Coming off contraception – Dr Imogen Staveley
When should I come off contraception?
For most women their fertility will resume to their normal level (for their age) straight after stopping their contraception (other than progesterone injection). Therefore, you could stop just at the moment you want to conceive. However, it is worth bearing in mind, for a small minority, your fertility can take up to 6 months to get back to normal. So you might want to think about stopping your hormonal contraception 6 months before you want to get pregnant.
Are there any other timing considerations?
In terms of timing, it’s important to know that it’s unusual to conceive in the first month of trying. Many women go through life imagining that the first time they don’t use contraception they will fall pregnant – this isn’t really the case, particularly as you get older. In the UK 84% of people having sex every 2-3 days will get pregnant in their first year of trying. So if you are thinking of conceiving in the next two years, it’s worth thinking about coming off contraception 6 months before you conceive and then factoring in that it could take up to a year.
Different considerations for each type of contraception
There are many different types of hormonal contraception so it is worth considering each one in turn.
Progesterone-only pill – once you stop this, your periods should resume and your fertility return to normal very quickly. Even if your periods do not return immediately you may still be fertile so take care if you don’t want to become pregnant straight away.
Implant – the implant is put in for 3 years but you can have it taken out earlier. Once it is removed your periods and fertility should resume back to normal pretty much immediately. Even if your periods do not return immediately you may still be fertile so take care if you don’t want to become pregnant straight away.
Intrauterine system (IUS) – Mirena, Jaydess etc. – this is different from the copper coil in that it is made of plastic and works through releasing progesterone hormone locally in the womb (uterus) area. People may tell you that coils cause infertility. In the past, when sexual health was less well managed and only copper coils were available there was a risk of infection being introduced to the womb which could lead to fertility issues. With the IUS there is still a small risk of infection when it is introduced but it is really small (much smaller than with the copper intrauterine device) and very rarely indeed linked to fertility issues. Its benefits generally outweigh any risks in this regard. For this reason it is commonly recommended for women who have not yet had a family. The risk of infection is usually present during the first 20 days after insertion and if you have any concern e.g. pelvic pain or abnormal vaginal discharge it is really important to see a healthcare professional to have this looked into. Getting an infection does not automatically lead to fertility issues – if it is treated quickly there is unlikely to be a problem.
Contraceptive injection – with this method, periods and fertility can take a few months to return to normal.
Contraception containing oestrogen and progesterone – The three types of contraception which contain both oestrogen and progesterone are: the combined oral contraceptive pill, the contraceptive vaginal ring and the contraceptive patch. The combined oral contraceptive pill is perhaps the most commonly used method of contraception. Many women like it because it regulates periods making the cycle predictable and it makes periods lighter and less painful. Furthermore, if you want to avoid a period for a holiday or special occasion you can take two packets back to back to avoid a period. In fact, new guidance suggests that tricycling your pill (taking three packs back to back) is fine, however, this is still an off-license use but many women make this choice for lifestyle reasons. There is no evidence that taking contraception containing oestrogen and progesterone impacts on fertility in the long term. However, it is clear that for some women, it can take up to 6 months for their periods to resume to their normal cycle and during that time their fertility may be slightly reduced but will resume back to normal.
If you’re not planning on trying to conceive in the near future, there can still be a lot of myths around contraception. Here we bust some of the most common ones:
Should I have a break from my hormonal contraception?
Many women hear on the grapevine that it is not a good idea to take hormonal contraception for years and years and that they would benefit from taking a break. There is no evidence that taking a break is a good idea and in fact we know that the greatest health risks tend to occur when you first start taking hormonal contraception. Therefore, stopping and restarting may actually be worse for your health than just continuing on contraception that suits you. The main risks of restarting are around risk of clots in the legs and lungs.
Is one type of hormone better than another?
There is evidence about which hormones are safer in terms of thromboembolic (clotting) risk but evidence as to whether one hormone is superior to another in terms of the contraceptive effect is limited. In truth, it is about a woman finding what suits her – we are all different. Some women will prefer the idea of a tablet to a coil and vice versa. Some women will find that some contraception suits them better eg. their skin. Some women will have health problems that mean they cannot have a particular type of contraception – you can discuss this with your doctor.