You're having a lovely evening perusing Instagram. Maybe you're looking for something specific (in my case, cool wallpaper and/or cat pictures), or maybe you're procrastinating (looking for cool wallpaper and/or cat pictures). Because you’re on Instagram and it's way too easy to find things that you weren't actually searching for but happen to be trending right now, you're suddenly seeing posts about birth control detox or birth control cleanses. Both refer to the process of stopping hormonal contraceptives like pills or the IUD. You might choose to do this in order to start trying to get pregnant, or because you want those hormones out of your system.
But what actually happens when you stop taking hormonal birth control? Do you need to do a cleanse in order to reset your hormones, hormone balance, and uterine health? What does that even mean? Whether you're thinking about going off hormonal birth control now or sometime in the future, here's what you should know.
What to expect in a post-hormonal birth control world
Okay, first, let's break it down: What happens when you're taking hormonal birth control, and what happens when you stop taking it?
Take birth control pills, for example. The pill stops you from ovulating (although it depends on which birth control pills you're on) with synthetic hormones like progestin and synthetic estrogen. No ovulation, no egg released — nothing’s available to join up with any sperm that happens to enter your body, so no pregnancy. But once you stop taking the pill, then what? (Besides the fact that you're at risk of getting pregnant if you don't use a barrier method like a condom.)
"Stopping birth control does not require an intricate process," says Dr. Renee Volny Darko, an OB/GYN practicing in Pennsylvania. "It does require an understanding of what to expect once it is stopped. I find that when patients’ expectations are well-managed, they tend to do much better." (Pro tip: If you're thinking about going off BC, establish a line of communication with your healthcare provider about it ASAP.)
You might experience withdrawal bleeding, also known as a false period, a few days after stopping your birth control. While some women ovulate two weeks after they stop taking the pill, if you've been on it for many years, it might take a month or so to get your period, since your uterine lining is thin and you don't have anything to bleed. Your period will return after a cycle where that lining has a chance to build back up — the result of your ovaries making estrogen again.
When Liz stopped taking hormonal birth control in order to get pregnant, she was miserable. Her periods were super heavy, she couldn't focus at work, and her emotions were all over the place. "I cried in the grocery store," she said. "I love the grocery store! Nothing bad was happening!" She got pregnant quickly, and after each of her two children were born, she had to hold off on getting back on birth control so she could establish a breastfeeding pattern (you can use a progesterone-only contraceptive while breastfeeding), and during this time, "I was a total weeping mess."
Side effects like mood swings, as well as headaches, acne, and irregular bleeding, should subside after a few weeks of being off birth control. If you had a low sex drive due to oral contraceptives, that should return soon after ending birth control. Weight gain or weight loss typically don't happen (unless you’re quitting Depo-Provera, which sometimes increases appetite).
It's important to remember that how one feels after stopping hormonal birth control depends entirely on the individual. "Many people transition off of birth control just fine," says Dr. Janelle Luk, a reproductive endocrinologist in New York City. "Everyone is different — it's similar to how some people need 10 hours of sleep, some need six. It depends on your body. Listen to what it's telling you."
To cleanse or not to cleanse? Quick answer: It’s unnecessary.
If you do a Google search for “birth control cleanse” or "birth control detox," you'll find references to "post-birth control syndrome," and "how to reset your hormones after the pill." Post-birth control syndrome refers to symptoms that arise after you get off birth control pills (painful periods, acne, headaches, feeling super emotional, etc). The term is frequently used, alongside "birth control detox," by naturopathic doctors, who practice forms of alternative medicine and sell cleansing products with natural ingredients like chasteberry and other nutrients. These are typically marketing ideas meant to sell products, not scientific ones.
Neither of these are medical terms, clarifies Dr. Darko. "Birth control is usually not considered toxic by MDs. so there is no cleansing or reset process needed to get the body ready for pregnancy. There are women who ovulate or even become pregnant while on birth control. I, myself, as an OB/GYN, ovulated while I was on the pill. It truly depends on the type of birth control and how a woman's body responds to it."
How you feel post-pill has a lot to do with why you went on it in the first place. Did you want to prevent pregnancy and were otherwise healthy? Post-birth control side effects can sometimes go away after only a few weeks. Did you start birth control pills because you have PCOS or endometriosis and you want to control symptoms like irregular periods, heavy bleeding, excess hair, etc? Once you stop taking hormonal birth control, those symptoms will likely return.
If going off of hormonal birth control is proving rough for you and you're experiencing things like acne, menstrual irregularities, as well as a heavy periods (if that's not normal for you) and increased cramping, Dr. Kecia Gaither, Director of Perinatal Services at NYC Health + Hospitals/Lincoln, recommends a healthy diet, decreasing your stress levels, and increasing your iron consumption (especially if your period is super heavy). She advises letting nature take its course: "Generally menstrual cycles autocorrect themselves within 3-6 months."
Hormonal birth control + fertility
Hormonal birth control does not cause infertility. You may not be able to conceive immediately after you stop taking it, especially if you've been on it for a long time, but while that can be frustrating, it's not necessarily cause for concern.
How you feel when you go off hormonal contraceptives, and what happens or doesn't happen with your period after you're off them, can reveal a lot about your overall health. Hormonal birth control treats (and therefore disguises) many symptoms of women’s health problems such as endometriosis or PCOS, so once you're off it, it's no longer doing the work of staving off the symptoms.
"The reason that a woman might have started the birth control might be the reason for her infertility," says Dr. Darko. “For example, I've had women patients in their late twenties come to me for infertility thinking that it was caused by being on birth control since the age of 16. When I asked for a detailed history of why they started on birth control at age 16, they typically described a scenario of PCOS or endometriosis. Well, PCOS and endometriosis alone are well-known risk factors for infertility, whether treated with birth control or not. Again, expectation management is important when starting or stopping any treatment regimen."
When to bring in the pros
How do you know if something's wrong once you've transitioned off of hormonal birth control? If your period hasn't returned after 2-3 months, check in with your doctor (though, if you were on Depo-Provera, it might take up to a year to regulate). Additionally, if the side effects that come with stopping birth control pills (like headaches) don't, well, stop, that's an indication that something could be up. You should also definitely seek medical attention if you develop any new symptoms, like numbness and shortness of breath. When in doubt, listen to your body and rely on your instincts — if you feel like something's not right, take action.
And speaking of action: Even if you're not thinking about going off your chosen method of birth control and trying to get pregnant now, you should still find out what's up in terms of your hormones and your fertility timeline. Modern Fertility's fertility hormone test and timeline tool are here to help you get important (and empowering) information when it comes to planning your future.
This article was medically reviewed by Dr. Jane van Dis, MD, FACOG. Dr. van Dis is an OB-GYN, co-founder and CEO of Equity Quotient, and Medical Director for Ob Hospitalist Group.