It can seem so simple: take a pill each day to suppress ovulation as long as you don’t want to get pregnant. When you’re ready to start a family, stop taking the pill and your cycles will come back. You’ll ovulate, conceive, and have a baby.
Unfortunately, this isn’t always the way things always play out. If your cycle wasn’t regular before the Pill, it’s not going to be regular after the Pill. Even if it was regular, your body may need three months or more to recalibrate hormone production and reestablish that regularity. Because all the systems in our bodies are interconnected, changing the dynamics of your body’s hormones can have more effects than those intended, both today and down the line.
Understanding your hormones and what birth control does to them
Hormonal birth control (the Pill, vaginal rings, injections, IUDs, and so on) works by releasing either synthetic progesterone (known as progestin) or a combination of progestin and estrogen into the body. This works to override a woman’s natural hormone levels and stop ovulation, or the release of an egg from an ovary. Without ovulation, there can be no conception, and therefore no pregnancy.
In cases where ovulation happens anyway (a phenomenon known as breakthrough ovulation), hormonal birth control also causes a thickening of the cervical mucus and a thinning of the uterine lining, or endometrium. The thick cervical mucus creates an obstacle for incoming sperm and the thin uterine lining makes it difficult for a fertilized egg to implant within the uterus.
When you stop taking the Pill, your body needs to begin ovulating and start producing progesterone again. It can take a few months for cycles to regulate, and levels may swing high or low over this variable time frame. In fact, there is a slight increase in the rate of fraternal twins in women who have recently come off of long-term hormonal birth control, as their bodies are more likely to release two eggs.
Getting off the pill to find your period is (still) irregular
If your cycles weren’t regular before you started taking the Pill—indeed, this is the reason many young women start the Pill—don’t expect them to be regular once you stop taking it.
The hormones in the Pill that seemed to “regulate” your cycle were really suppressing your cycle, leveling out your natural hormonal fluctuations with the same steady, continuous dose of synthetic hormones all month long (except when you took your sugar pills and had a bleed for five days once a month). But that “leveling out” you experienced while you were on the Pill only worked as long as you took them. This is why the effectiveness of the Pill is so dependent on consistent daily use. When you stop taking the Pill, any issues that you had before will return.
However, if your cycles were regular before you started taking the Pill and they don’t return to normal after three months without the Pill, it’s possible that you have “post–oral contraceptive pill cycle irregularity,” a condition with symptoms similar to polycystic ovary syndrome (PCOS). These symptoms include difficulty managing weight, hirsutism (unwanted hair growth), acne, and sleep problems. This condition can resolve over time, and healthy changes to diet and gentle exercise can help.
A rarely-discussed risk of birth control use
Another unfortunate side effect of using the Pill is the possibility of low levels of progesterone, the sex hormone whose fall triggers the onset of menses and whose spike is necessary to maintain a pregnancy.
You only make progesterone when you ovulate, and having enough of this hormone is essential to achieving pregnancy and carrying it to term. If your hormones are not functioning properly when you conceive—due to a thyroid disorder, a post-Pill imbalance, or another condition—it is possible that a pregnancy will end in miscarriage.
The good news is that charting your cycle before you conceive can help identify low levels of progesterone. Simple lifestyle changes including a healthy diet, low stress, good sleep, and regular exercise can naturally help regulate your hormones. In some cases, bioidentical progesterone supplements may help optimize levels to avoid pregnancy loss and the heartbreak that comes with it.
If you’re concerned about your hormone levels after coming off the Pill, seek out a trained FAM instructor, who can help you navigate the months of transition and get to know your body in a whole new—healthy, holistic—way.
This article was originally published as written by Lindsay Schlegel on September 20, 2018. It has since been updated by Natural Womanhood to offer more information.
Last updated March 25, 2022
