Things You Didn’t Know Might Happen While Coming off Contraceptive Pills

Have you finally decided it's time to start a family? Has the cost of the pill become too much of a burden to continue? Have the contraception side effects become too much for you to handle? The decision to stop taking contraceptive pills requires careful planning because if you stop taking the pill at once, it can lead to certain consequences, such as bleeding, which you should be aware of beforehand.

Whatever the reason might be, before you stop taking the pills altogether, talk to your partner and most importantly, your doctor about the possible outcomes. This article is your concise guide to different types of birth control methods and what may happen when you try to come off contraceptive pills.

Types of Birth Control Methods

Some of the most commonly practiced birth control methods are listed below.

1. Natural methods

  • Abstinence

Abstaining from intercourse is one of the natural methods of birth control. This method is regarded impractical as sexual activity is hailed important for psychological health of a person.

  • Withdrawal

Withdrawing the penis from vagina before ejaculation occurs is another natural contraceptive method which prevents the deposition of male sperms in the vagina and, therefore, prevents pregnancy. The timing is, however, very crucial in this method and the chances of failure are high.

  • Lactational amenorrhea method

In lactating women, high levels of the hormone prolactin suppresses the fertility hormones estrogen and progesterone and, therefore, prevents pregnancy. Having intercourse during this period is a temporary natural method of contraception [1].

2. Barrier methods

  • Condoms

A condom is a synthetic covering designed to cover an erect penis to accumulate the ejaculate. It forms a physical barrier that prevents sperm deposition in the vagina and consequently, prevents pregnancy.

  • Spermicides

These are various chemicals that form a physical block at the entrance of the uterus and either trap or kill the sperm, thereby preventing pregnancy. They come in various forms, such as foams, gels, and sponges.

3. Hormonal methods

  • Combined oral contraceptives (COCs)

COCs are basically a combination of two hormones: estrogen and progestin, which are administered in women to prevent pregnancy by interfering with ovulation. They also induce changes in the cervical mucus (secretions covering the walls of cervix), causing it to thicken, preventing the ascent of sperms. COCs come in various forms such as pills, topical patches, implantables etc.

  • Progestin-only formulations

Progestin-based formulas prevent ovulation, thicken the cervical mucus, and make the uterine environment less hospitable for pregnancy. The two commonly used forms are progestin only pills (POPs) and progestin only injections (Depo-Provera). They provide long term birth control [3].

4. Surgical methods

  • Tubal ligation

In females, the Fallopian tubes (the tubes leading out from uterus to the ovaries) are tied up so that the released eggs can no longer reach the sperm for fertilization. It is performed as a day procedure under general anesthesia. It is a permanent and effective contraception method and should be used only by couples who have completed their families after mutual consent.

  • Vasectomy

Vasectomy is the procedure in which vas deferens in males (the tubes that carry sperms from the testis to the urethra) are either cut, tied or clamped. It is another permanent method, done under local anesthesia [4].

What Happens When You Stop the Pill?

When you stop taking the pill, the process of ovulation starts again. If you were taking the pills for a reason other than birth control, such as regulation of irregular periods or for heavy menstrual bleeding, the problem will recur when you stop the pill. Beware of the following side effects that may occur [5].

1. Withdrawal bleeding

Bleeding after stopping birth control pills occurs because when you are on the pill, hormones constantly act on the lining of uterus and prevent it from shedding. Once the hormonal effect is gone, the wall of uterus weakens, and bleeding occurs. It is merely a normal physiologic response of the body and is not true period.

2. Cramps

Since pills prevent ovulation, they also reduce the abdominal pain and cramps associated with it. Stopping the pills can cause the cramps to start again. Additionally, your periods may also be associated with more abdominal cramps than before.

3. Irregular periods

With the lack of hormonal effects on the uterine lining, normal menstrual cycles take time to regulate after birth control withdrawal. You may or may not start having your period immediately when you stop taking the pill, but a certain amount of bleeding (withdrawal bleeding) is considered normal.

4. Weight loss

Combined pills that contain estrogen have been reported to be linked with weight gain due to its stimulating effects on appetite centers in brain. Increased appetite can result in weight gain in women taking the pill.

Also, the pill may cause retention of fluid in tissues, leading to additional water weight. After stopping birth control pills, the effects of high estrogen levels vanish and you drop all the extra weight you put on while on the pill.

5. Mood swings

As periods come back, so does the premenstrual syndrome (PMS), the most prominent symptom of which is mood swings due to fluctuating hormone levels. Other symptoms of PMS like bloating, appetite changes, abdominal pain, and nausea may also recur.

6. Acne and facial hair

In women who use contraceptive pills for polycystic ovarian syndrome (PCOS), stopping the pills can cause the symptoms of PCOS, like acne and facial hair, to return.

The Best Approach to Stopping Birth Control Pills

  • Always talk to your partner before embarking on the decision of stopping the pills if you intend to start a family. The decision should be mutual.

  • Consult your doctor about the possible effects of stopping the pills, the best time to stop the pill, and alternate contraceptive methods if you still wish to avoid pregnancy.

  • Although there is no hard and fast rule, experts recommend stopping the pill only when you reach the end of a pack so as to avoid coinciding withdrawal bleeding with your period as it can lead to excessive bleeding.

  • Keep an eye out for withdrawal bleeding after stopping birth control pills and recommencement of your period. Keep track of the cycles. If your period does not return to its normal pattern even after 2-3 months of stopping the pill, consult your doctor.

For more information on what happens immediately after you stop taking the pill, please check the video.

References

  • [1] Freundl G, Sivin I, Batár I. State-of-the-art of non-hormonal methods of contraception: IV. Natural family planning. The European Journal of Contraception & Reproductive Health Care. 2010 Apr 1;15(2):113-23.

  • [2] Gilliam ML, Derman RJ. Barrier methods of contraception. Obstetrics and gynecology clinics of North America. 2000 Dec 1;27(4):841-58.

  • [3] Halpern V, Lopez LM, Grimes DA, Gallo MF. Strategies to improve adherence and acceptability of hormonal methods of contraception. Cochrane Database of Systematic Reviews. 2011(4).

  • [4] Howe LM. Surgical methods of contraception and sterilization. Theriogenology. 2006 Aug 1;66(3):500-9.

  • [5] Lara-Torre E, Schroeder B. Adolescent compliance and side effects with Quick Start initiation of oral contraceptive pills. Contraception. 2002 Aug 1;66(2):81-5.