Taking hormonal contraceptives, such as the pill, significantly interferes with the balance of female hormones. Therefore, many women* are concerned that their fertility may be delayed or impaired after stopping the pill. (1) How quickly and in what way the menstrual cycle returns is an important question for women who wish to conceive.

After stopping the pill, the menstrual cycle may take longer than nine months to regenerate, and irregularities and cycle disturbances are common . (2, 3) This is due to the complex interactions of the hormones that regulate the menstrual cycle, the interplay of which is significantly altered by taking the pill. Therefore, it is important to know that the menstrual cycle may remain altered for some time even after stopping the pill. (3)

What exactly happens after stopping the pill?

Five hormones are primarily involved in regulating the female menstrual cycle: gonadotropin-releasing hormone (GbRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, and estrogen. (4) In healthy women* , their concentrations typically fluctuate significantly during the cycle , controlling its regular progression.

First, the pituitary gland signals to the ovaries, via FSH and LH, that an egg should mature. During egg maturation, increased amounts of estrogen are produced, a messenger substance that prepares the female body for a possible pregnancy. At ovulation, the mature egg is released into the fallopian tube and transported to the uterus. The follicle remains in the ovaries, where it transforms into the corpus luteum and produces the hormone progesterone. If the egg is not fertilized and therefore does not implant in the uterine lining, the progesterone concentration drops sharply. This leads to menstruation, and a new cycle begins.

In contrast, when taking the pill, hormone levels are kept largely constant. The pill takes advantage of the effects of the two female sex hormones, progesterone and estrogen, by artificially maintaining high progesterone levels, thus suppressing LH and FSH production and preventing the mid-cycle LH surge. Consequently, ovulation does not occur. (5) Furthermore, a mucus plug is formed in the cervix, making it impermeable to sperm. The buildup of the uterine lining is also significantly reduced. Thus, conception and a potential pregnancy are prevented through several mechanisms.

After stopping the pill, the complex interplay of sex hormones needs to readjust. Many couples are surprised to find that conceiving after stopping the pill is very difficult. On the one hand, taking the pill daily suggests high fertility on virtually every day of the cycle; on the other hand, menstrual irregularities often go unnoticed for years and only become apparent to the couple when they are unable to conceive. The knowledge of the natural cycle can be forgotten while taking the pill. (6)

When trying to conceive, the need for folate (vitamin B9) is increased ( 550 µg/day). "Folic acid" refers to the synthetically produced form of vitamin folate, which can be taken as a dietary supplement. Under the influence of the birth control pill, the folate concentration in a woman's body typically decreases.* Several studies suggest that the use of hormonal contraceptives is associated with impaired levels of various nutrients, including folate, vitamin B6, and vitamin B12 , all of which play an important role in embryonic and fetal development. (5, 7) For example, folic acid deficiency may increase the risk of neural tube defects (open or split spine, also known as spina bifida). (7) It is suggested that the possible mechanisms include poor absorption of folate polyglutamates, increased urinary excretion of folates and accelerated degradation of folates by induction of microsomal enzymes (5).

How quickly can you get pregnant after stopping the pill?

This question cannot be answered in general terms, as every woman's body reacts differently to hormonal changes. However, studies have shown that menstrual irregularities after discontinuing the pill are reversible, and that the use of contraceptives, regardless of type or duration, generally has no long-term effect on fertility. (1)

Statistics from a systematic review of various clinical studies showed that 83% of women became pregnant within the first twelve months after discontinuing oral contraception. (1) Neither the type nor the duration of progesterone or estrogen administered had a significant effect on the return of fertility after discontinuation of contraception. (1)

Another study used cycle monitoring to compare the menstrual cycles of 175 women* after discontinuing the pill with those of 284 women* who had never used oral contraceptives. The recorded cycle parameters allowed for the determination of cycle length and the time of ovulation, among other things. The results showed that after discontinuing the pill, 51% of the women* experienced a normal cycle in their first cycle, with a sufficient luteal phase and normal cycle length. Ten percent of the women* did not ovulate in their first few cycles. (8)

Women who recently stopped taking the pill showed statistically significantly lower values ​​for cervical mucus quality and delayed ovulation in the first two cycles. Menstrual bleeding was also significantly lighter in the first four cycles. Menstrual cycle parameters were altered for at least two cycles after stopping oral contraception, which may contribute to a temporary reduction in fertility. (3)

Couples can benefit from cycle monitoring by closely observing the menstrual cycle after stopping the pill, in order to increase the chances of pregnancy through accurate ovulation prediction. (3, 8)

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