Support Fertility after the use of Hormonal Birth Control

How cycles and associated fertility will re-emerge after the discontinuation of hormonal birth control is dependent on each woman’s personal health story. I recommend giving the body at least 3 months to return to a state of homeostasis post-birth control before trying to conceive. This is also a great timeline because the egg takes about 3 months to fully mature before it is chosen for ovulation. The healthier the egg, the healthier the pregnancy and the healthier future baby will be!

How birth control affects the body:

Before discussing how to support the body after coming off birth control it is important to understand how hormonal birth control affects natural female hormones.

Combined oral contraceptives and the ring: The most prescribed hormonal birth control contains synthetic hormones that mimic the effects of estrogen and progesterone in the body. Continued exposure to this shuts down the Hypothalamic-Pituitary-Ovarian (HPO) Axis, which is a bidirectional communication system that controls the rhythm of each cycle and ovulation. With the introduction of exogenous (aka outside) hormones, this communication system essentially goes on “do not disturb”. This is why on the pill or ring, you do not ovulate (if used correctly). Upon discontinuation of this form of birth control, this system slowly comes back online. The length of time it takes varies from woman to woman, but majority of women (about 80%) return to normal cycles within 3 months.

Other types of hormonal birth control, such as the progestin-only pill, implant, and hormonal IUD work by preventing pregnancy in more physical ways like keeping the uterine lining too thin for implantation to occur, and by thickening the cervical mucus plug to prevent sperm from reaching the uterus. They do not have as strong of an impact on the HPO axis in all women, but do in some; some women will still ovulate while on these types of birth control and some will not, but pregnancy is prevented due to the physical effects of this type of birth control on the body.

It should be noted that outside of contraception, a lot of women are put on hormonal birth control because of underlying symptoms or conditions, like PCOS, endometriosis, irregular cycles, heavy bleeding, and hormonal acne. When they go off birth control these symptoms often return, and not everyone has an easy transition back into a natural cycle. This is because birth control does not fix these symptoms, just quiets them.

If after 3 months off birth control, your cycles are still irregular or you have symptoms that may indicate an underlying hormonal imbalance, seeking out the care of a provider is recommended.

Now that we have a foundation of how birth control affects the body, let’s cover 3 main ways we can support our cycles and fertility holistically once we are off hormonal birth control.

1: Gently support detox organs

One of the goals after coming off hormonal birth control is gently helping the body clear any excess hormones.

I use the word gently, because in the 3-6 months before becoming pregnant, heavy detox protocols are avoided. This is because toxins are generally tucked away into storage in the body, which is protective, and the last thing we want to do before becoming pregnant is mobilize any toxins out of storage where they could be passed on to baby. If you have more time (6 months +), you can work with a provider on detox protocols if indicated for you.

The main 2 organs that are supporting detoxication of excess hormones are the liver and the gastrointestinal system:

• I like to implement a food as medicine approach to supporting the liver, which includes eating lots of dark leafy greens, cruciferous vegetables, herbs and spices, such as turmeric, ginger, rosemary, beets, berries, and dandelion root tea.

• For the GI tract, the focus is supporting regular bowel movements because one of the phases of hormone detox is through bowel movements. To keep things healthy and regular, include fiber and fermented foods in the diet.

  • Fiber (think plant foods- whole fruits and veggies, nuts and seeds, whole grains, legumes)- the goal is 25 grams per day for women!

  • Fermented foods such as kimchi, sauerkraut, pickled veggies, yogurt, kefir, and cultured cottage cheese supports the growth of good bacteria in the gut, positively impacting the microbiome and fertility outcomes.

If you have any abnormal GI symptoms, this is a good time to seek out care from an integrative provider, as the gut microbiome of mama is shared with baby.

2: Increase nourishment

Unfortunately, oral hormonal birth control decreases levels of essential nutrients in the body such as B vitamins (including folate, which is essential for healthy brain and neural tube development in the future baby), vitamin C, zinc, vitamin E, magnesium, and selenium.

I recommend lab testing prior to pregnancy to help establish a baseline of health. Ideally, your provider will be checking in on nutrient levels with these labs so deficiencies can be addressed prior to conception.

3: Get in tune with your cycles

If you were not already in tune with your cycles before starting birth control, now is a great time to start. There are excellent books written on the topic of cycle tracking, and great resources such as integrative providers and fertility awareness coaches and educators. Getting in tune with your cycle details can help determine whether you are having healthy, ovulatory cycles each month or not. There are also many types of wearables and fertility tech that helps you track signs of ovulation, such as the Oura ring and thermometers like the Temp Drop.

Book recommendations:

• Taking Charge of Your Fertility by Toni Weschler

• The Fifth Vital Sign by Lisa Hendrickson-Jack

Quick summary:

• Birth control containing hormones can impact your own hormone communication system and for 80% of women, it will take about 3 months for this communication system to come back online after you discontinue.

• You can support your body’s natural cycle and hormone communication system with nourishment and gentle detoxification. (Think fiber, colorful fruits and veggies, dark leafy greens, cruciferous veggies, fermented foods, and make sure you are pooping daily!)

• Learning about your own signs of fertility is the ultimate way to know if you have healthy regular cycles, which can clue you in to if you need extra support form a provider sooner than later based on your family planning goals.