Getting ready for the return of natural periods after the pill

getting ready for the return of natural periods after the pill

Whether you have been on the pill for a few months, or much longer, at some point there may be a reason why you wish to come off it. Changing or stopping contraception can cause some anxiety, as you prepare for unknown changes to your body. So what exactly happens when you come off the pill, and how can you best prepare for it?

Both types of contraceptive pill can suppress parts of the menstrual cycle. The combined pill stops eggs from being released (and, if you have a seven day break each month, the ‘period’ you have is actually a ‘fake’ one). The mini pill, on the other hand, tends to thin the lining of the womb and stops it from breaking down, which means you may not experience periods at all when you’re on it.

On stopping the pill, your body will, of course, no longer be affected by the hormones in it. As such, the hormones produced by the glands in the brain and the ovaries can start to function ‘naturally’ again, as the cycle is no longer being suppressed. Every individual will respond differently in this instance, and the time it takes for your period to return will also vary, depending on how long it takes for the external hormones from the pill to stop having an affect on your body.

Fertility can potentially return immediately once you stop taking the pill. In some people your first period (providing you don’t get pregnant immediately) can occur within a month.

In general, fertility can potentially return immediately once you stop taking the pill. In some people, then, your first period (providing you don’t get pregnant immediately) can occur within a month.1 For this reason it is advisable to use other forms of contraception if you aren’t seeking to get pregnant.

If you are considering pregnancy, as well as obtaining preconception advice, it is best to stop taking your combined pill at the end of the pill pack, so that a withdrawal bleed and then a menstrual bleed can occur. The mini pill, on the other hand, can be stopped at any time. However, for most women, it can take up to three months for periods to be regular on stopping the mini or combined pill.2 This is because the pill can stop the body producing eggs and therefore interfere with how the body produces the hormones that regulate periods. Within three months of stopping the pill, these hormones should be within the normal range for periods to occur.

What will my period be like when I come off the pill?

When you come off the pill, your period may be light or heavy, and depending on why you started taking it, other health conditions may reemerge upon stopping it. These include heavy periods with fibroids, due to the body’s hormones affecting the growth of the fibroids; and painful periods with conditions such as endometriosis. No periods (amenorrhoea) or irregular periods may also occur.

This is particularly common in conditions such as polycystic ovaries (PCOS) where there is a hormonal imbalance that may result in eggs being released irregularly — the pill is considered a first-line treatment for managing common PCOS symptoms, including acne and irregular periods.3 The perimenopause is another phase in which periods may be unpredictable upon stopping the pill, if you stop it around the time you would be expecting to enter perimenopause. Not only can the timing of your periods be unpredictable but the menstruation pattern can also vary from being very heavy to very light, going from irregular to regular for a few months and then back to irregular again. It is vital to go and see your doctor if you have any concerns about the pattern of your periods.

Being on the pill from your teenage years and then stopping it as an adult can sometimes be challenging, and physical and mental changes have been reported in some people. The combined pill, for example, can be effective in improving skin conditions such as acne, and as such adult onset acne and other hormonal imbalance features such as hirsutism may occur for the first time. If you come off the mini pill, you may find your breast size changes, as the progesterone in the mini pill can make them a bit bigger.

It is best to discuss stopping the pill with your healthcare provider especially if it is being taken for a medical reason.

It is best to discuss stopping the pill with your healthcare provider, especially if it is being taken for a medical reason. Alternative medication for such a condition may be required, for instance, if the pill was taken for heavy periods. In this instance, an anti-inflammatory medication that helps to make periods lighter may be required. If the pill was prescribed for acne, then other anti-acne medications may be needed. Sometimes it may not be advisable to stop taking the pill, especially if other medications or a condition that may be risky to the individual or a potential pregnancy has to be taken into account.

Having a healthy lifestyle is important for hormones to function optimally. This includes regular exercise, adhering to the recommendation of 150 minutes or more of activity per week.4 This helps with weight control and blood circulation and hence can maintain hormonal levels in the body, as oestrogen tends to be stored in fat cells.

A healthy, well balanced diet that includes green leafy vegetables, fibre, protein and good fats to aid absorption of fat soluble vitamins is important, as this helps to maintain hormones in balance which in turn may help to regulate periods with minimal associated symptoms. Managing stress and having good sleep hygiene helps to prevent an overproduction of certain hormones such as cortisol and adrenaline while improving production of melatonin at night. This in turn ensures there are good levels of nutrients available to produce the right amount of sex hormones that are required for the menstrual cycle.

Last updated July 2019
Next update due 2021

References

  1. NHS, ‘When will my periods come back after I stop taking the pill?’, NHS Health A-Z, 17 July 2018, [online], https://www.nhs.uk/conditions/contraception/when-periods-after-stopping-pill/ (accessed 8 July 2019)
  2. FSRH, Combined Hormonal ContraceptionFebruary 2019, [online], https://www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception/ (accessed 8 July 2019)
  3. Sanches de Melo, A., et al., Hormonal contraception in women with polycystic ovary syndrome: choices, challenges, and noncontraceptive benefits, Open Access Journal of Contraception, 2017, vol 8, pp 13-23
  4. WHO, ‘Physical activity and adults’, Global strategy on diet, physical activity and health, 2019, [online], https://www.who.int/dietphysicalactivity/factsheet_adults/en/ (accessed 8 July 2019)

Dr. Deyo Famuboni

Dr. Deyo Famuboni is a UK trained GP with over 10 years of medical experience. After graduating from the University of Edinburgh, she went on to do further training within a wide range of medical specialities including obstetrics and gynaecology. She has spent time working abroad as well as within the NHS and private sectors in the UK. She is a member and clinical advisor of the Royal College of General Practitioners and a diplomate of the Royal College of Obstetrics and Gynaecology, Royal College of Paediatricians and the Faculty of Sexual and Reproductive Health. She also has a strong interest in nutrition and health and blogs at https://doctordeyo.com/.

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