For the past 15 or so years, I’ve been part of the oral-contraceptive club. For almost as long as I can remember, I’ve woken up, walked haphazardly to the bathroom, popped my daily birth control pill, brushed my teeth, and gone on with my day.
Last week, as I was finishing up my current birth control pack, I went to tap “refill” on the drugstore app on my phone, and I had a moment of pause. Some background: I’m a single woman in my early 30s, riding out the new coronavirus pandemic on my own in my small New York City apartment. What’s the point for me to be even on the pill? I wondered.
As someone who uses the birth control pill primarily for pregnancy prevention (in addition to condoms for protection against sexually transmitted infections), I clearly won’t be needing that in my current sheltering-in-place circumstances. If you’re in a similar position, you might be wondering: Is now a good time to take a break from birth control?
So, hold up, does your body ever need a “break” from birth control?
It turns out there is actually no medical reason to give your body a temporary break from the pill, Alyssa Dweck, M.D., a gynecologist in New York City, tells SELF. “For a while there was a myth that women should take a break from birth control and see if everything was still working the ‘right’ way,” says Dr. Dweck. “That’s actually just not necessary.”
To explain why, let’s talk about what happens when you’re on the birth control pill. (FYI: This actually extends to all combined hormonal contraceptives that contain both estrogen and progestin—a synthetic form of progesterone—including the pill, the ring, and the patch.) When you’re taking the pill, your body gets a steady dose of estrogen and progestin to prevent pregnancy. Estrogen suppresses ovulation by inhibiting the secretion of hormones that are responsible for kickstarting a chain of reproductive events. Meanwhile, the progestin makes it more difficult for sperm to travel through the cervix by thickening cervical mucus and also thins the lining of the uterus so that, in the event that an egg does become fertilized, it has a harder time latching on for nourishment.
When you go off of the pill, these effects stop pretty much immediately, says Dr. Dweck, and the hormones are out of your system within a few days. You can read more about what happens to your body when you stop taking the pill, here. But, in general, you don’t need to take a “break” from birth control every once in a while, unless of course you don’t need or want to take it anymore, or if you have a medical reason to stop taking it.
When it comes to other birth control methods, the advice ranges a bit. With implants and IUDs, for example, you do need to be mindful of replacing them at the end of their useful life. But you can often remove and replace an IUD on the same day, with Dr. Dweck adding that there is no harm in using them back-to-back. And then there’s the birth control shot, which is not recommended for use longer than two years, as it can cause you to lose bone density. It can also take longer for your fertility to return after taking the shot than it would with other birth control methods, so this is one method where you actually should be mindful of when you’re starting and stopping it.
If your concern is less about stopping and starting birth control and more about long-term birth control use in general, that’s something to bring up with your doctor. They can help you find a birth control method that makes sense for your situation and your general health, taking into consideration any other risk factors you may have.
But remember: The birth control pill does a lot more than just prevent pregnancy.
My contemplation of whether or not to stop taking birth control while quarantined really came down to knowing I wouldn’t need it for pregnancy prevention. But there are plenty of other reasons people take birth control, and that’s something to keep in mind before you ditch it. Even if you didn’t initially start taking it for these reasons, you may be unintentionally reaping some benefits that you kind of want to stick around (especially while in a pandemic). On the other hand, you may just be curious about what your body feels like without birth control, which is valid too.
For many women, myself included, it’s easy to forget what life was like back when we first started using contraception. Remember hormonal acne and intense cramps? The pill may be the reason you don’t experience those things anymore, and those symptoms could very well return if you decide to ditch it, says Dr. Dweck.
In most cases, when you stop taking birth control pills, your period will go back to whatever it was like before you started. But that’s not necessarily the case, especially if you’ve been on birth control for a long time. Factors like age or health conditions (for example, thyroid abnormalities or disordered eating) can play a part in how your cycle shows up month after month. “We consider menstruation and gynecology to be almost like another vital sign,” says Dr. Dweck. “Oftentimes it’s sort of a window into somebody’s health. If your period is off, it really may suggest that there’s another issue.”
The pill can also control heavy bleeding and make your periods lighter and—thankfully—more regular. It can also help with symptoms of polycystic ovary syndrome (PCOS) and endometriosis pain.
“Women with PCOS oftentimes will present with irregular periods,” Mary Jane Minkin, M.D., clinical professor in the department of obstetrics gynecology and reproductive services at Yale Medical School, tells SELF. “So when these individuals get a period, it’s often heavy since they’re not ovulating on a regular basis. Birth control can help get that under control.”
Many people go on birth control to manage these conditions. Because of this, there isn’t much research on the possibility of developing these conditions while you’re on birth control—then not realizing it until you’re off of it. But it is a possibility. If you experience persistent complications upon going off of the pill, including symptoms of endometriosis, like painful periods, pain with intercourse, or heavy bleeding, Dr. Dweck recommends touching base with a physician.
Birth control can also lower your risk of ovarian cysts and mittelschmerz, both of which could be super uncomfortable to deal with on top of everything going on. If you’re prone to either of these conditions, certainly take that into consideration before going off birth control. In addition, acne is something that’s often managed by birth control, so you might find your skin a little less agreeable when you say goodbye to it.
Here’s what you can expect when stopping birth control.
Heads up: When you come off birth control, your period could be irregular for some time, says Dr. Minkin, adding that it could take one to two cycles—or even a few months—for things to level out. If three months go by and nothing returns, certainly reach out to a physician. Dr. Minkin also advises to give your ob-gyn a call if you have any intense pain. “It’s better to be cautious,” she says.
If all this ~change~ is something that makes you uncomfortable, then now may not be the time for you to give this a try, she advises. As you’re well aware, it’s harder than normal right now to just pop into your doctor’s office for a visit. So, even though it’s super easy to stop taking your birth control pill (you literally just…stop taking it), it’s a good idea to give your doctor a heads up first (ideally through a tele-health appointment at this time) just to get any advice that might be specific to your situation.
“People right now are pretty darn anxious,” Dr. Minkin says. “If you’re somebody who’s very anxious, that anxiety on its own can help give you wacky periods too. So ask yourself, Is this something else I want to be dealing with right now?”
That said, if you decide to stop your birth control pill, Dr. Dweck encourages women to stop at the end of their pill pack so that there is less of a chance for irregular bleeding. Also, keep track of your personal cycle and menstrual habits so that you can check in with your doctor if anything seems off.
“You may feel nauseous, your breasts could hurt, and your bleeding won’t be regular yet, which can feel frustrating,” says Dr. Dweck. “Whether you’re going off of birth control or getting back on, I’d say give the whole process two to three months so that your system can get used to it.”
Aside from unpredictable “funky” periods and the potential for unwanted pregnancy, there isn’t a detriment to stopping and starting birth control over the course of a handful of months, says Dr. Minkin. Dr. Dweck adds that at the end of the day it’s really a personal preference. While some women may love the feeling of being off of their chosen birth control method, others may feel the total opposite. “It’s really based on the individual,” she says. “We all learn over time what’s best for our own bodies.”
As for me, I went into reporting this article thinking I was going to ditch the pill and am coming out of it deciding to stay on. Per Dr. Minkin’s point: I’m anxious enough as it is, and I don’t really want to add possible menstrual cycle changes to the mix. In theory, it sounded good. But in practice, I’m finding some comfort in keeping things business as usual in any way possible in the midst of all of this chaos.
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