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How To Come Off Hormonal Contraception

You may have decided to come off hormonal contraception, but aren't sure what to expect. Can you just stop? Are there side effects? How long until you can fall pregnant?

contraceptive pill

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Birth control has been used since the 60s to control fertility and has revolutionised women’s lives.

However, by their very nature, hormonal contraception impacts women’s natural hormone fluctuations by disrupting the complex interplay between the control hormones (FSH, LH) and the ovarian response hormones (oestrogen and progesterone). This hormone network is key to women’s health and wellbeing, not just fertility.

So, if you’ve decided, for whatever reason, to come off hormonal contraception what’s the best approach to take? And what are the likely side effects?

First, let’s take a look at the types of hormonal contraception and what happens to women’s hormones when they take it.

Types of Hormonal Contraceptive

There are several types of hormonal contraception, these are:

  • Combined oral contraception pill
  • Contraceptive skin patch
  • Vaginal ring
  • Contraceptive injection
  • Contraceptive implant
  • Hormonal coil [1].

Oral contraceptives are the most common single type of contraception used in the UK with 42% of women using the pill [2].

There are two types of oral contraceptive pill, the combined pill and the progestogen-only pill.

The Combined Oral Contraceptive Pill

The combined pill is commonly known as “the pill”. It contains man-made versions of the ovarian hormones, oestrogen and progesterone.

The combined pill works in three ways to prevent pregnancy:

  1. It stops the release of an egg from the ovaries (ovulation).
  2. It thickens cervical mucus to stop sperm from entering the womb and fertilising an egg.
  3. Thins the lining of the womb to lower the chance of a fertilised egg implanting and developing [3].

The Progestogen-only Pill

The progestogen-only pill (POP) is also known as the “mini pill”. Unlike the combined pill, the mini-pill only contains one hormone, similar to progesterone.

The mini pill works by thickening the cervical mucus, to prevent sperm from reaching an egg. Mini-pills that contain desogestrel also prevent ovulation.

The mini-pill is useful for women who cannot tolerate oestrogen and those who are over 35 years old and smoke.

How Do Hormonal Contraceptives Affect Women’s Hormones?

During a natural menstrual cycle, women’s hormones fluctuate in an intricate network of feedback loops between the two control hormones FSH and LH, and the two ovarian hormones, Oestrogen and Progesterone.

Menstrual Cycle Graph

The rise in Oestrogen, FSH and LH during the follicular phase triggers ovulation, followed by a rise in Progesterone during the Luteal Phase to prepare the body for pregnancy should the egg become fertilised.

When you take hormonal contraceptives, this natural fluctuation in hormones throughout the menstrual cycle is changed.

Hormonal contraception uses artificial versions of Oestrogen and/or Progesterone. These hormones are used as they suppress the release of FSH and LH which are required to trigger ovulation around day 14 and ‘restarting the cycle after a menstrual bleed [4]. 

Therefore, hormonal contraceptives prevent the natural menstrual cycle by maintaining consistent levels of Oestrogen and/or Progesterone to prevent ovulation, thickening the cervical mucus to stop sperm from entering the womb and fertilising an egg; as well as thinning the lining of the womb to lower the chances of a fertilised egg implanting and developing.

The combined oral contraceptive pill mimics the menstrual cycle by taking the pill daily for 3 weeks followed by a week of no pills causing what’s known as a withdrawal bleed or ‘break-through bleeding’ due to the drop in hormones. So, although it may appear a woman is having a ‘normal’ menstrual cycle, the high levels of Oestrogen and Progesterone prevent the natural menstrual cycle that underpins ovulation [4].

Changes to the natural fluctuation of hormone levels when women start taking hormonal contraception can cause a number of side effects, these include:

  • Mood changes
  • Breast tenderness
  • Headaches
  • Nausea

How To Come Off Hormonal Contraception

There is no specific way you need to come off hormonal contraception you can just stop, and your hormones will adjust back to the natural fluctuations across the menstrual cycle.

If you are taking oral contraception, then it is advised that you come off once you’ve finished your last course of tablets – although you can stop taking oral contraception at any time.

If you are using other methods of hormonal contraception such as IUD then you will need to see your GP or healthcare professional to have it removed.

Female Hormone Mapping - You Mapped Out

How Long Does It Take For Your Body To Get Back To Normal After Birth Control?

When you stop using hormonal birth control, it can take a few weeks for your body to get back to normal. Some women have a period between 2 and 4 weeks after stopping the pill but this can depend on the individual and their cycle. When you first stop taking the pill, it can take up to three months for your periods to become more regular. Therefore, it is important to give your body time to readjust and allow your cycle to re-establish itself.

When you stop taking the pill, the first period following is called a withdrawal bleed. The bleed after this one is your first natural period [3].

There is no evidence to suggest that the use of hormonal contraceptives negatively affects fertility [4]. In fact, some women fall pregnant immediately after they stop using birth control.

Coming Off Birth Control

Some women experience some side effects when they begin using hormonal contraception. It’s also not uncommon to experience some changes when they stop using hormonal contraceptives, too.

There have been anecdotal reports of symptoms such as [6]:

  • changes in the menstrual cycle
  • heavier periods
  • cramping during ovulation
  • premenstrual syndrome (PMS)
  • changes in mood
  • weight changes
  • acne
  • unwanted hair growth
  • headaches
  • tender breasts
  • changes in sex drive

The term “post-birth control syndrome” has been widely used on the internet and within the holistic world to describe the symptoms some women experience after coming off of hormonal contraception.

However, in the medical world, there is no evidence that such a condition exists. After stopping hormonal contraception, if your periods do not resume within 6 months you should consult your doctor for further investigations.

Equally, if you were prescribed hormonal contraception for reasons other than to prevent pregnancy, such as to treat acne, heavy periods, or conditions like PCOS, it is likely these pre-existing issues will return once you stop.

How To Improve Symptoms After Getting Off The Pill

When you stop using hormonal birth control, it is likely that you will notice some changes. That’s because your body is changing back to its pre-birth control state. The symptoms vary from person to person as a woman’s natural menstrual cycle is totally unique to her.

There are things you can do to support hormone health such as eating a healthy balanced diet, reducing stress and taking plenty of exercises combined with adequate rest.

When To Seek Help

If you are struggling with the symptoms since stopping hormonal birth control, then you may need to seek medical advice.

If you are interested in finding out more about your natural hormone fluctuations across your entire menstrual cycle after stopping hormonal contraception, then our Female Hormones Mapping product can help. Once you've had your first breakthrough bleed after stopping contraception and start to have your natural menstrual cycle, you will be able to use our test.  The test measures your hormone levels from finger-prick blood samples taken on day 14 and day 21 of your cycle.

Learn more about Female Hormone Mapping>>

Conclusion

There are no specific ways to come off hormonal contraception and you can stop whenever is the right time for you.

Your hormones may take a few weeks to get back to normal and for your periods to return. But otherwise, unless you were taking hormonal contraception to alleviate symptoms related to your hormones, you shouldn’t feel any side effects other than what is normal for your menstrual cycle.

If you are concerned that your periods haven’t returned after 6 months or have become irregular, you should seek medical advice.

Read Next: The Role Of Hormones In Women's Health>>

View More Female Health Articles>>

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This ground-breaking product maps how the 4 key female hormones fluctuate over your entire cycle rather than just a single day. Combining blood analysis with artificial intelligence and clinical expertise, our algorithm uses 8 lab results to plot how each of your hormones fluctuates throughout your cycle, totally unique to you. Giving you unparalleled insight into your menstrual cycle, whether you want to improve your wellbeing, optimise sports performance, are entering the perimenopause or are thinking about starting a family.
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Medically Reviewed
Dr Nicky Keay
Chief Medical Officer, BA, MA (Cantab), MB, BChir, MRCP.​
This article has been medically reviewed by Forth's Chief Medical Officer, Dr Nicky Keay.
Nicky has extensive clinical and research experience in the fields of endocrinology and sport and exercise medicine. Nicky is a member of the Royal College of Physicians, Honorary Fellow in the Department of Sport and Exercise Sciences at Durham University and former Research Fellow at St. Thomas’ Hospital.

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