15 Mar When To Stop The Oral Contraceptive Pill For Conception
It is important to understand the hormonal changes of the menstrual cycle, in order to see the effects of how the pill changes this.
Understanding the menstrual cycle
The normal cycle consists of several distinct phases that average approximately 28 days in total (but may be shorter or longer).
Each phase corresponds to physical changes that occur to “build up” and “break down” the uterus in preparation for pregnancy, with ovulation ideally occurring at the midpoint of the cycle.
These phases are associated with dramatic changes in the levels of certain hormones that follow steps in promoting ovulation and (in the absence of fertilization) menstruation.
The shedding of the uterine lining leading to the observed bleeding is the Menstrual Phase.
As bleeding ends, Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) show small peaks above their normal low levels, leading to thickening of the uterine lining and maturing of the oocyte (egg) containing follicles in the ovary.
At the same time, oestrogen (Oestradiol) is steadily rising to a peak a few days before ovulation, after which point FSH and LH spike once more, triggering the release of a mature oocyte.
Levels of progesterone and oestrogen rise for the next two weeks, preparing the uterine lining for the implantation of an embryo.
If no implantation occurs, both hormone levels drop sharply, triggering menstruation.
If fertilization and implantation do occur, levels of progesterone and oestradiol remain high throughout pregnancy, suppressing the spikes of FSH and LH that drive ovulation.
The standard combined oral contraceptive pill consists of both hormones, synthetic progesterone and oestrogen taken daily for three weeks, followed by a week of no pills (or placebo pills) that trigger what’s known as “breakthrough bleeding”, induced by the drop in hormones.
The outward appearance is the same as a “normal period” (menstrual bleeding in week 1 of a 28-day cycle) the constant high levels of progesterone and oestrogen for a woman taking the pill actually abolish the normal hormonal cycling that underlies ovulation.
The Pill, therefore, replaces the normal menstrual cycle with an artificial cycle (3 weeks of “mimicking pregnancy”, followed by 1 week with breakthrough bleeding).
Many women still wonder if it is safe to eliminate menstruation using oral contraceptives.
Masking other health conditions
It is important to establish the reasons for starting the pill, if you had regular periods, and no significant symptoms of PMS and you are using it as contraception then it may be good in the shorter term.
However many people are prescribed the pill by their GP for symptoms like irregular, absent, or abnormal periods and say it will “regulate” your period. This does not address the root cause of the issue.
While hormonal birth control can give you a predictable withdrawal bleed, this isn’t a natural cycle-driven period and it’s not fixing what’s causing your period problems.
The underlying cause of these symptoms may very well be due to polycystic ovarian syndrome (PCOS), hypothalamic amenorrhea, thyroid disease, or other medical conditions that can lead to difficulty conceiving.
This means that if you are on the pill for symptom management then you may find it difficult to get pregnant when you stop. This doesn’t mean that it causes fertility struggles (although it does deplete many essential vitamins and minerals for preconception care). But it may prolong the time it will take women to address their health problems, delaying the time and resulting in stress and frustration when they do eventually decide they want to get pregnant.
Even women with a history of regular periods have reported missing periods within the first six months of discontinuing the pill, a term which is termed post-pill amenorrhea
How the pill may be affecting fertility
1. Depleting antioxidants.
Almost 20% of women seeking treatment for fertility struggles show signs of advanced ovarian ageing. Antioxidants protect our cells from free radicals and are crucial in ovarian health. The pill is associated with the depletion of antioxidants like CoQ10, vitamin E, vitamin C, and selenium.
Several small studies have shown that women using the pill have lower levels of CoQ10, which can affect fertility. One study concluded that suboptimal CoQ10 levels can cause fertility problems due to the decrease in mitochondrial function (the engine house of the cell) which in turn leads to age-associated egg deficits. As we age, the production of CoQ10 in the body declines and is one factor in the decrease in mitochondrial function in the ovaries. This means that the OCP and the natural ageing process can reduce your fertility.
If you’re over 35, are a past or current smoker, have a family history of early menopause, or any condition that increases oxidative stress, then hormonal birth control is one more factor that could contribute to these issues by way of lowering antioxidant protection.
2. Thinning the uterine lining.
The use of hormonal birth control for five years or more has been associated with thinner endometrial (uterine) lining in women undergoing fertility treatments, which could make it more difficult to have healthy implantation and healthy pregnancy.
More research is needed in this area, but the same mechanism that provides protection against endometrial cancer while on birth control may be the cause of this observed phenomenon.
This study was with women who were already undergoing fertility treatments, so there may be additional factors involved
3. Making it harder to find a “compatible” mate.
Several studies have shown that women on hormonal birth control select for mates with genes more similar to their own—in other words, they potentially select a partner that isn’t the most compatible for baby-making, which may contribute to difficulty conceiving when coming off of the pill. We don’t know if this affects fertility definitively due to the lack of research, but it’s worth mentioning.
4. Unearth the root cause.
If you started hormonal birth control for symptoms such as heavy periods, irregular periods, painful periods, intense PMS symptoms, or acne, now is the time to work with your Naturopath to figure out why you had those symptoms and start addressing the underlying cause.
Stopping Birth control for Conception
There have been studies showing no significant difference in the amount of time it takes to conceive after coming off the pill compared to other birth control methods, but then there have been other studies showing a delay in the return of ovulation and regular menstrual cycles.
I advise coming off of birth control a minimum of 4 months before trying to conceive, with one year being the ideal. This allows time for you to address potential issues masked by birth control, rebuild your nutrient stores, and prepare your body for pregnancy.
Whether you’re still taking it or have recently stopped—you can begin to implement strategies to improve your fertility now. It takes 90 days for the egg you ovulate to mature, so what you do today can help your eggs in future cycles.
Begin a quality prenatal vitamin.
While on birth control, nutrients such as folate, B12, B6, zinc, magnesium, and others are depleted. These are all important for fertility, a healthy pregnancy, and a developing baby.
My advice is to those who are contemplating getting pregnant at any point in the future to take a prenatal while using hormonal birth control. Be sure to avoid prenatal with food dyes, hydrogenated fats, and other fillers. There are many retail products that have poor nutrient profiles and poorly absorbable forms of nutrients so get qualified advice.
Consider a CoQ10 supplement.
Animal studies have shown delayed ovarian reserve depletion when supplementing with CoQ10. We know birth control depletes CoQ10, and this directly affects mitochondrial health. Supplementing with CoQ10 may support better egg quality and pregnancy outcomes.
Nourish your ovaries.
Load up on more nutrient-dense leafy greens, which are an excellent source of folate, and antioxidant-rich foods like berries, artichokes, and nuts. Healthy fats from avocados and cold-water fish can boost egg health and help keep your ovaries young, too, make as many of these foods as you can organic since many pesticides are hormone disrupters that may negatively affect fertility
Sleep well.
Melatonin is not only a sleep hormone but a key antioxidant in protecting your ovaries. Exposure to light at night (especially shortwave blue light from our tech devices) decreases melatonin production, so turning in at a reasonable hour is recommended.
If you’re a smoker, get some help to quit.
Smoking increases your risk of stroke while on the pill, but it also compromises your fertility. Years of data have shown that smoking can make it difficult to become pregnant and lead to early menopause.
Resources:
https://pubmed.ncbi.nlm.nih.gov/7252445/ tipshttps://pubmed.ncbi.nlm.nih.gov/23852908
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929620/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568976/
https://doi.org/10.1098/rspb.2008.0825
https://pubmed.ncbi.nlm.nih.gov/12396560/
