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Hormonal contraception and fertility

What’s the relationship between hormonal contraception and fertility? We get asked this a lot. The pill, the patch, the ring, the IUS, the injection – there’s a lot of contraception methods out there. Well… for women. It’s downright confusing trying to figure out if hormonal conception has an impact on your fertility. 

Spoiler alert: several large-scale meta analyses have found that contraceptive use (irrespective of duration and type) does not have a negative effect on your ability to conceive in the long run.

So, use the method that works for you, and come off it when you’re ready. If you do want to get pregnant, when you come off is more important: with some methods, you just might need to plan a little further down the line than others. 

For those of you who want detail, let’s look at types of hormonal contraception methods and discuss the difference. Then, we’ll look at the impact each method has on fertility. 

Is all hormonal contraception the same?

Nope! The two types of hormonal contraception are: progesterone-only methods and ‘combined’ methods (containing oestrogen and progesterone). 

Common progesterone-only methods include: 

  • the progesterone-only pill (also called the ‘minipill’)
  • the implant 
  • the intra-uterine system (IUS) or intra-uterine device (IUD) (known as the ‘hormonal coil’), commonly sold under brand names Mirena or Jaydess
  • the injection 

‘Combined’ methods include:

  • the ‘combined’ pill
  • the vaginal ring
  • the contraceptive patch

What is the relationship between progesterone-only hormonal contraception and fertility?

It depends what kind you’re using. Let’s get into it below. 

No impact on fertility:

The progesterone-only ‘minipill’:

The pamphlet in your pill box will tell you this: as soon as you stop taking the pill, your fertility returns to normal very quickly. Your period should resume fairly quickly too, but even if it doesn’t come back immediately, you may still be fertile.

The implant:

This is usually placed in your arm for three years, but can be removed earlier. As soon as its out, your period and fertility should go back to what’s normal for you, immediately. Just like with the minipill, even if your period doesn’t make a grand appearance – be aware you could still be fertile.

Limited or temporary impact on fertility:

The IUS/IUD:

This differs from the copper coil because it’s made of plastic and releases progesterone right into the womb and uterus. Maybe you’ve heard old wives’ tales that coils will make you infertile. These are likely based on past cases from when sexual health was less well-managed: the original copper coils came with a risk of infection being introduced into the womb. That infection could sometimes cause infertility. The IUS/IUD poses a far lower, minute risk of infection, and only in the first twenty days after insertion. While you don’t need to worry unnecessarily, do visit your GP if you have pelvic pain or abnormal discharge. Please also remember infection doesn’t necessarily render you infertile if well managed. Aside from this, the IUS/IUD should return your fertility to normal within a year of coming off (for some, far sooner, but it could be up to a year).

The injection:

In the UK, the most common injections are Depo-Provera (lasts 13 weeks), and Noristerat (last 8 weeks). It can take up to a year for periods and fertility back to normal after the injection wears off.

In short: the minipill and the implant won’t impact fertility. The IUS/IUD and the injection will have a temporary impact where it could take up to a year for fertility to get back to your baseline. So, it’s worth thinking about when you need to come off or switch to another method depending on if, or when you want a baby. 

What is the relationship between combined hormonal contraception and fertility?

For combined methods, you will generally have your baseline period and fertility back within a year of discontinuing use. Let’s take a closer look:

The combined pill:

Your period and baseline fertility should come back within six months of stopping, but in some cases this can be a year. This is true even if you’ve been taking the pill back to back, without the 7-day break (read more here). This is also true if you’ve been taking the pill for years. 

The ring:

Same as the combined pill, you’ll have your period and fertility back to normal. Your fertility might be temporarily reduced after the ring is removed, but should return within six months. 

The patch:

No surprises here either, once you stop using the patch your periods and fertility will return to normal fairly shortly afterwards. Again, it could be up to six months until it’s back to what is normal for you – but in the interim you could still get pregnant. 

When should you come off contraception if you want to get pregnant? 

This is a personal decision. Medically speaking, when you come off your contraception depends on the type, and how quickly you want to get pregnant. So, the minipill would be convenient to ditch closer to when you want to start trying, whereas if you were using the injection you may want the last injection to wear off three months before you want to start trying. And – start those prenatal vits early, just in case you conceive right after you stop using contraception.

That’s all folks! I hope this explains why you should make contraceptive choices based on what is safe and suitable for your body – without worrying about your fertility running out. That’s a myth. Busted.