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What to expect when going off birth control

What to expect when going off birth control

9 min read

This article was last updated April 27, 2021.

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 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 for pregnancy prevention, heavy or irregular bleeding, cramps, acne, mood swings, and headaches before we even know our bodies very well. According to the Guttmacher Institute, 4 out of 5 sexually active women have used the pill at some point in their lifetimes.

Whatever your reasons are for stopping hormonal birth control — and whether you're on the pill, the hormonal intrauterine device (IUD), ring, patch, shot, or any other hormonal BC — we're here to answer the following questions for you:

What is hormonal birth control, anyway?

When we say hormonal birth control, we’re talking about contraceptives that use synthetic hormones to prevent pregnancy. (Other birth control methods like condoms and spermicide don't fall into this category.)

Here's how hormonal birth control works to prevent pregnancy:

  • Combined oral contraceptive pills (COC): The duo of synthetic progestins and estrogens in combination pills work on the brain to prevent the release of hormones needed for follicular development and ovulation (luteinizing hormone, or LH, and follicle-stimulating hormone, or FSH), thereby blocking ovulation. They also thicken the cervical mucus to make it harder for sperm to get through, and prevent thickening of the uterine lining.
  • Minipill (aka progestin-only pill): The dose of progestins in the minipill is not high enough to prevent ovulation for all users. But the minipill exerts conception-blocking effects for all users through thickening the cervical mucus, and preventing thickening of the uterine lining.
  • Ring and patch: You can think of the ring and patch as the same as combination pills, with the only difference being how the hormones get into the body and how often you have to think about taking them. The progestins and estrogens in these methods work on the brain to prevent the release of LH and FSH (which means no ovulation), and also thicken cervical mucus and prevent the thickening of the uterine lining.
  • Implant and injectable: These work like the ring and the patch (despite not containing estrogens) by preventing ovulation, thickening cervical mucus, and preventing the thickening of the uterine lining.
  • Hormonal IUD: The progestin in hormonal IUDs primarily thickens the cervical mucus, making it near impossible for sperm to get through, and secondarily, prevents the thickening of the uterine lining. The extent to which hormonal IUDs block ovulation depends on the hormone dose but overall, ovulation stops in just a small percentage of cases.

Why do people quit 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 negative effect on libido (for example, the pill decreases production of androgens, the hormone in charge of your sex drive).

Another commonly cited side effect of hormonal birth control is its effect on mood, anxiety, and depression. Anxiety and depression have been shown to fluctuate when women take hormonal birth control (it improves symptoms for some, worsens them for others). But it’s difficult to say whether those changes are due to birth control or other external factors that can impact mental health (work, relationships, family, etc.).

If you’re experiencing any of these side effects, quitting hormonal birth control might provide you with relief.

What happens when you stop taking birth control?

When you go off hormonal birth control, you might feel or notice some changes in your body — but those aren’t “side effects” as we typically think of them. Rather, your body and reproductive system are transitioning back to their pre-birth control state.

Dr. Jane van Dis, MD, FACOG, OB-GYN and member of our medical advisory board, explains: "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." Some of these changes — like weight gain or weight loss while on birth control — can especially affect your menstrual cycle after stopping.

The post-BC changes you’ll experience (if any) vary from person to person, but here’s some of what you might expect after stopping birth control:

1. The “adjustment” period: For most people who quit taking birth control with estrogen and progestin (97%, Dr. van Dis says), your ovaries and menstrual cycle will return to “normal” within 90 days — whatever that looked like for you before starting birth control.

  • Some people have heavy or painful periods, or bleeding in between periods,” Dr. van Dis says. If your initial reason for going on birth control was to lighten a heavy flow or shorten your period, your original flow and pattern may return.
  • If you were specifically using a hormonal IUD that either lightened or completely stopped your period, it likely will resume upon removal.
  • If you were specifically using a hormonal IUD that either lightened or completely stopped your period, it will immediately resume upon removal.
  • If your birth control helped treat menstrual cramps, then you’re likely to experience cramping again during your period once you’ve stopped using it.

The length of time you’ve spent on birth control will not affect this 90-day time frame, Dr. van Dis explains, since most of the medications clear from your system in 48 hours.

  • If your cycle still isn't normal after 90 days, that's not a result of starting and stopping hormonal contraceptives. Instead, your BC could have been treating underlying issues — like polycystic ovary syndrome (PCOS), thyroid conditions, or endometriosis — that you had before starting birth control.
  • In these instances, Dr. van Dis suggests taking charge of your menstrual health and checking in with your provider.

Finally, you don't need to do a cleanse after stopping birth control.

2. Headaches: Some people experience menstrual migraines around day 14 of their menstrual cycles, Dr. van Dis says. “For those people, their brain experiences the downslope of estrogen as a migraine, so if they’ve been on birth control to manage headaches, they might come back.” That’s because some birth control pills have a small amount of estrogen in the “sugar pill week” (aka the week of placebo pills), which helped to keep those headaches at bay.

3. Weight changes: Weight gain or weight loss post-BC isn't likely, unless you're specifically coming off the Depo-Provera shot. "Depo-Provera is the only means of birth control that we know can cause weight gain," Dr. van Dis explained, because the shot is linked to increased appetite. Transitioning off of this specific birth control could result in weight loss.

4. Acne: If hormonal birth control cleared up your acne, then it's likely your skin will break out again after stopping. “Birth control helps to decrease the amount of circulating testosterone in your body,” Dr. van Dis says, which treats acne cysts. So once those synthetic hormones are out of your system, you might expect some skin problems to return.

5. Mood swings and depression: Since birth control pills can be associated with changes in mood for some people, stopping BC can result in mood swings, and increased or decreased feelings of depression.

“The chemistry of how birth control affects the brain can increase risk for depression in some people," Dr. van Dis explains. "But for a lot of women, they also experience the anxiety and depression that comes around the potential of having an unintended pregnancy once off birth control.” So, going off BC may increase some people's anxiety and others may feel more positive after quitting (if the hormonal medication had altered their mood).

6. The return of ovulation: Going off and on birth control is not likely to have any impact on your fertility, unless you’re transitioning off of the Depo-Provera shot: “It's the only means of birth control that we know can cause a delay in return to your fertility," Dr. van Dis says. One study suggests ovulation can be delayed for up to 18 months, while another widely cited 1998 study found that ovulation can be delayed for up to 22 months. For every other hormonal BC, Dr. van Dis says that, on average, 83.1% of women will get pregnant within 12 months of stopping.

What are the benefits of quitting birth control?

The benefits are also different for each person, but going off birth control may help in some of the following ways:

  • If your sex drive was diminished on birth control, going off it might help increase it. “Studies show that, for some people, birth control does decrease their sex drive,” Dr. van Dis explains. “So once you’ve stopped taking it, you may find yourself more interested in having sex.”
  • If birth control adversely impacted your mood, going off it might improve it. While we previously discussed the many different ways birth control may or may not affect someone’s mood, those who experience depression as a side effect of their BC may feel an improvement in their general mood.

How do you transition off of birth control?

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 by your healthcare provider, 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 or remove the patch or an IUD, you’ll likely get back to normal fast. Cue the sighs of relief. As we mentioned earlier, the majority of former birth control users will resume their pre-BC cycles within three months and conceive within 12 months of trying to get pregnant.

As for the conception rates after use of each of the most common hormonal birth control methods, here's a breakdown per one 2018 study:

  • Ex-oral contraceptive users: 87.04% pregnant within 12 months
  • Ex-hormonal IUD users: 84.75% pregnant within 12 months
  • Ex-injection users: 77.4% pregnant within 12 months
  • Ex-implant users: 74.7% pregnant within 12 months

How can you manage "side effects" of going off birth control?

There are a few different ways you can deal with uncomfortable bodily changes after quitting hormonal contraception:

  • Acne: If you notice acne making its triumphant return, you can talk to your healthcare provider about topical or oral medications.
  • Painful cramps: Over-the-counter pain relievers may become your new best friend. Ibuprofen (Motrin, Advil) or naproxen sodium (Aleve) one day before you expect your period, on the first day of your period, or when you first start experiencing discomfort can help alleviate cramping. Continuing to take ibuprofen or naproxen sodium for 2-3 days as directed or until your cramps are gone is recommended. Exercise and heating pads can also be great home remedies. If you still find yourself dealing with painful cramps, talk to your provider.
  • PCOS symptoms: Dr. van Dis mentions metformin as one of the non-contraceptive medications that can help manage PCOS symptoms. One huge benefit of metformin if you’re trying to conceive with PCOS is that it can also help induce ovulation. Dr. van Dis suggests speaking with your provider before going off birth control to discuss alternative medications to help you build a roadmap for managing PCOS and planning for pregnancy.
  • PMS symptoms: Maintaining a healthy sleep schedule and fitting in 30 to 60 minutes of exercise daily can greatly benefit overall mood. Selective serotonin reuptake inhibitors (SSRIs) may also be an option.
  • Amenorrhea: Depending on your birth control method, if your period doesn’t come back after two to three months of stopping (diagnosed as amenorrhea), Dr. van Dis says it’s time to schedule a visit with your OB-GYN — especially if you’re over the age of 35.

What are some options for non-hormonal contraception?

For anyone looking to prevent pregnancy without taking hormonal contraceptives, you’ve got plenty of options:

  • Condoms: When used correctly, condoms are 98% effective (and also the only contraceptive that helps prevent STI transmission!), but due to human error, condoms do have a 15% failure rate at preventing pregnancy.
  • Copper IUD: If you’re hoping for another one-and-done contraceptive, the non-hormonal copper IUD, or ParaGard, might be the best choice for you. It’s the most effective form of birth control (more than 99%!) and can last for 10 years.
  • Diaphragm or cervical cap: These two barrier methods can help prevent pregnancy when combined with spermicide (they’re otherwise ineffective). Like condoms, you’ll need to remember to insert a diaphragm or cap every time you’re going to have sex. Diaphragms are 92%-96% effective, while cervical caps are only 71%-86% effective.
  • Sponge: Another barrier method, the sponge is 88% effective at preventing pregnancy and must be used every time you have sex.

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, 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 a practicing OB-GYN, volunteer clinical faculty at USC Keck School of Medicine where she serves on the Gender Equity in Medicine and Science Committee, CEO of Equity Quotient, co-founder of OB Best Practice, and co-founder of TIME'S UP Healthcare.

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Ryann Summers

Ryann Summers is an Oakland-based writer and prenatal yoga teacher. Her work focuses on mental health, trauma healing, and women's reproductive health. Follow her at www.medium.com/@ryannsummers.

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