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What to Expect When Transitioning Off of Hormonal Birth Control

About five years ago, I decided to stop taking the hormonal birth control I’d been on for ten years. I’d been on many different pills — from Ortho Tri-Cyclen to Apri (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? 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 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 experienced women have used the pill at some point in their lifetime.

Celia, 29, talks about transitioning 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 just curious about trying a natural approach, or you’re planning to start trying for a family, there’s an adjustment...period.

So, gather round, and let’s talk about transitioning off the pill, hormonal IUD, patch, or whatever your current hormonal BC of choice might be.

First things first, what’s hormonal birth control? And which hormones are we talking about?

When we say hormonal birth control (or BC) we’re talking about contraceptive pills, IUDs, the patch, ring, and Depo-Provera shot. Hormonal birth control is the pregnancy prevention method that uses synthetic hormones to mimic the estrogen and progestin (sometimes also called progesterone) naturally produced in a woman’s body. (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 monthly 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.

Now, for logistics around transitioning off of these two methods: 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 some studies have shown it’s a bit easier during your period when the cervix is naturally softer, according to Planned Parenthood and VeryWellHealth.

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.

MF: First, let’s talk benefits and side effects when transitioning off hormonal BC. What can we expect?

KE: This really varies from person to person. If you went on birth control for a specific reason other than pregnancy prevention (to alleviate menstrual cramps or shorten periods), these original problems will likely resume after stopping birth control.

If there were any aspects of your birth control that you didn't like (mood changes, decreased libido) you may see these problems resolve. Low libido can sometimes be seen in birth control pills, so it's possible your sex drive may see a bump after coming off.

Some women suddenly notice a brief twinge of pelvic pain once a month. The culprit? Ovulation. 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.

That being said, some women may not notice any changes at all. An important thing to remember, though, is that with all birth control methods except for the Depo-Provera shot, fertility resumes immediately. So, it’s possible to get pregnant right away. When coming off of the Depo-Provera shot, it may take up to a year before your fertility (read: ovulation) is back to normal.

MF: And how does the body transition from synthetic hormones to natural ones?

KE: For the most part, your body picks up right where it left off. Once you remove the contraception (you stop taking a pill, take off a patch, remove an IUD), your body resumes its normal pattern. 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.

MF: What tends to happen in terms of period cramps? Heaviness of flow? Breast size? Weight? Headaches? Mood swings?

KE: If you’re coming off of the birth control pill, you may notice that your period cramps may worsen and your flow may get heavier compared to when you were on the pill.

Your weight shouldn't be impacted, as studies show the only birth control that can impact weight is the Depo-Provera shot, which causes an increase in appetite in some women.

If you struggled with PMS symptoms prior to starting the pill, you may see these pick back up. Birth control pills tend to be prescribed as a first-line treatment for managing PMS, along with SSRIs (antidepressant medications like Zoloft, Lexapro, etc.).

Breast size and headaches are pretty individual. Some women experience headaches during their period, which we call estrogen-withdrawal headaches. Why? We think the dip in estrogen during your period is what can cause them. 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.

Breast size and tenderness also varies — if your breasts changed when going on the pill, they may change going off (getting bigger or smaller). Basically, expect your pre-pill body to come back in full-force.

If you’re removing a hormonal IUD, expect your periods to come right back. But because the IUD is a low-dose of progesterone, we typically don't see many other changes.

MF: Any tips for to combat some of those not-so-great effects?

KE: If you’re struggling with acne, I recommend seeing a dermatologist. There may be other tricks to keeping your skin flawless aside from birth control pills.

For menstrual cramps and heavy cycles, you can try 800mg of ibuprofen every eight hours the day prior to Aunt Flow. Take this every eight hours through the first few days of your period. Studies have shown this helps to alleviate cramps as well as lighten periods. Obviously, this is only applicable to women who are medically able to take ibuprofen (some cannot). Diet can also be beneficial — cutting back on refined sugars and fried foods can improve cramps and mood. Meditation, mindfulness, and in some cases an SSRI, can also really help with PMS symptoms.

MF: That’s really helpful. Can you also talk about what’s not-so-normal? AKA when to call the doc?

KE: When stopping the Depo-Provera shot, it may take longer for periods to get back on a normal cycle. This varies from person to person, but it can take up to a year after your last injection for cycles to re-regulate.

But for any other method, if your period doesn't resume within four to five months of discontinuation, please pay your provider a visit. For most women, periods resume regularly within the month, but that isn't always the case.

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), dermatologist, ibuprofen, or trusty heating pad for support.

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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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