“The Pill” (the combined oral contraceptive pill) has given Australian women control over their reproductive health since the 1960s and remains the most widely used contraceptive method by Australian women.
Its use peaks with around 60% of Australian women in their late teens and early 20s using the pill, and drops to around 35% in their mid to late 20s.
Used perfectly, the pill prevents pregnancy 99.5% of the time, but in the real world where pills are occasionally forgotten, it works 93% of the time.
Read more: How effective is the pill?
In Australia, half of women who start taking the pill will not take it six months later. Women go off the pill for many different reasons, including:
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trying to get pregnant
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try a different contraceptive option
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side effects (including headaches, bloating, weight gain, not having a regular period, unpredictable discomfort or “breakthrough” bleeding, nausea, depression, reduced libido)
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develop a medical condition where the pill is no longer safe (the most common of which are migraine or deep vein thrombosis, or smoking after age 35)
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no longer needs contraception
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wanting to know what their cycle and natural periods are like.
If you’re getting ready to come off the pill, it’s hard to know what to expect, especially if you’ve been on it for a long time.
Read more: There’s strong evidence the pill can cause depression, and some types are worse than others
What can happen when you come off the pill
Regardless of how long you’ve been on the pill, synthetic hormones are cleared from your body within a few days. Your body releases different amounts of estrogen and progesterone again throughout the cycle, although what is “normal” for your body may have changed.
Teens may have irregular periods for the first few years before a more regular rhythm is established. Many things may have changed since you first took the pill: your body may have developed a disease, you may have a different lifestyle, you may have changed in size or shape, or you may have had children. All of these can affect how your body’s natural hormones can affect you.
Regardless of how long you’ve been on the pill, synthetic hormones are cleared from your body within a few days. Unsplash/artem kovalev, CC BY
Here are some of the changes you might expect when you come off the pill.
Periods!
For many women, periods return within a month of stopping the pill, and almost all women have their period within three months. Your periods may start out irregular, but they usually return to your natural menstrual cycle after three months. Women on the pill often have fairly light periods, so when you come off the pill you may experience heavier or longer periods. The natural cycle can also be affected by exercise, diet, stress and underlying medical conditions. It’s a good idea to see a doctor if your period hasn’t returned in three months.
fertility
Women can expect their fertility to return to their baseline “natural” level about three cycles after coming off the pill. That said, you can definitely get pregnant as soon as you come off the pill. Taking the pill does not affect fertility in the long term, even if it has been taken for many years, so there is no medical need to take a “break” from the pill to “normalize” things for the body.
Read more: No, women don’t need to “take a break” from the pill every two years
Underlying medical problems
For some women, coming off the pill can reveal problems that the pill has been masking. For women with endometriosis, the pill usually reduces their symptoms of painful periods, cramping, heavy bleeding and painful sex, and suppresses the growth of endometrial tissue in areas other than inside the uterus, where it belongs. Going off the pill can cause an increase in your period and pelvic pain. For women with a history of polycystic ovary syndrome, periods are likely to become irregular again once they come off the pill.
Acne
For women who experience hormone-induced acne (commonly seen around the jawline and which fluctuates with the menstrual cycle), acne may appear after coming off the pill. Aging or lifestyle changes can affect this, so a certain acne won’t come back.
mental health
There is growing evidence that the hormones on the pill can cause or worsen depression in some women, and it is one of the most common reasons for stopping the pill. However, for women who experience depressive symptoms in the week leading up to their period (a condition known as premenstrual dysphoric disorder), taking the pill stabilizes mood and works as an antidepressant. It goes without saying, then, that women coming off the pill may see changes in their mood or anxiety levels, and it’s a good idea to keep your mental health care provider informed.
Read more: How to choose the right birth control pill for you
5 things to do before coming off the pill
- Talk to your GP or other health professionals beforehand, especially if you have had heavy periods, pain or other problems in the past. If you’re not satisfied with your particular type of pill, know that there are other birth control options, including other birth control pills that may not cause the same side effects.
If you’re not satisfied with your particular type of pill, know that there are other birth control options. Unsplash/Prince Akashi, CC BY
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Have an alternative birth control plan if you are likely to be at risk of pregnancy and want to avoid it. If you have a regular partner, you may want to have a conversation with them and discuss other options
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Consider monitoring and recording your cycle and symptoms (period heaviness and pain, mood and anxiety) for 2-3 months before and after you come off the pill. This can help you and your doctor recognize if coming off the pill uncovers any unexpected problems. Seek medical advice soon if you have heavy or painful periods
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try to pick a time when life isn’t too stressful or chaotic, if possible. This will help you figure out if your symptoms are related to hormones, life in general, or both!
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if you’re coming off the pill to prepare for pregnancy, it’s a good time to book an antenatal check-up. This may include talking about preparing yourself physically and mentally, supplements, and doing some blood tests to check for immunity to certain viruses.