No, you don’t need to “take a break” from the Pill.
Let’s be real: birth control is awesome, whether you opt for condoms, an intra-uterine device (IUD), an implant, a shot, the Pill, or something else. Being able to control your reproductive future and if, when, or how you get pregnant is kind of a big deal. But birth control also attracts misconceptions, particularly when it comes to fertility. If you’ve ever heard that being on hormonal contraception will decrease your ability to have a baby later, or that the Pill causes you to have blood clots when you get pregnant, you’re hearing a birth control fertility myth.
Some of these myths are based on outdated information, others on fears that aren’t founded in science. There are many out there, from worries about IUDs causing ectopic pregnancy after they’re taken out (they don’t) to the idea that the morning after pill only works if it’s taken on the morning after (actually, some pills work for up to five days afterward — though you should still take it ASAP). If you have concerns about how your birth control method might affect your health and your ability to conceive in the future, always talk to your OB-GYN.
Here are six myths about birth control and fertility that doctors want to be debunked once and for all.
Your older sister might be a fanatic about "not having excess hormones" in her system, but you actually don’t need time off from your hormonal birth control.
“It is not true that people need to ‘take a break’ from hormonal birth control,” Dr. Jonathan Schaffir M.D., OB/GYN at Wexner Medical Center at Ohio State University, says. Birth control hormones don’t "build up" in your body. “Birth control such as the pill, the ring, the patch, and the shot are all very safe for long term use, and may be used for as long as a woman wants to avoid pregnancy.” He says there is no benefit in taking a break as long as your health continues to be fine and your OB-GYN hasn’t recommended it — but there is a risk of unintentionally getting pregnant.
“It is also a myth that the pill reduces fertility,” Dr. Schaffir says. “Once hormonal contraception is discontinued, fertility quickly returns to just what it would have been without the medication.” Same goes for a copper (non-hormonal) IUD. Even if you’re on a hormonal method of contraception for years, it won’t affect your fertility if you stop. A large analysis published in Contraception & Reproductive Medicine in 2018 pooled studies involving over 14,000 women who stopped using contraception, both hormonal and non-hormonal. "Contraceptive use, regardless of its duration and type, does not have a negative effect on the ability of women to conceive following termination of use, and it doesn’t significantly delay fertility," the study said.
A Danish study published in 2013 in Human Reproduction found that, no matter how long you’ve been on the Pill, aside from a "transient delay" after you stop taking it, your fertility has no problem returning to how it would have been without the Pill. After stopping hormonal contraception, you should expect to start ovulating within the next three or four months. Once you stop the Pill, you can ovulate by your next cycle.
The one exception to this rule, Dr. Schaffir says, is the Depo-Provera shot, a hormonal shot used for birth control by injecting it every 12 weeks. “It may take nine months for fertility to return to normal after the last shot,” he says.
The hormonal pill can increase your risk of blood clots, but it’s not that big a deal unless you have a history of them or are classified as high-risk of clotting, Dr. Sherry Ross M.D., an OB-GYN and author of she-ology, tells Bustle. You may have heard that blood clotting disorders are associated with more frequent miscarriages — which is true — and freak out that your Pill use might create problems with pregnancy in the future, but that’s not the reality.
“The hormones in the pill can make your blood thicker than usual causing hyper-coagulation,” she says. Estrogen is the culprit behind the hyper-coagulation in the combined pill, which is why other hormonal birth control methods without estrogen, like hormonal IUDs and progestin-only pills, don’t carry the same risk.
It doesn’t have a long-term effect on your fertility, but if you have any history of blood clots, combined pills aren’t for you.
Sorry, you absolutely can. “While it’s hard to get pregnant during your period, there are many people who use their period as a form of contraception,” Dr. Ross says. People with shorter intervals between their periods — for example, 21 days — can getting pregnant at the very end of their periods, between days five and seven, because they’ll begin to ovulate earlier in the month.
“Even though the risk is small, pregnancy can happen since sperm can live for three days,” Dr. Ross says. End-of-period sex, if you’re not using any other methods of birth control, can lead to pregnancy.
The exception to this is if you’re having a withdrawal bleed while on the Pill. Many pills come with 21 active pills and 7 inactive or sugar pills, to simulate a period. It’s not a true period, though, and the pill’s hormones continue to suppress ovulation. No pregnancy for you. (You can also skip the withdrawal bleed entirely with no side effects, if you like.)
This isn’t true, Dr. Schaffir says. “Hormonal contraception that suppresses periods (such as the shot, the continuous pill or the IUD) do so by preventing the lining of the uterus from growing and bleeding,” he says. “There is no blood being ‘stopped up’ and there are no unhealthy humors that have to come out. They simply prevent the bleeding from occurring in the first place.” In fact, he says, this can be a huge plus for people who get really intense or painful periods.
This is an old myth that dates back to the 1970s, and has no truth to it, Dr. Ross says. IUDs are much more popular in Europe than in the U.S., she explains — up to 20% of European women use IUDs, as opposed to up to 10% of Americans, according to the CDC. “The IUD got a bad rap as a result of the Dalkon Shield used in the 70’s, that lead to many women getting severe pelvic infections and infertility," says Dr. Ross. The Dalkon Shield was very poorly designed, with a string that could bring infections up into the reproductive system. That meant people were afraid to get them if they hadn’t had kids yet.
This isn’t the case any more. “In a recent Committee Opinion on adolescents and Long Acting Reversible Contraception (LARC’s), the American College of Obstetricians and Gynecologists (ACOG) recommends the IUD as a "first-line" option for all women of reproductive age,” Dr. Ross says. If you have a uterus, it could be a good choice for you — and it doesn’t matter if you’ve had a child or not, she says.
The one reason your doctor might advise against them these days? They may be slightly more painful to insert if you haven’t given birth.
Dr. Sherry Ross M.D.
Dr. Jonathan Schaffir M.D.
Hatch, E. E., Hahn, K. A., Mikkelsen, E. M., Riis, A. H., Sorensen, H. T., Rothman, K. J., & Wise, L. A. (2015). Pre-gravid oral contraceptive use in relation to birth weight: a prospective cohort study. European journal of epidemiology, 30(11), 1199–1208. https://doi.org/10.1007/s10654-015-0053-2
Girum, T., & Wasie, A. (2018). Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and reproductive medicine, 3, 9. https://doi.org/10.1186/s40834-018-0064-y
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