Coming off the pill: cycle and hormone recovery

You have come off the pill and are waiting for your first real period, but for weeks nothing happens. For many women that is a confusing moment: is this normal, or is something wrong? In most cases your body simply needs a little time to take back the lead.

I always say it honestly: the pill does not "hide" a fertility problem, but it can lie over one for a few months. Only when your own cycle is running again do you see what it really looks like.

The pill suppresses your own ovulation. After stopping, the interplay between your brain and ovaries has to get going again. In most women the cycle recovers within three months, but variation is normal.

What can you expect month by month?

Below is a rough picture of what many women experience. Your pace may differ, and that in itself is no cause for concern.

Complaints that the pill suppressed, such as acne or an irregular cycle, can return. That does not mean the pill caused them: it masked them.

Why does your period sometimes stay away?

If your period stays away for more than a few months after stopping, this is sometimes called "post-pill amenorrhoea". Often this is temporary and recovers on its own. Sometimes an underlying cause surfaces that the pill hid, such as PCOS, a thyroid problem or a raised prolactin. According to NHG and Thuisarts, further testing is reasonable if your period is still absent after six months, or sooner with an active wish to conceive.

What can you do yourself during recovery?

You cannot speed up recovery with a trick, but you can give your body a calm foundation. Many women notice that a regular daily and sleep rhythm, enough exercise and a varied diet help the transition go more smoothly. The Voedingscentrum (Netherlands Nutrition Centre) emphasises that a varied diet forms the basis, also when you have just come off the pill.

Do you wish to conceive? Then start folic acid before pregnancy, as the Gezondheidsraad (Health Council) advises, and do not wait until your cycle is regular again. The one has nothing to do with the other: your fertility can already be back while your cycle still looks somewhat irregular. During that period, track when your bleeds come, so that together with a doctor you can recognise a pattern.

When is a hormone check worthwhile?

A blood test can reassure you or give you a direction. It is mainly worthwhile if:

• your period is still not back after six months;
• you wish to conceive and want to know whether you are ovulating again;
• complaints such as acne, excess hair growth or fatigue return strongly.

The Hormones Women panel maps, among others, oestradiol, FSH, LH, prolactin and your TSH. If you have an active wish to conceive, the Fertility assessment suits that well. Every result is assessed by a BIG-registered doctor.

Want to know which test suits your question? Then read our pillar on hormone testing in women.

Frequently asked questions

How long until my cycle is normal after the pill?

In most women the cycle recovers within three months, but it can take longer. If your period is still absent after six months, discuss this with your GP.

Can I get pregnant right after the pill?

Yes, pregnancy is possible as soon as you ovulate again, sometimes already in the first cycle after stopping. So you do not have to wait months first.

Will my old complaints return after the pill?

Complaints the pill suppressed can return, because the pill masked them rather than resolved them. A hormone check can help bring an underlying cause into view.

References

1. NHG. NHG-Standaard Anticonceptie. Dutch College of General Practitioners. Available via richtlijnen.nhg.org.
2. Thuisarts.nl. I want to stop taking the pill. Dutch College of General Practitioners. Available via thuisarts.nl.
3. NHG. NHG-Standaard Subfertiliteit. Dutch College of General Practitioners. Available via richtlijnen.nhg.org.

Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.