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Mythbusting around hormonal contraception and fertility

Rose, from the company Adia, highlighted to me that many women have heard myths about hormonal contraception and she suggested I write a blog on this.  She is just right, many of my patients come to me asking the sorts of questions I have tried to answer below with an evidence-base.

Can taking hormonal contraception impact on my fertility?

There are many different types of hormonal contraception so it is worth considering each one in turn.  I will start by looking at progesterone only methods of contraception and then move onto contraception containing oestrogen and progesterone.

Progesterone only methods of contraception

Those with no effect on fertility:

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.

Those which could have an impact on fertility albeit either very unlikely or temporary:

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.  (Just to add, although the IUS releases hormone locally, some women do find some side-effects reaching the rest of their body e.g. some women get acne when they use the IUS.  The good news it he IUS is very easy to remove so if they do find they have a side-effect they can have it taken out quickly in a family planning clinic or in their GP surgery.)

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 absolutely fine however this is still an off-licenced use but many women make this choice for lifestyle reasons (1).  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.

I want to conceive in the next two years, when should I stop my hormonal contraception?

As with most difficult questions the answer is, it depends!  For example, if you and your partner are young (under 35 years old) and neither of you have any significant health problems or health problems in the past then there is absolutely no need to stop your contraception until you want to get pregnant as the likelihood is your fertility will resume back to normal at maximum 6 months after you stop your contraception (and for most women it will return to normal immediately).

However, if you are over 35 and/or perhaps you have a health problem of some sort, it might be worth you considering whether you really want to wait two years to conceive.  Fertility in general decreases more rapidly over 35 and it is worth maximising your chances of conceiving by doing it as young as possible.  However, clearly you have to be in the right place in your time and that is totally up to you.  However, you just need to make an informed choice – for most women their fertility will resume to their normal level (for their age) straight after stopping their contraception (other than progesterone injection).  Therefore, they could just stop just at the moment they want to conceive.  However, bearing in mind, for a small minority, things can take up to 6 months to get back to normal they might want to stop their hormonal contraception 6 months before they want to get pregnant.

I must add here that any couple it is unusual to get pregnant in the first month of trying.  In the UK 84% of people having sex every 2-3 days will get pregnant in their first year of trying (2).  This is another reason why if you are thinking of conceiving in the next two years anyway, perhaps it is worth just starting right away as it can take that long particularly as you get older and this can be totally normal.  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.  So perhaps, talk it through with your partner now – would it really be that bad to start trying right away bearing in mind it can take some time?

This article gives great advice on what to do when trying to conceive:

https://patient.info/health/planning-to-become-pregnant

If you or your partner have a particular health problem such as diabetes or epilepsy or if you are taking any regular medications it is worth booking an appointment with your GP to discuss getting pregnant as you may want to alter your medication regime or take extra supplements such as higher dose folic acid.

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 re-starting may actually be worse for your health than just continuing on contraception that suits you.  The main risks of re-starting 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 have health problems that mean they cannot have a particular type of contraception – you can discuss this with your doctor.

I hope that this blog helps demystify hormonal contraception and fertility.  If you have further queries or comments do post them in the comments below or get in touch @PregnaPouch or PregnaPouch@gmail.com.

Originally posted on the PregnaPouch website: https://pregnapouch.wordpress.com/2018/05/13/mythbusting-around-hormonal-contraception-and-fertility/

References

  • https://www.cnwl.nhs.uk/wp-content/uploads/Pill-information-leaflet.pdf
  • https://www.nhs.uk/conditions/infertility/

Useful further reading

Tips on what to do when trying to conceive: https://patient.info/health/planning-to-become-pregnant

General contraceptive advice: https://www.fpa.org.uk/

Support for those trying to get pregnant: https://www.adiahealth.com/

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