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This article is not intended to treat any condition or replace guidance from your healthcare provider. This article does not describe all the benefits, risks, contraindications, medication interactions, dosage instructions, or other important details related to hormonal contraception. This also does not discuss permanent or hormone-free forms of birth control, such as condoms or the copper IUD. This topic also does not cover emergency contraception. Please do not make any health-related decisions in accordance with this article – it is purely informational based on a question received about what to expect when coming off the pill. Please seek the advice of an OB/GYN or other trusted health care provider. Let your provider know of any medications or supplements (including herbal) that you take, as these can lead to medication interactions.
In this article, for brevity, women refers to those assigned female at birth (AFAB) of reproductive age, though we recognize and respect that women may in other contexts represent a range of individuals, and that not every AFAB identifies as their respective assigned gender. It is our hope that our message is inclusive, and we welcome feedback on how to respectfully communicate with our audience.
“Combined” in the context of birth control refers to using a combination of the hormones estrogen and progestin, such as in combined oral contraceptive pill (COCP), the vaginal ring, and patches (4). Other forms of hormonal birth control include – the mini pill, the hormonal IUD, the implant, and DMPA (“Depo”) injection, all progestin-only; these may be beneficial options for women who cannot or do not want to take estrogen-containing medication (history of blood clots, high blood pressure, migraine with aura, on seizure medication, among other reasons) (4).
Here are links for helpful comprehensive for patient education on different forms of birth control; again, this does NOT replace a discussion with your healthcare provider:
Clinicians and patients have reported various reasons for discontinuing hormonal birth control, including the desire for greater autonomy over birth control choices. There are advantages and risks involved in the decision, which should be discussed with a health care provider. Unfortunately, there is a lack of published, credible, peer-reviewed research on this topic, which can be detrimental to women and our healthcare system. (1)
Another concern for women who stop using hormonal birth control is the return of fertility. However, hormonal contraception can mask underlying causes of infertility, so it's important to be aware of any reproductive health issues. Unless there are underlying reproductive issues, women can resume their ability to become pregnant within one to two cycles (8). Periods typically resume within 4 weeks after stopping combined contraception, but can vary depending on individual factors (3). Those on the COCP, patch, or vaginal ring typically resume regular ovulation 1-3 months following hormonal birth control cessation. Delay of fertility can occur following discontinuation of the injectable form of birth control, as some people do not resume periods for up to 18 months. After stopping the injection, approximately 50% of people who desire pregnancy are pregnant within 10 months. After removal of the implant or hormonal IUD, ovulation typically resumes within one month (8).
One phenomenon associated with discontinuing hormonal birth control is Post-Birth-Control-Syndrome. This refers to a collection of symptoms experienced by women when they stop using hormonal contraception (1). Discontinuing hormonal birth control may lead to unwanted side effects, including abdominal discomfort, return of endometriosis-related pain, withdrawal bleeding, or worsening of acne or hisutism. Hormonal birth control can provide several benefits, including treatment of menstrual pain (dysmenorrhea), abnormal uterine bleeding (such as heavy bleeding from fibroids, which can lead to anemia (6, 8)), reduction of hyperandrogenic signs (acne and hirsutism), management of pain from endometriosis, and decreased risk of endometrial (uterine), ovarian, (4) and colon cancers (6); therefore, cessation of hormonal contraception may reverse these benefits. According to the American College of Obstetricians and Gynecologists, consistent use of hormonal contraception can reduce frequency of migraines (though they are contraindicated in patients who also have aura) (6). One study identified four of the most pressing concerns, subjectively by patients – weight change, headaches, moodiness, and sexual satisfaction, though other side effects were not explored. This study demonstrated that most participants denied changes in these common concerns after stopping oral contraceptive use. (2) Perhaps most important to some women, stopping birth control or missing a dosage can also result in unintended pregnancy. In 2011, 45% of pregnancies in the US were unplanned (5).
Hormonal birth control is safe for most women. However, for women on combined contraception (because of the estrogen component), there is a small risk of blot clots, that can lead to pulmonary embolism (blood clot in a lung blood vessel), stroke, or myocardial infarction (heart attack) (6, 7). After discontinuation of hormonal birth control, it may take 4-6 weeks following the cessation of the medication to reduce clotting factors in the blood (4). Nausea, changes in mood, breast tenderness, irregular bleeding (or “breakthrough bleeding”, “spotting”), and bloating may occur when starting the pill, patch, or vaginal ring, but usually improve within 2-3 months. Forgetting a pill can also result in irregular bleeding (8). Overall, studies show mixed results, there is some evidence that those who take the pill have a slightly higher risk of breast cancer later in life than those who do not take this form of birth control (8).
In conclusion, the decision to stop using hormonal birth control is a personal one, and it's important to be aware of the potential consequences. Women who are considering discontinuing hormonal birth control should consult with their healthcare providers to determine the best course of action for their individual situation.
Lazorwitz, A. & Davis, A. R. (2018). Discontinuation of hormonal contraception: An overview for the practicing obstetrician-gynecologist. Reviews in Obstetrics & Gynecology, 11(1), 26-32. doi: 10.3909/riog0943
Bitzer, J., Simon, J., & Mueck, A. O. (2017). Complaints attributed to hormonal contraception after stopping the pill: A pilot study in general practice. European Journal of Contraception and Reproductive Health Care, 22(6), 409-414. doi: 10.1080/13625187.2017.1393927
Lopez, L. M., Grey, T. W., Hiller, J. E., & Chen, M. (2013). Education for contraceptive use by women after childbirth. Cochrane Database of Systematic Reviews, 7, CD001863. doi: 10.1002/14651858.CD001863.pub4
American College of Obstetricians and Gynecologists. (2020). Hormonal contraception. Retrieved from https://www.acog.org/womens-health/faqs/hormonal-contraception
Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008-2011. New England Journal of Medicine, 374(9), 843-852. doi: 10.1056/NEJMsa1506575
Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., Berry-Bibee, E., Horton, L. G., Zapata, L. B.,...Whiteman, M. K. (2019). U.S. medical eligibility criteria for contraceptive use, 2016. Morbidity and Mortality Weekly Report, 65(3), 1-103. doi: 10.15585/mmwr.rr6503a1
Lidegaard, Ø., Nielsen, L. H., Skovlund, C. W., Løkkegaard, E., & Venø Skovlund, C. (2012). Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9. British Medical Journal, 345, e6423. doi: 10.1136/bmj.e6423
American Society for Reproductive Medicine. (2018). Progestin-only hormonal contraception: Pill and injection. Retrieved from https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/progestin-only-hormonal-contraception-pill-and-injection/