How Long Is Too Long to Be on Birth Control?

Millions rely on hormonal birth control: to clear up acne, lessen cramps, and of course, provide peace of mind when it comes to preventing pregnancy.

Whether you choose a vaginal ring, patch, intrauterine device (IUD), implant, injection, or birth control pills, you might wonder what the hormones in these methods are doing to your fertility long-term. If you want to have a baby and stop taking birth control, will you be able to?

Does Birth Control Cause Long-term Effects on Fertility?

Being on hormonal contraception has no long-term effect on female fertility. However, it might complicate conception for other reasons.

“With most birth control [methods], as soon as you stop them, you will probably resume ovulation immediately or within the few weeks,” said Nichole Mahnert, MD, ob-gyn and assistant professor of obstetrics and gynecology at the University of Arizona, Phoenix. “You almost immediately return back to your normal hormonal levels.”

A 2017 study conducted with 50,203 women using oral contraceptives in the United States and seven European countries women backs this up. Of the group of women who stopped contraceptive use with the intention of becoming pregnant, 89% conceived within two years.

A review of numerous studies published in Contraception and Reproductive Medicine looked at 22 studies and a total of 14,884 women who discontinued contraception. The analysis found that the rate of pregnancy was 83.1% within the first 12 months of contraceptive discontinuation, regardless of the type of contraceptive. The researchers concluded that contraceptive use, regardless of its duration and type, does not have a negative effect on the ability of women to conceive after discontinuing the contraceptive and doesn't significantly delay fertility.

One Danish study of 3727 participants found that 51% achieved a pregnancy within six cycles after discontinuing oral contraceptives.

What Affects the Time to Conceive?

Why will it take just a month off of hormonal contraception for some to conceive, while for others, it takes up to a year or longer?

Age

One explanation has to do with the age at which you decide it's time to toss your pill pack. “The longer we take birth control and we delay childbearing, the older we get, and as a result of that, our eggs get older, and it can become more difficult to get pregnant,” said Dr. Mahnert.

Endometrial Lining

Another potential complication concerns the endometrial lining. Progesterone in hormonal contraceptives limits the growth of the uterine lining. One of the benefits of this is a lighter period, but a drawback appears to be a delay in conception.

Debra Wickman, MD, ob-gyn, and director of female sexual medicine, menopause, and vulvar health at Banner University Medical Center in Arizona, explained that, when you’re on the pill, the thin lining makes your uterus an unfavorable environment for an embryo. Go off contraception, however, and it might take some time for the lining to return to the thickness needed for an embryo to implant.

A study published in Obstetrics and Gynecology found that long-term use of oral contraceptive pills (five years or more) can potentially affect optimal endometrial growth. These women were significantly more likely to have thinner endometrial linings.

Different Contraceptive Methods

The time it takes to conceive also depends on the type of hormonal contraceptive you were using.

A cohort study of nearly 18,000 women found that users of injectable contraceptives had the longest delay in the return of normal fertility (five to eight menstrual cycles), followed by users of patch contraceptives (four cycles), users of oral and ring contraceptives (three cycles), and users of hormonal and copper intrauterine devices and implant contraceptives (two cycles).

Individual Differences

Still, remember that every person is different, and some might have an endometrial lining that returns to normal immediately or within a few months, noted Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine. But for others, it could take longer.

“Some people do get erratic cycling the first couple of cycles off the pill,” said Dr. Minkin, which is why she tells patients to wait two to three months before trying to get pregnant. By waiting, you’re giving your body time to readjust and start cycling regularly.

Is There a Time Limit for Being on Birth Control?

Would a time limit for being on birth control help you avoid any possible pregnancy setbacks? No. “You can’t say there’s a set amount of months or years that’s too long, but women just need to be tapped into their own experience,” said Dr. Wickman, meaning that whether you're on the pill or not, speak to a healthcare provider if you notice any puzzling changes in your cycle.

Your fertility should return to normal once you go off of your contraception. If you're trying to get pregnant, but it doesn't happen, don't panic. “You can have a post-pill disruption of your natural ovulatory cycle; that’s not uncommon. But for most women, that is going to reverse, and once you’re ovulating normally, the pill should have no long-term effect on fertility,” said Jennifer Wider, MD, women’s health specialist.

To coax your body into ovulating normally, Dr. Wider suggested avoiding stress. Worrying about not being able to conceive immediately after stopping the pill can lead to a vicious stress cycle, explained Dr. Wider. If all else seems normal, try to sit back and let your body do its job.

A Quick Review

Hormonal methods of birth control are convenient and effective in helping many people avoid pregnancy but can birth control harm your fertility?

While there is no impact on future fertility, the time it takes to conceive may be delayed based on the method of contraceptive you chose, your age, or other factors.