What to expect when coming off the pill, and five things to do before you do

"The pill" (the combined oral contraceptive pill) has been giving Australian women control over their reproductive health since the 1960s and remains the most commonly used method of contraception by Australian women.

Its use peaks with around 60% of Australian women in their late teens and early 20s using the pill, and drops to around 35% by the mid to late 20s.

Used perfectly, the pill prevents pregnancy 99.5% of the time, but in the real world where pills are occasionally forgotten it works 93% of the time.

In Australia, half of the women who start on the pill won't be taking it six months later. Women come off the pill for lots of different reasons, including:

• trying to get pregnant
• trying a different contraceptive option
• side effects (including headaches, bloating, weight gain, not having a regular period, unpredictable nuisance or "breakthrough" bleeding, nausea, depression, reduced libido)
• developing a medical condition where the pill is no longer safe (the most common of these is migraine or deep vein thrombosis, or smoking over the age of 35)
• no longer needing contraception
• wanting to know what their natural cycle and periods are like.

If you're preparing to come off the pill, it's hard to know what to expect—particularly if you've been on it for a long time.

What may happen when you come off the pill

Regardless of how long you've been taking the pill, the synthetic hormones are cleared from the body within days. Your body returns to releasing different amounts of estrogen and progesterone throughout the cycle—although what's "normal" for your body may have changed.

Teenagers can have irregular periods for the first few years before a more regular rhythm establishes. A lot might have changed since you first went on the pill—your body could have developed a medical condition, have a different lifestyle, changed size or shape, or had children. This can all impact how natural hormones in your body can impact you.

Here are some of the changes you might expect when coming off the pill.

Periods!

For many women, periods come back within a month of stopping the pill, with almost all women getting their period within three months. Your periods may start off irregular, but generally return to the natural menstrual cycle within three months. Women on the pill often have quite light periods, so coming off the pill you might experience heavier or longer periods. The natural cycle can also be impacted by exercise, diet, stress and underlying medical conditions. It's a good idea to see a doctor if you haven't got your period back within three months.

Fertility

Women can expect their fertility to return to their baseline "natural" level around three cycles after coming off the pill. That being said, you can definitely get pregnant as soon as you come off the pill. Being on the pill does not impact long-term fertility, even if it was taken for many years, so there's no medical need to take a "break" from the pill to "normalize" things for the body.

Underlying medical issues

For some women, coming off the pill can reveal problems the pill has been masking. For women with endometriosis, the pill commonly reduces their symptoms of painful periods, cramping, heavy bleeding and painful sex—and suppresses growth of the endometrial tissue in areas other than inside the uterus, where it belongs. Coming off the pill can cause a ramping up in period and pelvic pain. For women with a history of polycystic ovarian syndrome, periods are likely to return to being irregular once coming off the pill.

Acne

For women who experience hormonally driven acne (commonly seen around the jawline and which fluctuates with the period cycle), acne can flare after coming off the pill. Getting older or lifestyle changes can impact this though, so it's not a given acne will return.

Mental health

There is growing evidence the hormones in the pill can bring on or worsen depression for some women, and is one of the most common reasons for stopping the pill. However, for women who experience depressive symptoms in the week leading up to their period (a condition known as premenstrual dysphoric disorder) taking the pill stabilizes the mood and works as an antidepressant. It goes without saying then that women coming off the pill can see changes to their mood or anxiety levels, and it's good to keep your mental health care provider in the loop.

Five things to do before coming off the pill

• talk to your GP or other health professionals beforehand, particularly if you have had heavy periods, painful periods or other issues in the past. If you're not happy with your particular type of pill, know there are other options for contraception including other contraceptive pills which may not cause the same side effects
• have a plan for alternative contraception if you're likely to be at risk of pregnancy and want to avoid it. If you have a regular partner, you might wish to have a conversation with them and discuss other options
• consider monitoring and writing down your cycle and symptoms (heaviness and painfulness of periods, mood and anxiety) for 2–3 months before coming off the pill and afterwards. This can help you and your doctor recognize if coming off the pill uncovers some unexpected issues. Seek medical advice early if you are having heavy or painful periods
• try to choose a time when life isn't too stressful or chaotic, if possible. This will help you to work out if your symptoms are related to hormones, life in general—or both!
• if you're coming off the pill to prepare to conceive, it's a good opportunity to book in for a prenatal check up. This can include talking about preparing yourself physically and mentally, supplements, and doing some blood tests to check for immunity against some viruses.