About five years ago, I decided to stop taking the hormonal birth control I’d been on for a decade. I’d taken many different pills — from Ortho Tri-Cyclen to Apri (which I dubbed the “monster pill” for my wacko mood swings) and finally to Tri-Sprintec. I’d done my fair share of experimentation and I wanted to know: What does my body feel like on its own, without the birth control? How’s my mood? My sex drive? What’s my period like? My cramps?
I tried to think back to life before the pill — what were my periods like then? But the truth was, I had no idea. I’d been on birth control for about as long as I’d had a period. And that’s true for a lot of us, as the pill is often prescribed to us before we know our bodies well. It’s prescribed for pregnancy prevention, cramps, acne, mood swings, and headaches. According to the Guttmacher Institute, four out of five sexually active women have used the pill at some point in their lifetimes.
I spoke with Celia, 29, who transitioned from oral contraceptives to the ParaGard (a non-hormonal copper IUD): “It took awhile for my period to become regular on a 28-day cycle, but eventually it did. A few things I noticed pretty quickly were an increased sex drive (yay) and fewer mood swings. Oh, and my boobs shrank a cup size.”
Whether you’d like to stop taking hormonal birth control because it’s not working for your body, you’re sick of the side effects, you’re curious about trying a natural approach, or you’re planning to start trying for a family, there may be an adjustment period (no pun intended).
So, gather round, and let’s talk about transitioning off of the pill, hormonal IUD, vaginal ring, patch, or whatever your current hormonal BC of choice might be.
What is hormonal birth control, anyway?
When we say hormonal birth control, we’re talking about contraceptive pills, IUDs, the patch, ring, and Depo-Provera shot. Hormonal birth control uses synthetic hormones to mimic the estrogens and progesterones naturally produced in a woman’s body during pregnancy. (So, other birth control methods like condoms and spermicide wouldn’t fall into this category.)
Let’s talk about pills and IUDs specifically, since they’re two of the most popular methods:
- Pills prevent pregnancy by preventing ovulation (the release of an egg during your menstrual cycle) so that there’s no egg available to be fertilized.
- Hormonal IUDs prevent pregnancy by creating a thick wall of mucus around your cervix. The thick mucus acts like a plug to the cervix, making it very difficult for the sperm to get through and fertilize an egg.
Why women quit taking birth control
Aside from trying to get pregnant, some women stop taking hormonal contraception because of how it makes them feel.
One of the biggest side effects — and most talked about — is hormonal birth control’s effect on libido (for examplle, the pill decreases production of androgens, the hormone in charge of your sex drive).
Another side effect commonly cited is on hormonal birth control’s effect on mood, anxiety and depression. Anxiety and depression have been shown to fluctuate when women take hormonal birth control (for some women it makes symptoms better, for some, worse). But it’s difficult to say whether all those changes are due birth control, or whether they’re due to all of the other external factors that might impact your mental health (work, relationships, family, etc).
If you’re experiencing any of these side effects, quitting hormonal birth control might provide relief.
What happens when you quit birth control
We spoke with Kara Earthman, a women’s health nurse practitioner (WHNP) from Nashville, to get the scoop on going off all types of hormonal birth control. Earthman said that side effects will vary from person to person. If your initial reason for going on birth control was to deal with menstrual cramps, heavy flows, acne, or to shorten your period, "these original problems will likely resume after stopping birth control" — and if you were using an IUD, your period will immediately resume.
Those who struggled with PMS or estrogen-withdrawal headaches in the past may see symptoms come back (the “sugar pill week” included in some birth control packs have a small amount of estrogen that keeps headaches at bay). Earthman added that anyone who experienced breast changes after starting birth control might see another shift after going off it. “Basically, expect your pre-pill body to come back in full force.”
Some birth control pills have a small amount of estrogen in the “sugar pill week” (AKA the week of placebo pills), keeping these headaches at bay. But if you didn't have headaches before starting the pill, you probably won't suddenly get them after stopping.
Then there’s the twinge of pelvic pain some women experience on their periods. According to Earthman, “When on pills, ovulation is suppressed. Not all women can feel when they ovulate, but some do, and once off the pill, your ovaries resume business as usual.”
After quitting birth control, there’s also an increased risk for hair loss. One study showed that hormonal contraceptives change the rate at which your hair goes from the growing phase to the resting phase, and keeps it in rest mode for longer (although it's important to note that this study is from 1970s). Hair loss can be hereditary, but it may be exacerbated by taking birth control and then stopping.
As for gaining or losing weight post-transition? According to Earthman, the only expected change would come after stopping the Depo-Provera shot, which is sometimes linked to increased appetite.
Luckily, some women might not notice anything different after going off birth control. One thing to keep in mind, though, is that for all birth control methods, excluding the Depo-Provera shot, fertility picks right back up. “So, it’s possible to get pregnant right away,” Earthman told me. But if you’re transitioning off of the Depo-Provera shot, “it may take up to a year before your fertility (read: ovulation) is back to normal.”
And now...the benefits of quitting birth control
On the plus side, Earthman said, “If there were any aspects of your birth control that you didn't like (mood changes, decreased libido), you may see these problems resolved.”
Going from synthetic hormones to the real stuff: how to transition off of the birth control pill or an IUD
You can stop taking the pill safely at any point in your cycle, though it can be helpful to finish a pack so you can predict your next ovulation or period if you’re looking to plan or prevent pregnancy. As for an IUD, it can also be removed at any point, though removing it during your period when the cervix is naturally softer could be a bit easier.
Your body is really resilient—once you stop taking the pill, remove the patch, or an IUD, you’ll likely get back to normal fast. Cue the sighs of relief: “There typically isn't much of an adjustment period where your hormones are concerned. The only exception is with the Depo-Provera shot, as the progesterone will impact your hormones for at least three months following your last injection,” Earthman said.
Recommendations from the expert
Earthman has a few tips for anyone looking to mitigate the side effects after quitting hormonal contraception. If you notice acne making its triumphant return, she suggests going to the dermatologist: “There may be other tricks to keeping your skin flawless aside from birth control pills.”
If you experience painful cramping and heavy cycles, 800mg of ibuprofen will become your new best friend. According to Earthman, if you take ibuprofen every eight hours for a couple days at the onset of your period, it can reduce pain and lighten your flow. Just a friendly reminder: “This is only applicable to women who are medically able to take ibuprofen.” In those cases, Earthman recommends decreasing your intake of refined sugars and fried foods, and looking to the practice of meditation and mindfulness to help with PMS symptoms. Sometimes, she said, SSRIs (selective serotonin reuptake inhibitors) can also have a powerful effect. Exercise has also been shown to be effective for cramping.
When it’s time to call the doctor
If your period doesn’t come back after two to three months after coming off birth control (diagnosed as amenorrhea), schedule a visit with your OB-GYN. For most women, though, regulation will happen within a month.
The exception here? If you were using the Depo-Provera shot, getting back to your normal cycle might take up to a year, according to Earthman.
Alternative non-hormonal contraception
For anyone looking to prevent pregnancy without taking hormonal contraceptives, you’ve got plenty of options. There’s, of course, the classic condom method, though you’ll have to remember to use one each time you have sex and it has a 15% failure rate. Similarly, you can use a diaphragm, cervical cap, or sponge whenever you want to reduce the chances of conception. If you’re hoping for another one-and-done contraceptive, the copper IUD might be the best choice for you (it’s also the most effective!).
So, if you’re ditching your pill or removing your patch, know that your body is likely to transition back to its “before” state over your next few cycles. And if you’re not feeling great, enlist your primary care provider (PCP), OB/GYN, dermatologist, some ibuprofen, or a trusty heating pad for support.
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.