What happens to your body when you come off the pill?

Coming off the pill

From your moods to your fertility, you may be wondering what life would be like if you stopped taking the pill. We speak to Karin O'Sullivan, clinical consultant at the Family Planning Association (FPA), and Dr Helen Munro, consultant and clinical lead for the Faculty of Sexual and Reproductive Healthcare (FSRH). These sexual health experts explain how your body adjusts to coming off the pill.

What happens to your hormones when you come off the pill?

According to O'Sullivan, no matter how long you've been taking the contraceptive pill - whether it's 10 years or 10 days, the hormones clear from your body very quickly when you stop taking them.

The sexual health nurse says "
Your periods and fertility go back to 'normal' - although what's normal for you might have changed since you started taking the pill."

Regardless of how long you've been on the pill, there's no truth in the myth that the synthetic hormones build up. Once you come off, your natural menstrual cycle returns to releasing different amounts of hormones at different times - instead of the regular dose of hormones you get on the pill - and this may affect how you feel throughout the month.

"If you've been taking the pill for a while then other things in your life have probably changed, and this might mean your menstrual cycle is now different to how it was before the pill," O'Sullivan says.

"Now you're older, you may have gained or lost weight, developed a medical condition, started on medication, become more happy or sad, moved house, or started or ended a relationship. These factors can all affect how you feel, and how the natural hormones in your body will affect you."

Physically, she adds: "You might also notice a change in your vaginal discharge, which can change from being thick, sticky and white, to become more slippery, a bit like raw egg white, at the time of ovulation."

If you previously suffered from hormonal issues which the pill has been keeping at bay - such as period pain, mood swings or acne - then there is a chance that these problems will return after coming off the pill. However, as O'Sullivan points out, it's worth remembering that getting older and changes to your lifestyle can also have an impact on any of these symptoms.

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How many days after stopping the pill does your period start?

"For some people, their normal menstrual cycle will return straightaway after coming off the pill, while for others it may take a few months before their periods start again or settle into a pattern," O'Sullivan explains.

As a general rule though, she adds, if your periods haven't restarted after a few months then it's worth seeing your doctor to check for any medical issues or an unexpected pregnancy.

Will your period change?

If you've been taking the combined oral contraceptive pill (COC), you may have found that your monthly withdrawal bleed was much lighter and less painful than a normal period. If you've been on the progestogen-only pill (POP) then you may have stopped bleeding altogether.

As with the other symptoms, O'Sullivan explains that you may find your periods go back to exactly as they were before the pill - with your monthly bleed becoming longer, heavier and more painful again once you come off - or they may be different due to changes in your body and lifestyle.

For example, if work or your personal life is currently causing you a lot of stress - more than you felt during your last natural menstrual cycle - then you may find your natural period is more painful than you remember¹.

How long after coming off the pill will you be fertile?

The main function of birth control pills is to prevent your body from ovulating, or releasing an egg, and fertility should return quickly once you stop taking the pill.

Dr Munro says: "If you consider the missed pill rules, which is the advice we give to women taking the pill, there is a risk of ovulation after just 48 hours, and therefore a risk of unplanned pregnancy if unprotected sex occurs around the same time."

In other words, if you're coming off the pill but don't want to get pregnant then make sure you have an alternative method of contraception lined up straightaway.

"Long-acting reversible contraception (LARC) - such as the implant, hormonal and non-hormonal coil, and contraceptive injection - is the most effective option we have, and can be used by most women," Munro explains.

"My advice is that there is no perfect contraception method but it's important you attend a GP or specialist contraception clinic to discuss your options - especially if you've had a poor experience of the pill, or negative side effects," she adds.

However, if you're coming off the pill because you are hoping to get pregnant, O'Sullivan says be prepared that it may not happen straightaway - although remember also that it could.

"Factors such as age and how fit and healthy you are can affect how long it takes to get pregnant, but the majority of couples trying for a baby will get pregnant within a year if they're having unprotected sex regularly every 2-3 days," she advises.

Will there be any lasting affect?

Munro says: "There are no known lasting affects on fertility, even if you have been using either the COC pill or the POP for many years. This is often a concern for women, who come to my clinic voicing a perceived need for a break from the pill and a temporary return to their natural menstrual cycle. There is no evidence that this is needed, and could lead to an unplanned pregnancy if no other method of effective contraception is used in its place," she explains.

Also remember that use of the COC pill is linked with a reduced risk of both ovarian and endometrial cancer which, Munro adds, "continues for several decades even after coming off the pill - a really positive side effect that's often overlooked and not mentioned."

Further reading

1. Pakpour et al: Depression, anxiety, stress, and dysmenorrhea: a protocol for a systematic review.