Can you skip placebo pills on Slynd?

In this article:

• Role of placebo pills
• Can I skip placebo pills on Slynd?
• Side effects
• The bottom line

In this article

• Role of placebo pills
• Can I skip placebo pills on Slynd?
• Side effects
• The bottom line

Slynd is a progestin-only, estrogen-free hormonal contraceptive that prevents pregnancy primarily by suppressing ovulation. Slynd contains 24 active hormone pills and four placebo pills, for a total of 28 tablets. According to James Lyons, MD, Physician at Synergy Houses, some people notice lighter or less frequent bleeding on Slynd, but the placebo phase helps create a pattern that can feel more predictable and manageable.

The role of Slynd placebo pills

The non-hormone placebo pills are included to help users maintain the habit of taking a pill every day. “During the placebo days, the hormone drop causes a withdrawal bleed, mimicking a period. While this bleed is not medically necessary, some people find it reassuring because it signals that their birth control is working as expected. It also gives a precise rhythm to the monthly cycle, which can feel more natural for some,” says Dr. Lyons.

According to Amy Paris, MD, MS, director of family planning at Dartmouth Health’s Department of Obstetrics, Gynecology, and Nurse Midwifery, scientists developed birth control pills with the placebo pills because they thought that experiencing a monthly period would make the pill more comfortable for users. For some, having monthly bleeding is a sign that they are not pregnant. However, it’s important to note that a period is not perfectly predictive of not being pregnant, according to Dr. Paris. It’s possible to have breakthrough bleeding that resembles a period during pregnancy.

Can I skip the placebo pills on Slynd?

Whether you choose to simply not take the placebo pills while waiting four days to start a new pack or skip the placebo pills and immediately start a new pack of active tablets, this practice is medically safe.

“While this approach is off-label, you can take Slynd without the placebo pills, preferably at the same time daily, without missing any doses,” says Rayan Elkattah, MD, OB-GYN at Iris Wings Sanctuary for Endometriosis Surgery & Wellness. Doing so does not affect the effectiveness of the pill and has no specific health risks, he adds.

According to Dr. Lyons, skipping the placebo pills and starting a new pack right away can help you avoid the withdrawal bleeding that typically occurs when taking the placebo pills. “Skipping placebo pills can be super convenient for people who do not want to deal with monthly bleeding. It can also reduce cramping or mood swings that might come with hormone fluctuations during the placebo days,” adds Dr. Lyons.

While the most common reason for skipping the placebo pills is to avoid the withdrawal “period” that occurs while not taking a daily hormonal pill, it’s also common to experience fewer cramps, bloating, and mood fluctuations, according to Dr. Elkattah.

However, Lauren Demosthenes, MD, an OB-GYN and Senior Medical Director with Babyscripts, notes that it’s possible to have breakthrough bleeding with either approach. Breakthrough bleeding is normal as your body adjusts to constant hormone use. At the same time, giving your body a four-day break from hormonal birth control may also help decrease the chance of unscheduled vaginal bleeding.

Dr. Paris concurs: “The most common side effect of progestin-only contraceptive methods, such as Slynd, is breakthrough bleeding, meaning unexpected or unscheduled bleeding. The placebo pills may have a role in decreasing unscheduled bleeding by giving the uterus a chance to “reset” every month.”

Which approach to take ultimately comes down to personal preference and medical history. Some people prefer to continue with the reminder (placebo) pills, and others prefer to skip them to avoid any bleeding around special events or vacations. If you do wish to skip the placebo pills, it’s important to seek your healthcare provider’s medical advice first to ensure it’s the right choice for you and address any concerns you might have.

Potential side effects of skipping the placebo pills

While the most common side effect of skipping placebo pills is irregular bleeding or spotting, there are a few other potential side effects to be aware of, though these are likely temporary as your body adjusts to continuous hormone use.

Side effects include:

• Breakthrough bleeding, especially in the first few cycles
• Breast swelling or tenderness
• “Unfamiliar” feeling of skipping your menstrual period
• Uncertainty around pregnancy

Beyond side effects, there are a few other considerations to take into account when weighing whether to skip your placebo pills. If you choose to simply not take the placebo pills while still waiting the four days before starting the next pill in your next pack, it might also make tracking where you are in your pill pack harder, so keeping on top of your schedule is important, says Dr. Lyons. In the event of a missed pill, Slynd users have a 24-hour window to catch up on a missed active tablet. When taken on the first day of menstruation, this progestin-only pill will work immediately.

Secondly, while not a side effect, another consideration is cost. You will need more oral contraceptive packs per year if you skip four days per month, so there could be a cost associated with this.

Possible side effects of Slynd include high potassium levels, blood clots, ectopic pregnancy, liver problems, and high blood sugar levels in people with diabetes. Those with kidney disease, liver disease, liver tumors, adrenal disease, or who have had breast cancer should not use Slynd and consider another method of birth control.

If you experience chest pain, sudden severe headache, irregular heartbeat, shortness of breath, jaundice, or yellowing of the skin or eyes, call your healthcare professional right away. Do not take Slynd with certain supplements, including St. John’s wort, or medications, including clarithromycin or spironolactone. Contraceptive pills do not protect against sexually transmitted diseases.

The bottom line

The inclusion of placebo pills gives users a scheduled break, which can regulate breakthrough menstrual bleeding—a common issue with drospirenone-based birth control. However, it’s generally safe to skip the inactive pills to skip or reschedule that period of bleeding.

“Whether you decide to skip placebo pills or not, consistency is key as your body adjusts to your chosen strategy. If you have any concerns about how it might affect your health or cycle, it’s best to explore this with a healthcare provider who can offer personalized guidance based on your specific healthcare needs and goals,” says Dr. Elkattah.