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Getting Pregnant after Stopping Hormonal Birth Control

If you’ve been using hormonal birth control, you might be wondering how you can get pregnant after stopping the drug.

Whether you’ve been taking an oral contraceptive pill for a few months or several years or having shots of Depo-Provera (medroxyprogesterone acetate), your body will start functioning on its own again after you stop taking the drug, meaning you’ll start producing follicles and ovulating again.

However, it is advisable to talk to your health care provider about your stopping hormonal birth control if you desire to get pregnant.

How Does Hormonal Birth Control Work?

To understand how hormonal birth control works, you need to understand your menstrual cycle and how the hormones in birth control drugs or devices affect your fertility.

How Does Your Menstrual Cycle Work?

During menstruation, your uterine lining breaks down and you lose about 10 to 80 mL of blood through your vagina. The menstrual phase usually lasts 3–5 days.  

The average duration of the menstrual cycle is 28 days (range, 21–45 days). In the first part of your menstrual cycle (days 1 to 13, considering a cycle duration of 28 days), your hypothalamus stimulates the pituitary gland to produce follicle stimulating hormone (FSH), which causes follicles in your ovaries to develop into mature eggs.

The maturing follicles produce estrogen, which in turn causes the endometrium (inner lining of the uterus) to grow. As the level of estrogen increases, the pituitary gland detects this and releases luteinizing hormone (LH). The LH surge acts on the ovaries and causes the release of a mature egg within 12 to 36 hours.

After egg release, the follicle from which the egg was released (also called the corpus luteum) produces progesterone. Progesterone causes the inner lining of the uterus to become thicker and prepares it for the implantation of the fertilized egg.

If your egg is fertilized, the corpus luteum will continue producing progesterone to sustain the pregnancy. Otherwise, the egg disintegrates after about 24 hours and the progesterone levels fall. The inner uterine lining will begin to break down after about 12 to 16 days after ovulation.

What are Birth Control Pills?

Three types of oral contraceptive pills are currently available. These include combined estrogen-progesterone, progesterone-only, and the extended use or combined oral contraceptive pill.

Birth control pills are used to prevent pregnancy and are the preferred contraceptive method used by about 16% of women of reproductive age (15–44 years) in the United States. Most women who use oral contraceptives are commonly prescribed the combined estrogen-progesterone hormonal pill.

Birth control pills are generally regarded as effective, with a failure rate of < 1% among women who use them consistently and correctly. The failure rate is higher (approximately 9%) among women who do not always use the pill consistently or correctly.

How Does the Pill Prevent Pregnancy?

Progesterone-only contraceptive pills act by suppressing ovulation and have a variable moderating effect on the peaks of FSH and LH. These pills also reduce the number and size of glands in the endometrium and cause a decrease in the motility of cilia within the fallopian tube.

Combined estrogen-progesterone oral contraceptive pills primarily prevent ovulation due to the synergistic action of estrogen and progesterone on the gonads. They also cause the following effects:

  • modify the consistence of the cervical mucus, making it to remain thick and sticky so sperm cannot swim to meet an egg,
  • prevent the uterine lining from thickening and thereby making it unfavorable for implantation,
  • interfere with tubal transport.

How Long Will It Take to Ovulate after Coming Off the Pill?

In general, the hormone(s) will be out of your body within a few days after you stop taking oral contraceptives. In the absence of the hormones from pills, your body will start working normally again; however, it will take some time for you to start ovulating depending on your body. Some women will start ovulating within less than 2–3 or a couple of months after stopping birth control pills; some women might take longer.

If you had irregular periods (and ovulation) before taking the pill, these problems might reappear after you stop taking the pill. Even if you didn’t have ovulatory disorders prior to taking the pill, it could take a few months for your regular cycle to get back on track. So, it should come as no surprise if you have an occasional period followed by skipped months in between.  

What about Getting Pregnant after Stopping Depo-Provera?

Depo-Provera is different from oral contraceptives in that, contrary to the pill where the hormones are cleared out of your body when you stop taking the drug, blood levels of medroxyprogesterone acetate (1 ng/mL) are maintained for 3 months. Depo-Provera, at concentrations of 1 ng/mL, inhibits ovulation by suppressing FSH and LH and eliminates the LH surge.

Given that a single shot of Depo-Provera can inhibit ovulation for as long as 15 weeks in most women and the drug can be cleared from your system within 7–9 months, it can take a long time for your body to start ovulating on its own again. That’s why this form of contraception is usually preferred in women who do not wish to get pregnant again.

Can You Get Pregnant after Removing an Intrauterine Device with Hormones?

Intrauterine devices (IUDs) with progesterone (e.g., levonorgestrel) release a small amount of the hormone into the uterine cavity. Levonorgestrel, at a single dose of 0.75 mg, has an elimination half-life of 24.4 ± 5.3 hours and is excreted mainly in the urine and feces.

Therefore, like oral contraceptive pills, your body can start ovulating on its own within a few weeks to months after an intrauterine device (IUD) with hormones is removed.

Tracking Your Fertility after Hormonal Contraception

If you’ve decided to come off the pill or some other form of hormonal contraception, chances are you’re planning to get pregnant. But how do you know you’re ovulating after you stop these birth control methods?

You can track your basal body temperature (BBT) by using a thermometer designed for fertility charting. Some apps, such as Fertility Friend, can help you track your BBT.

If you chart consistently, you should see a small rise in your body temperature one to two days after ovulation. Your BBT will help you determine whether your luteal phase (the period after ovulation and before the beginning of your period, when your uterine lining thickens in preparation for a possible pregnancy) is long enough. The data will also help you predict your next period date.

You can use temping in conjunction with cervical mucus analysis or an ovulation predictor kit (OPK). Standard and digital OPKs measure the presence of LH in urine, whereas advanced OPKs, in addition to detecting LH, measure estrogen in urine, giving you an advanced warning of when ovulation would probably occur. While OPKs will tell you when your body is gearing up to ovulate (so that you can plan intercourse), BBT will tell you if ovulation occurred.

You can choose to use fertility monitors, which detect estrogen and LH and take into account other information that you enter into the device to tell you when exactly you can test.

Signs of Ovulation after Hormonal Birth Control

In general, the signs of ovulation are the same in most women whether there’re on the pill or not. Here’s an interesting video that describes ovulation and how you can know when you’re ovulating.

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Medical disclaimer: The information provided here is intended to supplement, not substitute for, the expertise and judgment of your doctor or pharmacist. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be interpreted to indicate that use of any drug is safe, appropriate or effective for you or anyone else. Always consult your doctor or pharmacist before taking any drug, making modifications to your diet or starting or discontinuing your treatment.

Princila M
 

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