This article was last updated on May 13, 2021.
You turn to Instagram for a little mindless scrolling and suddenly see a bunch of ads for birth control cleanses and detoxes. Are those ads suggesting products you actually need to buy if you think you might stop taking birth control? And are these products really necessary for "resetting" your hormone levels and uterine health after birth control?
We explain it all below, but here's the answer in a nutshell: No, you do not need to "cleanse" or "detox" from hormonal birth control. Read on for what you need to know about this myth and what actually happens after you transition off of birth control, whether you're doing it right now or sometime in the future.
What are we talking about when we say birth control "cleanse" or "detox"?
Both terms refer to products or home remedies that "wash" the hormones out of your system after stopping hormonal contraceptives like pills or the hormonal intrauterine device (IUD). You'll find these terms alongside mentions of "post-birth control syndrome" and suggestions for "how to reset your hormones after the pill" — often from naturopathic doctors who sell products designed to address these so-called problems.
"Post-birth control syndrome," which is not a medical term, is used to categorize "symptoms" that arise after stopping birth control — but, as we'll go into more detail about later, what you experience after birth control aren't "symptoms" or “side effects” as we typically think of them. Rather, your body and reproductive system are simply transitioning back to their pre-birth control state.
Do you need a birth control "cleanse" or "detox"? Short answer: no
Dr. Jane van Dis, MD, FACOG, an OB-GYN at OB Hospitalist Group and a Modern Fertility medical advisor, says that you do not need to "cleanse" or "detox" after hormonal birth control. “There's a sense that because you're taking a drug that comes in a little blister pill pack that there's something inherently toxic about the drug or the manufacturing of the hormones," explains Dr. van Dis, "but the fact is that there isn't anything toxic about hormonal birth control.” Suggestions that stopping hormonal birth control will require cleansing or detoxing are often made to sell products — not because there's any science supporting them.
Here's how Dr. van Dis likes to frame this idea for her patients: “If you've had a prescription for oral contraceptives," she says, "likely when your doctor or nurse practitioner prescribed them, they mentioned that if you miss one (1) pill, you take the next pill as soon as you remember the following day." That's because the pills will no longer have a contraceptive effect after 48 hours — meaning the synthetic hormones aren't lingering in your body after two days without taking them. Put simply: You can’t have a drug that's completely gone from your system within hours and also need a “detox” from that drug.
How long does hormonal birth control stay in your system?
As we explained in the last section, synthetic hormones leave your body all on their own. Here’s how long it typically takes for different birth control methods:
- Oral contraceptives: Combination birth control pills (which consist of estrogen and a progestin) are cleared from your system 48 hours after ingesting them — and so are minipills (which are progestin-only).
- Long-acting reversible contraceptives (LARC): This method of birth control (which includes hormonal IUDs and the implant) is immediately cleared from your system as soon as it’s removed by your doctor. (The copper IUD is also a type of LARC, but we won’t discuss it here since it’s non-hormonal.)
- The ring: You are no longer protected from pregnancy by the vaginal ring (NuvaRing) if it isn't reinserted within 48 hours of removal, so we can assume it’s cleared from the system after 48 hours.
- The shot: Depo-Provera remains in your system for a longer span of time than all other forms of hormonal birth control. This injection keeps you protected from pregnancy for three months, so it remains in your system for at least that long (though it can impact ovulation for as many as 18-22 months).
What can you expect in a post-hormonal birth control world?
First, let's break down what happens when you're taking hormonal birth control. Synthetic estrogens and/or progestins work by blocking ovulation. They also thicken the cervical mucus to make it harder for sperm to pass through and/or prevent the thickening of the uterine lining so it's not a habitable home for a fertilized embryo.
Once you stop taking hormonal birth control, then what? How someone feels after stopping hormonal birth control depends entirely on the individual, but what happens or doesn't happen after stopping birth control can reveal a lot about overall health:
- Hormonal birth control treats (and therefore disguises) many symptoms of reproductive health problems such as endometriosis, heavy and/or irregular periods, or polycystic ovary syndrome (PCOS), so once you're off it, it's no longer doing the work of staving off the symptoms.
- If you receive a PCOS diagnosis after stopping birth control (or if you already know about your PCOS diagnosis but used hormonal birth control to treat it and now want to try to conceive), you can talk to your healthcare provider about a non-contraceptive medication called metformin that has the added benefit of helping to induce ovulation.
Let's dive deeper into how your body may change after hormonal birth control.
Your menstrual cycle after hormonal birth control
There is a common myth that the longer you take contraception, the longer it takes to clear your system or for ovulation and your menstrual cycle to resume. "There's no such thing as 'birth control build-up,'" says Dr. van Dis. As we mentioned before, the hormonal medication clears from your system in as little as 48 hours, no matter how long you’ve been taking it — and your cycle should return to your normal within 90 days. If you don't get periods after 90 days, talk to your healthcare provider.
Different forms of hormonal birth control can affect your periods and ovulation differently:
- Oral contraceptives: For most people transitioning off of combination pills and progestin-only pills (97% of them!), their periods will return to their normal within 90 days:
- You may go through an “adjustment” period with irregular bleeding. If your cycle doesn't return to your normal after 90 days, that may point to an undiagnosed reproductive health issue that birth control could have been masking (more on this in a bit).
- Hormonal IUDs: This method of birth control often greatly lightens or completely stops menstrual bleeding, but your normal period resumes immediately upon removal.
- Implant (Nexplanon): Like hormonal IUDs, many people stop getting their period after one year of using the implant — but once it’s removed, your period immediately resumes to normal.
- The shot (Depo-Provera): One study says that, after quitting Depo-Provera, ovulation can be delayed for up to 18 months, while another suggests up to 22 months. That said, some people get pregnant right away after stopping Depo-Provera — it's unique to the individual.
- The ring (NuvaRing): Your period usually starts two to three days after removing the ring, and you can expect the same 90-day time frame for your body to readjust back to its normal cycle.
"Side effects" after hormonal birth control
"If you're going off birth control, expect that some of those experiences and side effects you had before you went on will come back," says Dr. van Dis. Here are some of the "side effects" you can expect after transitioning off birth control — and what you can do to get relief:
1. Headaches: Some people may experience menstrual migraines around day 14 of their cycle if that’s how their body reacts to decreasing estrogen levels without hormonal birth control in their systems.
2. Acne: Since birth control decreases your testosterone levels, it can prevent breakouts. If starting the pill or other types of birth control with synthetic hormones helped to treat your acne, you might expect a return of those breakouts once you’ve stopped. If this happens to you, ask your healthcare provider or dermatologist if there are topical or oral medications you can use to treat breakouts.
3. Mood swings: Birth control’s effects on mood and depression are unique to each individual:
- For some people, synthetic hormones impact their brain chemistry and increase feelings of anxiety and depression that may cease after stopping.
- Other people might experience more mood swings and depression during their transition off of birth control, either because of fluctuating hormone levels or external anxiety related to no longer being protected from pregnancy.
- Sticking to a healthy sleep schedule and fitting 30-60 minutes of exercise into your daily routine to help decrease stress levels is a great way to help with mood changes. If feelings of depression and anxiety persist, you may want to ask your provider about selective serotonin reuptake inhibitors (SSRIs).
4. Weight changes: Weight gain or weight loss typically don't happen after stopping a hormonal form of birth control — unless you’re quitting Depo-Provera, which can affect your appetite. That said, if weight changes do happen, that can impact your menstrual cycle after transitioning off of hormonal BC.
5. Changes in sex drive: If you had a low sex drive due to oral contraceptives, your drive should return soon after ending birth control.
6. Menstrual cramps: If you had heavy or painful periods when birth control wasn’t adjusting your hormone levels, you can expect those symptoms to return. Heating pads and exercise can help — as can taking nonsteroidal anti-inflammatory drugs (NSAIDs) like Motrin, Advil, or Aleve either one day before you expect your period, on the first day of your period, or when you first start cramping. "Some women need to take NSAIDs around the clock in the days leading up to and including their period," adds Dr. van Dis.
When is it time to bring in the pros?
How do you know if something's wrong once you've transitioned off of hormonal birth control? If you’re coming off of a type of birth control other than Depo-Provera and your period still hasn't returned after two to three months (which is diagnosed as amenorrhea), this is the time to check in with your doctor. If you’re older than 35 and trying to conceive, then it’s especially important to see your provider right away.
Here are two situations that might lead to a longer return to ovulation:
- Underlying reproductive health issues: Remember what we said about hormonal birth control potentially masking undiagnosed issues? If your period hasn’t returned after three months, your hormonal birth control isn’t to blame — but it’s possible you were unknowingly managing PCOS, endometriosis, or thyroid conditions with BC.
- Other health conditions: If the other side effects that come with stopping birth control pills (like headaches) don't stop, that's an indication that something could be up. You should also 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.
An important reminder: Hormonal birth control doesn't impact your fertility long term
Hormonal birth control is not likely to impact your ovulation and fertility long term, but it's important to remember that Depo-Provera users can experience ovulation disruptions after they stop taking the shot.
One study from 2018 gathered the conception rates among people who’d previously used various hormonal forms of birth control:
- People who formerly used oral contraceptives: 87.04% pregnant within 12 months
- People who formerly had hormonal IUDs: 84.75% pregnant within 12 months
- People who formerly received injections (like Depo-Provera): 77.4% pregnant within 12 months
- People who formerly had the implant (Nexplanon): 74.7% pregnant within 12 months
If you're preparing to stop birth control so you can begin trying to conceive, the best move is to schedule a preconception visit with your healthcare provider so you know how else you can prep your body for pregnancy.
Getting insight into your body after coming off birth control
If you’re looking to get reacquainted with your body and its ovulation patterns after hormonal birth control, we’ve got you covered:
- The Modern Fertility Ovulation Test lets you track your luteinizing hormone (LH) levels to predict your two most fertile days. With our test, you’ll get more insight than just a positive or negative result — you’ll be able to see your LH change daily and track low, high, or peak levels. This is key for understanding whether you're in your fertile window and approaching ovulation (when you have the highest chances of pregnancy). The tests works ~like magic~ with the free Modern Fertility App where you can scan and log your results using your phone’s camera, as well as track your periods and sex or insemination.
- The Modern Fertility Hormone Test measures the same fertility hormones that a doctor would test in a fertility clinic (for a fraction of the price) and helps you understand how your fertility is changing over time. Our Fertility Hormone Test gives you insight into the number of eggs you have and can help you identify red-flag issues — like PCOS or thyroid conditions — that could affect your reproductive health down the line. Each test is customized for you based on your birth control — if you’re not on hormonal birth control, you can test up to seven different fertility hormones.
- And once you're trying to conceive, test for pregnancy and trust the result with the Modern Fertility Pregnancy Test — which is just as accurate from the day of your missed period as leading pregnancy tests, but more affordable. Use the Modern Fertility App to log your results and know the best time to test for pregnancy.
With our at-home tests and digital tools, you’ll have everything you need to get in sync with your cycle and check in with your reproductive health after birth control.
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.