Are fertility apps a reliable form of contraception?
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What happens to your body when you come off the pill?
The contraceptive pill has long been hailed as a feminist revolution in sexual health. First licensed during the 1960s, 'the pill' has been giving women control over their reproductive systems for nearly six decades. But, in recent years, there's been a growing movement of women turning their backs on this method of birth control. So, with many of us having been on the pill since our teens, what actually happens to your body if you do decide to come off?
Recently, after almost a decade, I stopped taking the pill. Not because I plan on getting pregnant (sorry, mum!) but because I, like a growing number of fellow millennials, had started wondering what life would be like without my daily dose of synthetic hormones.
After investigating the pros and cons of both hormonal and 'natural' contraception, I decided to take the plunge and give contraceptive app Natural Cycles a whirl, in (extremely cautious) combination with condoms. I took my final pill, got all my details set up in the app, began dutifully taking and recording my temperature each morning, and waited for the app's algorithm to start alerting me to my 'green' (non-fertile) days.
Having been on the pill for almost my entire adult life though, I quickly realised I wasn't quite sure what to expect. Would I instantly revert back to a hormonal teenager? Or would I instead be transformed into some kind of empowered earth mother, in tune with my natural cycle? And how long would it actually take for my periods - and my fertility - to go back to 'normal'?
What happens to your hormones?
Whether you've been taking the pill for ten years or ten days, clinical consultant Karin O'Sullivan from sexual health charity fpa tells me: "The hormones clear from your body very quickly [when you come off], and 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 secretions, 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, as in my case, acne - then there is a chance that these problems will return when you stop taking it. 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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Will your period change?
"For some people, their normal menstrual cycle will return straightaway, 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.
If you've been taking the combined oral contraceptive (COC) pill, you may have found that your monthly withdrawal bleed was much lighter and less painful than a normal period; or, if you've been on the progestogen-only pill (POP, or mini-pill) 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.
How quickly will you be fertile again?
The pill's main function is to prevent your body from ovulating, or releasing an egg, so it's safest to assume that normal service will resume as soon as you stop taking it.
"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," says Dr Helen Munro, a consultant in contraception, sexual and reproductive health (CSRH), and chair of the Clinical Standards Committee for the Faculty of Sexual and Reproductive Healthcare (FSRH) at the Royal College of Obstetricians and Gynaecologists (RCOG).
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 to women is always that there is no perfect contraception method, unfortunately, but it's important they attend a GP or specialist contraception clinic to discuss their options - especially if they've had a poor experience of the pill, or negative side effects," she adds.
If, however, you've come off the pill because you are hoping to get pregnant, O'Sullivan says be prepared that, although it could, it may not happen straightaway.
"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 impact?
Finally, Munro says: "There is no known impact 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 to 'normalise things'. 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.
As an added bonus, use of the COC pill is associated with a reduced risk of both ovarian and endometrial cancer which, Munro adds, "continues for several decades even after stopping it - a really positive side effect that's often overlooked and not mentioned."