“I’ve been off the pill for almost six months but still haven’t had a period. What’s going on?” I’ve heard this so many times. What are your ovaries doing if they’re not pumping out healthy, regular cycles?? The key word for understanding what’s going on when coming off the pill is called cycle regulation, a process governed by your own hormones.
Once you begin hormonal contraception, of any kind, your system is halted. The symphony of hormones that usually occur in a menstrual cycle are suppressed. Instead, you just have a small, steady dose of synthetic estrogen and/or progestin (depending on the type of contraception you are on) keeping your regular hormones at bay. When you take the placebo pills or remove your ring or patch, you have a hormonal withdrawal bleed. But you are neither ovulating nor menstruating(1).
The day you throw out your pills, toss your ring, remove your hormonal IUD, it’s different. Progressively your reproductive system wakes up and begins to activate again. Some women begin ovulating and menstruating regularly right off the bat. But most women will experience a period of adjustment as their hormones begin the process of cycle regulation again.
There are three scenarios in which the process of cycle regulation is completely expected and normal: puberty, the return of fertility following pregnancy/birth, and perimenopause (which is actually a process of ending cycles). When coming off the pill, cycle regulation most closely resembles return of fertility after pregnancy. But unlike pregnancy, the absence of ovulation during hormonal contraception has been synthetically induced.
FSH, Estrogen, LH, and Progesterone are the four main hormones ruling the menstrual cycle, and in that order. Each hormone needs to reach a sufficient level for the next hormone to launch. This rarely happens the first time around after ditching the pill. Rome wasn’t built in a day, and neither was the menstrual cycle.
Here are completely normal things you can expect as the body works on returning to fully ovulatory cycles.
Lots of cervical fluid. Or none. Or some that doesn’t have a distinct pattern. Think of your observations of your cervical fluid as having your ovarian hormones on speed dial. Your cervix responds to progesterone and estrogen. Therefore your cervical fluid tells you exactly when these hormones are rising and falling. Lots of super fertile fluid may not actually mean you are fertile or ovulating. That pretty pattern of fertile fluid–>super fertile fluid–>dry up after ovulation you see in the text books? It likely won’t look like that for you right away. If you are working with a certified FABM instructor, they should be able to help you determine what this means for you.
Irregular bleeding. Why? Because your uterine lining is thin as long as progesterone is not being produced. The only thing that creates progesterone (not to be mistaken for progestin, the synthetic hormone in almost all hormonal contraception) is ovulation. A thin uterine lining is unstable and easily shed. This bleeding may have nothing to do with the ovulatory menstruation you are hoping to achieve. In other words, you may bleed, but it doesn’t mean your menstrual cycles are back in business! The good news is that by charting other fertility signs, like cervical fluid and basal body temperature, you can tell if the bleeding is a true ovulatory period or not.
Symptoms you experienced prior to getting on hormonal contraception. Unless you had a baby (which can change our hormonal makeup) it’s highly likely you will experience whatever you experienced with your cycles before getting on hormonal contraception. Painful periods? Acne? Irregular cycles? PMS? PCOS? The pill (and patch and ring, etc.) may be great for managing your symptoms. But when it comes to treating them – well, it doesn’t. If you want to address these symptoms at their root, your best bet is to find a medical protocol that uses fertility charting to regulate hormones. Like this or this. Remember, debilitating pain during your period and PMS are not just “part of being a woman” – they are signs something needs to be addressed in your endocrine system.
Temporary difficulty conceiving. Many women get off the pill because they are ready to plunge into motherhood. While some women get pregnant right away, it is not the case for many. If you are trying to conceive coming off of hormonal contraception, be prepared to give your cycle lots of TLC, and time. Depending on how long you have been on hormonal contraception, it can take months, even years to regain fully ovulatory cycles. Nourishing your system post pill is important for everyone, but especially for those seeking to conceive. The miracle of life is based on a finely tuned system. Give it time to clear out those old hormones. Stay tuned for another post soon with tips on nurturing your body post pill.
Regardless of the reason for coming off of hormonal contraception, it’s crucial to get support during this time. Loading up on vitamins, drinking lots of water, and working on liver detoxification are all great steps. For some, a healthy diet and a few lifestyle changes (and simply the virtue of patience) are enough to gain back ovulatory healthy regular cycles. Other women may need a little more expert support for the transition.
(1) It is important to note that while the primary function of hormonal contraception is to prevent ovulation, it doesn’t always succeed. On occasion a woman may experience what is called “breakthrough ovulation”. This type of cycle still doesn’t look the same as a fully ovulatory cycle off of HC, because there are still synthetic hormones affecting the endometrium layer and the cervical fluid created by the cervix.
Last updated February 13, 2021.