new cycle of pills. You may or may not experience bleeding, but since there are no placebos, some women opt to either start a new pack the next day or take a short break before beginning.

Have you ever wondered the purpose behind all this? According to an article with Vice, placebo pills were first introduced in the ‘60s as a reminder for women to take a pill each day. Skipping one week of bleeding was not looked upon kindly then.

It wasn’t until the early 2000s that brands started offering birth control pills that wiped out a bleeding period altogether. It then turned into a medical and personal debate about whether or not one should suppress their menstrual period.

Called “extended cycle pills”, they’ve been deemed safe by OB/GYNs and boil down to whether or not a woman wants to have a period while on the pill. Many have found that ditching a placebo option also means ditching migraines, cramps, acne, and other conditions.

Others don’t mind having a 7-day break or a shortened one. But when it comes to science, there really wasn’t a reason for the placebo pills to be included in the first place other than as a quaint reminder.

Taking placebos is not a must, nor is it a bad thing.The choice is yours, ladies. It is best to discuss your reproductive health with your doctor, and if you have questions about the various ways you can take the pill and menstrual suppression safety, ask them.

Did you know about the use of placebo pills in birth control packs? Do you have a preference for if or how to take them? What’s your stance on “menstrual suppression”?