Contraception and the return to fertility

Reviewed: July 19, 2021
fertility-and-the-pill-the-lowdown
When it comes to contraception, avoiding pregnancy is most likely the first thing on your mind. But what happens when you want to come off it when you are actively looking to get pregnant? Is fertility affected by the pill? We give you all the info.

Making the decision to come off contraception is a big one. And if you’re looking to start a family right away, it can bring the topic of fertility to the forefront of your mind. But how exactly does contraception impact a woman’s fertility? Let’s take a look.

TL;DR – what’s the lowdown?

  • The combined pill and most other contraceptive methods work to prevent pregnancy in the short term but have no long-term impact on fertility
  • The majority of women discontinuing hormonal contraception return to their normal menstrual cycles within 3 months
  • Evidence suggests it can take a while for fertility to return to those who have been using the contraceptive injection
  • Contraception can mask underlying causes of fertility problems
  • Periods do not equal fertility, but irregular or problematic periods may indicate an underlying medical problem that could affect your ability to conceive

 

Family planning: a phrase that conjures up the image of a 1950s housewife and her desire for 2.4 children with her darling husband living in an idyllic house in the country. Whilst this may inhabit the realms of truth, family planning and access to services supporting this are actually central to gender equality and women’s empowerment. It is defined by the World Health Organization as the process which allows “individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility”, or put simply,  controlling when pregnancy occurs. The ability to determine whether or not to become pregnant, and how many children to have, has long been recognised as a human right. 

For many women not yet ready to start a family – and living in the harsh realities of the present day – this looks more like the active avoidance of pregnancy mixed with the occasional fear of missed pills, incorrect calculations of dates, and other mishaps where we may not have ‘planned’ things quite carefully enough!

But when that 180 flip in thinking hits, and our mindsets switch from ‘I hope I don’t get pregnant’ to ‘I want nothing more than to have a baby’, we might find ourselves questioning whether our thoughts and actions surrounding family planning should have come a little sooner.

So when exactly should you start thinking about your fertility? And should you be concerned about the impact the contraceptive pill may have?

Does being on the pill affect fertility?

Whether you’re taking the combined pill back-to-back or taking a monthly break, there is no evidence to suggest the use of combined hormonal contraceptives has any long-term impact on fertility. Some may be concerned about the length of time they’ve been on the pill, but this, too, has no impact.

It is possible to get pregnant as soon as you stop taking the combined pill, as you start to ovulate again (any time from 7 days after your last packet has finished). Studies show the majority of women will ovulate within a month of stopping the pill. However, it is important to remember when you stop using the pill, your fertility will return to whatever is normal for you, i.e. whether you are able to get pregnant will be the same for you whether or not you have used contraception, bearing in mind any increase in age and the effect this will have.

Here at The Lowdown, we conducted our very own survey to determine what happened to women’s periods after they stopped their method of contraception. We asked women using the combined pill, the progestogen-only pill, the implant, the hormonal coil and the copper coil:

’How long did it take for your period cycle to return to normal after you stopped using this method of contraception?’ 

Of course, everyone’s ‘normal’ is different, but we asked women to consider their own personal experiences. Of those surveyed, the majority found a return to normal within 6 months, with The Faculty of Sexual & Reproductive Healthcare (FSRH) reporting studies that show 99% of women return to their normal cycle within 3 months.

A return to normal cycles is always reassuring, but it’s important to remember that periods do not necessarily equal fertility. But, more on that later.

But what about fertility after the contraceptive injection?

We also surveyed women who had previously used the contraceptive injection, asking them the same question about their menstrual cycle. This is where we found things took a little longer. Our results show it took up to 18 months for the majority of women to return to their normal menstrual cycles.

A study carried out looking at the link between the use of contraceptives and a woman’s ability to become pregnant found the contraceptive injection did indeed result in the longest delay to the return of fertility. But why should this be the case?

The contraceptive injection works by stopping ovulation and commonly causes changes to bleeding patterns, with some finding a stop to their periods a beneficial side-effect. One user of The Lowdown wrote:

“Really recommend the injection. Loved that it stopped my periods completely. No effect on my mood which was great as other contraceptives I’ve used have made my mood really low. Really convenient only having to get it every 12 weeks.”

Due to the link (known as the menstrual cycle!) between periods and ovulation – where the all-important egg is released in preparation for fertilisation – the delay in the return of your periods may be associated with a delay in the return of ovulation, and may result in a knock-on effect on your chances of conception.

This delay, however, is only short-term. And while you may be experiencing irregular cycles after stopping the injection, you may be ovulating. 80% of women trying to conceive fell pregnant within 15 months of their last Depo-Provera injection and after 2 years there is no significant difference in pregnancy rates when compared with users of non-hormonal contraception.

Waiting for your fertility to return after stopping the injection can be a stressful experience, so if you’re planning a pregnancy in the next few years think about the options available to you, such as switching from the injection to another method that has a more easily reversible contraceptive effect. 

How long does it take to get pregnant after coming off the pill?

If only there was an easy answer! We know that there is no evidence to suggest that the combined pill results in long-term reduction in fertility, and after the initial delay following discontinuation of the pill, pregnancy rates in the 1-2 years that follow are comparable with those who had previously used barrier methods or no method of contraception at all.

But there are many factors that come into play when thinking about a woman’s ability to conceive. Age, genetic factors, lifestyle, and medical conditions such as PCOS are all factors that can influence the chances of conception.

My periods haven’t yet returned. Can I still get pregnant?

Actually, yes! This is all down to the timing of ovulation. Occurring around 2 weeks before your period, it is possible for you to become pregnant on that first ovulation before your periods have returned. So, in theory, you could become pregnant after stopping your contraception without having had a period.

The same can be said for irregular cycles. Ovulation may still occur, just not in a particularly regular fashion. This means you are still able to get pregnant even if your cycle hasn’t yet returned to normal. But remember, irregular periods can be a sign of an underlying issue, one which may have been masked by the use of contraceptives. So, it’s important to discuss any concerns you have with your doctor.

On the flip-side of this, regular periods are not necessarily an indicator of fertility. It is possible for a woman to have periods but for her not to ovulate. This is called anovulation. There are also other causes of fertility problems including  blocked or damaged fallopian tubes and endometriosis.

To find out more information on fertility, check out our free webinar. Our founder Alice talks to Consultant Gynaecologist and Subspecialist in Reproductive Medicine and Surgery, James Nicopoullos, alongside fertility advocate and IVF mum, Alice Rose. They delve deeper into the causes of infertility and the options available to those struggling to conceive.

Start planning!

It may seem like a distant wish right now, but thinking about the future and your desire to have a family should be a factor when considering your contraception options, especially if the injection is a main contender. Nurse and The Lowdown user Shannon has shared her experience of the injection and fertility.  You might find her story and Dr Mel’s comments  helpful when thinking about your contraception options, so check it out.

Sources:

BMJ: Pregravid contraceptive use and fecundability: prospective cohort study

FSRH: Clinical Guideline: Combined Hormonal Contraception

SmPc for Depo-Provera 150mg/ml Injection Sterile suspension for injection. Electronic Medicines Compendium. Datapharm Communications Ltd. https://www.medicines.org.uk/emc 

NHS: Irregular periods

NHS: Infertility

Partnership for Maternal, Newborn & Child Health. The ABC’s of family planning OpEd for Globe and Mail. Dorothy Shaw, MB, ChB, FRCSC, Canada G8/G20 Spokesperson for the Partnership for Maternal Newborn Health. 2010

This guide was brought to you by The Lowdown. We are the world’s first contraception review platform, providing real-life experiences from thousands of reviews collected from our community of men and women.

Why not leave us a review of your contraceptive experience? Whether you’ve got good things to say about the Mirena coil or had trouble with implant removal, we want to hear about it! Tell us about your experience and help people around the world find the right method for them.