Should I come off the pill?

The contraceptive pill is a very safe and effective form of contraception. It works by using hormones to stop or reduce ovulation (the release of an egg from the ovary), thicken the cervical mucus to keep sperm out of the uterus (womb), and thin the lining of the womb to prevent fertilised eggs from attaching.

Although the contraceptive pill is often recommended by doctors as a good option for contraception, some people may decide that the pill is not for them, or want to take a break for health reasons.

In this article, we will take a look at some of the most common reasons for coming off the pill, and how you can go about doing so safely.

Reasons to come off the pill

There are a few reasons you might consider coming off the pill. They’re all valid, but it’s important that you understand what effects this might have on your body and what you might need to be aware of. Coming off the pill for a break

If you’re on the combined contraceptive pill, you’ll likely be taking a short break every month anyway. Most people follow a 21 days on, seven days off regime, during which you bleed as you would during your natural period.

Some people believe that a longer break from the pill can be good for your health, but there’s no evidence to support this, and it’s perfectly fine to take the combined contraceptive pill for extended periods.

If you still want to take a break from the pill, you should make sure to use other contraceptives to avoid unwanted pregnancy, such as condoms.

Coming off the pill to get pregnant

Of course, getting pregnant might be your aim, and to do that you will need to come off the contraceptive pill. There’s no ‘waiting period’ for pregnancy after coming off the pill, so you can begin trying immediately.

Coming off the pill for another method of birth control

Although the pill is perfectly safe for most people you might find that you experience side effects. If these side effects become unbearable, you can switch to another method of birth control.

If you’re switching from one type of pill to another, the process depends where you are in your current pack. Find out more about switching pills here.

If you are switching from the pill to the implant or coil, you might need to continue taking the pill for a few days after having it fitted. Your doctor or nurse will discuss this with you at your appointment.

You might want to consider using a backup method of birth control during the transition, such as condoms and spermicide, to ensure you do not get pregnant.

No matter your reason for switching or stopping, you might notice some irregularity with your periods after you do so. This is normal, but if your periods become very heavy or you experience excessive pain, you should speak to your doctor immediately.

Benefits of coming off the pill

The pill remains one of the most effective forms of birth control, however, coming off the pill has some benefits. These include:

Improved mood

The hormones inside the contraceptive pill - oestrogen and progestogen - are quite powerful, and you might find that they impact your mood in a negative way. Whilst not guaranteed, the pill can make some people more irritable, and sometimes worsen existing mood disorders like depression. Because of this, coming off the pill can improve your mood.

Before coming off the pill completely, you should speak to your doctor about alternatives that might impact your mood less severely.

Increased sex drive

Studies and anecdotal evidence show that the contraceptive pill can impact your libido and lower your sex drive. This differs from person to person, and there’s no guarantee your sex drive will be affected by the pill. However, if you’ve noticed a change, coming off the pill will usually restore your libido.

As mentioned above, you can become pregnant immediately after stopping the pill, so if you plan on coming off it to increase your sex drive, you should use other forms of contraception to prevent unwanted pregnancy.

Side effects of coming off the pill

If you choose to come off the pill, you might find that you experience side effects due to withdrawal and changes in your body’s chemistry. These side effects include:

• Headaches
• Weight change
• Acne
• Mood swings
• Missed periods or irregular periods

And of course, you do run the risk of getting pregnant if you're having unprotected sex.

There are many myths about the contraceptive pill. These side effects are normal, but if something doesn’t feel right or you’re struggling, you should speak to your doctor.

What happens when you come off the pill?

The adjustment period

It can take your body some time to get used to not being on the pill. You might notice spotting, heavier periods, cramping or twinges, and a return of any pre-menstrual tension (PMS) you experienced prior to starting the pill. Other changes might include new hair growth, acne, and weight changes. More positive changes can include an increase in libido.

First bleed after coming off the pill

Known as the ‘withdrawal bleed’, your first period after coming off the pill is usually irregular, or heavier than you’re used to. This is normal. Withdrawal bleeds usually occur within two to four weeks of stopping the pill, and your second period will likely be your first natural period after coming off the pill.

If you’re worried about your period after stopping the pill, you should talk to your doctor.

How to come off the pill safely?

There’s no wrong way to come off the pill, and it’s perfectly safe to go ‘cold turkey’. There is no need to ‘wean’ yourself off the pill as you might with other medications. After you stop taking the pill, your menstrual cycle will take some time to readjust, leading to an irregular cycle for a few months.

While there’s no medical reason to stop your pill at a specific time, finishing your current pack means you have a better idea of when your period is likely to happen. If being able to better predict your period is important to you, then you should stop at the end of your current pack.

It may be helpful for you to seek the advice of your GP before stopping your pill so you know exactly what to expect.

What happens if you get no period after coming off the pill?

If your period doesn’t return within a few months of stopping the pill, you may have a condition called post-pill amenorrhea. As the pill prevents you from creating the hormones involved in menstruation, it can take some time for your body to start production again.

Your period should return within three months, however, if it doesn’t you should speak to your doctor. You should also take a pregnancy test to ensure you’re not pregnant.

Other contraceptive methods if you come off the pill

If you are coming off the pill due to side effects, but do not want to get pregnant, there are a few other methods of birth control you can consider.

Hormonal methods of contraception

• The implant

  One of the most commonly prescribed alternatives to the contraceptive pill, the implant is a small plastic rod that is inserted under the skin of your upper arm by a doctor or nurse. You might have also heard it being called Nexplanon. It works by releasing the hormone progestogen into your bloodstream to prevent pregnancy and lasts for around three years.

  Your periods may stop completely after getting the implant, but this is normal. The implant can be removed immediately if you experience any problems, and your fertility will return to normal straight away.

• Intrauterine system (IUS)

  Similar to the implant, an IUS is a small plastic device that is implanted into the womb, designed to release progestogen to stop you from getting pregnant. The IUS can be uncomfortable initially but is thought to be 99% effective when inserted correctly. It can be removed at any time by a trained doctor or nurse.

  As with the implant, the IUS can cause your periods to slow down or stop altogether, but it is a good option for those who cannot tolerate oestrogen or forget to take their pill regularly.

• Contraceptive injection

  Given every eight weeks or every 12 weeks depending on the type, the contraceptive injection works similarly to the pill. The injection contains progestogen, making it ideal for people who cannot use contraception with oestrogen.

  It can also be good for those who struggle to remember to take their pill, however, you must keep up with the injections for it to remain effective.

• Progestogen-only pill

  Another good option for people who cannot take oestrogen-based contraceptives. Progestogen-only pills are thought to be around 99% effective when taken every day, but only around 91% effective in typical use.

• Contraceptive patch

  The contraceptive patch works the same way as the pill, containing oestrogen and progestogen to prevent pregnancy. Benefits of the patch over the pill include not needing to remember to take a pill every day, and the fact that it remains effective if you experience vomiting or diarrhoea, which can impact the effectiveness of the pill.

  The patch isn’t usually recommended for those who smoke and are 35+, or who weigh over 14 stone (90kg), and must be replaced every week to be effective.

• Vaginal ring

  Popularly known as the NuvaRing, the vaginal ring is placed into the vagina, where it steadily releases oestrogen and progestogen into the bloodstream, preventing pregnancy in a similar way to the pill.

  The ring is generally kept in place for 21 days, and then removed and replaced after seven days, similar to how you use the pill. You can continue to have sex whilst the ring is in place, and it’s thought to be around 99% effective if replaced regularly.

  Remember, no method of hormonal contraception - whether it’s the pill or the implant - can stop you from contracting a sexually transmitted infection (STIs). You should use condoms if you are concerned about STIs or when with a new partner.

Non-hormonal methods of contraception

• Intrauterine device (IUD)

  IUDs are small copper and plastic coils implanted into the womb which release copper rather than hormones to prevent you from getting pregnant. Copper changes your cervical mucus, which in turn makes it harder for sperm to survive in your womb. Copper can also prevent a fertilised egg from implanting itself.

  Your periods may be slightly heavier after getting an IUD, but once implanted it can remain in place for up to 10 years, and is thought to be around 99% effective at preventing pregnancy.

• Single use contraceptives

  If you do not want a long-term hormonal or copper contraceptive, you can instead opt for single-use contraceptives such as male or female condoms or diaphragms. These are less effective than the pill, and require you to remember to use them each and every time you have sex.

  When used properly, condoms are thought to be around 98% effective, whereas female condoms are thought to be around 95% effective. You can use spermicide to increase the effectiveness of these methods.

  Diaphragms, meanwhile, should only ever be used with spermicide, and are thought to be around 92-96% effective when used properly.

• Sterilisation

  This is a permanent solution which involves surgery to block off or seal the fallopian tubes and prevent pregnancy. This usually involves using metal or plastic clips or rings to prevent eggs from travelling down the fallopian tubes. The tube might also be cut or tied.

  Although it is technically reversible, sterilisation is described as a permanent solution as it is very difficult to reverse fully, and should only be considered by people who are absolutely certain it’s the right course of action for them. You’re more likely to be accepted if you’re over 30 and have already had children.

  Your doctor might also recommend trying a different method of contraception or even counselling before you make your decision.

Conclusion

The contraceptive pill is one of the safest and most effective forms of contraception. It allows you to reliably avoid unwanted pregnancy with very little fuss.

However, the pill isn’t for everyone, and other options - both hormonal and non-hormonal - are available. To find the best option for you, you should talk to a GP.

References

https://pubmed.ncbi.nlm.nih.gov/16913282/
https://www.sexualwellbeing.ie/sexual-health/contraception/your-choices/the-implant/the-implant-or-the-bar.html
https://www.sexualwellbeing.ie/sexual-health/contraception/your-choices/intraurine-system-ius-/intrauterine-system-ius-.html