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By Veronica Thomas
So you’re thinking about going off the pill. Maybe you've been feeling depressed, getting headaches, or keep forgetting to pop the tiny tablet. Perhaps you’ve been experiencing some really strange stuff that didn’t happen before you started the pill—like inflamed, bleeding gums or cringing at another person’s touch.
Both personal anecdotes and research studies have linked these and other side effects, such as breast tenderness and nausea, to the pill. (One study suggested it might even make you pick the "wrong" partner by altering your chemical attraction to a man's scent.)
Most randomized control trials haven't actually found any real difference in the frequency of side effects among women taking the pill versus those taking a placebo.
"It's an interesting phenomenon," says Dr. Alisa Goldberg, director of clinical research and training at the Planned Parenthood League of Massachusetts. "Clearly some women are sensitive to the pill and experience these things, but when you try to study it scientifically on a population basis, there's really no difference."
Still, while four out of five American women have used the pill at some point, 30 percent have discontinued its use due to dissatisfaction—most commonly because of its side effects. The latest federal statistics on contraception use are due this fall, and experts expect trends from recent years to continue: IUD use will continue to rise, while pill use seems to have plateaued.
I tried five different formulations of the pill, but never managed to escape all the annoying symptoms.
The issues a woman experiences—or whether she has any at all—vary greatly based on the specific dosage of hormones and the unique individual swallowing them every day. Personally, along with bloating and mood swings, I got migraines with an aura, or what felt like a laser light show in my left eyeball. Twice I had to retreat to my office's “Pump and Pray Room”—reserved for new mothers and religious employees—to lie down and recover. (What I did not know at the time was that, because of this symptom, I should not have been on an estrogen-containing pill in the first place. Women with aura migraines, along with other conditions that put them at risk for strokes, blood clots, heart disease or some cancers, should not take combination pills.)
Finally, I gave up on the pill—only to be blindsided by a whole new challenge: the unexpected side effects of going off the pill. To help others avoid similar unpleasant surprises, I spoke with three experts about what to expect when you ditch the pill for another birth control method.
Of course, just as each woman has a unique reaction to the pill, she'll also have a unique reaction to going off. According to the feminist women's health organization Our Bodies, Ourselves, there is "enormous variability in any individual's response to her own hormones or any synthetic hormones she takes." One woman's skin may break out in pimples, while another's clears up completely.
With this disclaimer in mind, here are eight possibly unexpected changes you might experience when you cancel your monthly refill of that crinkly foil packet:
1. Most of the side effects should disappear in a few days.
First off, while many women decide to have their period before pitching the pack, it's safe to stop taking the pill at any point. However, you should stop immediately if experiencing any serious side effects, like headaches or high blood pressure, says Dr. Jennifer Moore Kickham, the medical director of a Massachusetts General Hospital outpatient gynecology clinic.
Because they are taken daily, the synthetic hormones from oral contraceptives leave your system in a couple days. This is why you have to use another form of birth control after missing more than two doses of the pill. But it's also why most acute side effects, like nausea, will go away pretty soon after giving the pill the boot. Other issues, such as mood swings or irregular bleeding, may take a bit longer. If they persist, you should visit your doctor to investigate possible other causes, Dr. Kickham says.
In addition to migraines, I had major stomach bloating while on the pill—a side effect so perpetual that I came to view it as normal. I also experienced anxiety and a general irritability that I'm sure my family and boyfriend didn't particularly enjoy. Eventually, after six years of being on and off the pill, I couldn't tolerate it anymore. I decided to ditch it for good. I felt better almost immediately. After a month, my headaches and bloating vanished. (I had no idea I could eat without my stomach inflating like a balloon!) My mood issues took a bit longer, but eventually faded away, too.
When you stop the pill after a few years, you may actually realize you were experiencing mild side effects the entire time, like bloating or breast tenderness. According to Dr. Kickham, "Some women come off and say, 'I didn’t realize I had a low-level headache the whole time I was on the pill, and now it’s gone.'"
2. But some of the pill's benefits will go too.
Though I may have started this story with a little pill-bashing party, oral contraceptives do have major benefits that usually outweigh any negative side effects. "The pill is an effective form of contraception with a lot of great benefits," Dr. Kickham says. "So as long as it’s safe for patients to use and they’re not having horrible side effects, it can be a really great option."
While about half of my friends are dumping the pill in favor of IUDs, the other half have had serious commitments with the same oral contraceptives for years with little or no side effects. "There are some women who are very sensitive to the hormones and switch a variety of times and always have some type of side effect," says Dr. Goldberg of Planned Parenthood. "Then, other women can tolerate most formulations without much difficulty."
Because most versions of the pill include both estrogen and progestin, it also has a number of health perks that you can't get from progestin-only or hormone-free methods, like IUDs or condoms. In fact, many women who don't actually need birth control take the pill for its other health benefits, like lighter periods and reduced cramping. Other benefits of the pill include some protection against: acne, PMS symptoms, iron deficiency anemia, endometrial and ovarian cancer, and additional health problems.
When you stop taking the pill, you may lose these benefits. It's like flipping a coin. The benefits you got on the pill morph into the new side effects of being off it, whereas the side effects you had turn into benefits. The light, regular periods you had on the pill may be replaced by spotting and cramping, and your porcelain skin may turn into a pimply mess. But, on the flip side, your sex drive may return and your irritability may evaporate.
"All these choices are a balance of risks and benefits," Dr. Kickham explains. Do the benefits tip the scale in the pill's favor, or are the side effects weighing you down like a bag of bricks? “For any medication, if the risks or negative side effects are outweighing the benefits, then they should consider other options," she says.
3. You'll need to use another form of birth control. Immediately.
Protection from an unwanted pregnancy is one crucial—and obvious—benefit of the pill that will vanish almost instantly. Just as acute side effects should stop in a couple days, the contraception will too.
“Most women resume ovulation pretty quickly after stopping the pill," Dr. Goldberg explains. "So, the most important thing for women to know is that when they stop the pill they are at risk for pregnancy almost immediately." It's crucial to find a new method as soon as possible without any gaps in coverage, she says.
4. Your normal period might not return for a while.
Although my teenage self would hate me for saying this, I actually looked forward to having a regular period when I went off the pill. The low-dose oral contraceptive that I had taken for the past three years made me stop having one all together. I waited for eight months. No period. I had no idea this wasn't normal at first. I just thought it was part of transitioning off the pill.
After a number of doctor visits, blood tests and even a rather uncomfortable ultrasound, I was diagnosed with secondary amenorrhea—the absence of menstruation. I had to take two weeks of progestin-only pills, then restart the pill for a month in order to "jumpstart" my hormones and ensure my body could cycle.
I dropped the pill last September without knowing what changes to anticipate in my body. I eagerly welcomed most of them, but my unexpectedly absent period made me worry about fertility and my future. In fact, this surprising change was my impetus for writing this story.
According to the experts I spoke with, if your period hasn't returned for three months after stopping the pill, you should visit your doctor, who can investigate other potential causes. I'm not alone in my post-pill amenorrhea. It took one of my friends nine months to regain her period after stopping the pill.
But for most women, ovulation should resume in a few days and periods should return within a couple of months. "If you stop the pill and you don't get a regular period for a month or two, it's just a delayed menses—give it a little more time," Dr. Goldberg says.
Even if your period does return right away, it might be different. The pill often lightens bleeding and reduces cramping, while also making your periods more regular and predictable. According to Dr. Kickham, this is why many women love the pill.
When you stop taking the pill, you may experience irregular periods for a few months or even years, especially if you had erratic menstruation pre-pill, says Judy Norsigian, executive director of Our Bodies, Ourselves. If you had heavy, crampy periods before the pill, they might also return when you go off.
5. You may find yourself more interested in sex.
Lying down with a heating pad on your stomach is not the only thing you might be doing more of in bed. After discontinuing the pill, you may also find yourself wanting to get sexually intimate more often. The combination pill limits the amount of free testosterone in the blood, which creates anti-androgenic ("anti-masculine") symptoms in some women, including lower libido and sexual dysfunction.
"Where the pill helps with acne and hair growth, some of my patients will come back saying 'I don’t have the desire I used to and I don’t know why, I’ve noticed a difference,'" Dr. Kickham explains. Other women may actually experience increased libido while on the pill because it reduces their anxiety about getting pregnant.
Several studies over the past 30 years have found that oral contraceptives hinder sexual function by decreasing sexual interest and arousal, as well as the frequency of sexual intercourse and enjoyment. When you stop taking the pill there is more free testosterone in your system, so don't be surprised if you notice a big boost in your sex drive. Reminder of No. 3 above: You need new protection right away.
6. Your skin may break out like a prepubescent teenager's.
For the first time in a while, you're not bloated or moody, and you're the one initiating sex. You're feeling confident and sexy—like a million bucks. But then, a pimple pops up on your chin. Then, a few more. Soon, you feel like a prepubescent teen desperately trying every acne face wash and zit-zapper from the drugstore. So much for that boost in libido.
This is exactly what happened to me. After years of clear skin and a mostly pimple-free adolescence, a painful mess of cystic acne covered my chin and jaw—often where hormonal acne appears in adults. The pill can help mitigate hormone-related symptoms like acne and hair growth, so when you stop taking it, these issues may, literally, surface.
Cue a visit to the dermatologist. After a couple months of very unsexy, painful acne, I finally got my skin under control with salicylic acid and spironolactone (a medication that reduces circulating androgens), but I'm left with red acne marks and blotchy skin.
Some women with post-pill acne may actually find out they have Polycystic Ovary Syndrome—a common hormonal disorder often accompanied by acne. “If a woman has been on the pill for a long time, like 10 years, other pathologies could have developed and be unmasked when she comes off,” says Dr. Goldberg. Say a woman had mild PCOS before going on the pill but wasn't diagnosed. The pill may help improve or control the symptoms of acne and irregular periods so much that the PCOS doesn't become apparent until she stops taking it a decade later, she says.
For many women, cystic acne is worse than any side effect they experience while taking the pill. For me, I'd still rather apply an extra coat of concealer every morning than risk ruining my relationships because of my erratic mood swings and irritability.
7. Your emotions and mood swings might get better—or worse.
Although this change is difficult to prove and slightly resembles a daytime talk-show confession, I finally feel like "myself" since ditching the pill. I have more energy and excitement about school and my relationships, and don't find myself wanting to strangle a friend who asks about my day.
According to Judy Norsigian, mood swings, depression and general brain "fogginess" are some major reasons women go off the pill and use other birth control methods.
On the other hand, women who use the pill to treat severe PMS or premenstrual dysphoric disorder may actually experience improvements in their mood while taking it. If they have mood fluctuations related to their natural cycle, the balancing effect of the pill's synthetic hormones can help, so mood issues may return when they go off, Dr. Kickham explains.
"It is hard to predict who will respond in what way to the variety of pills," she says. "For instance, I’ve definitely had people call me a couple weeks after starting the pill saying, 'I’m crying all the time, I’ve noticed a huge change in my mood.' So we have them come off it right away, immediately."
Since the hormones metabolize out of the system within a couple days, your mood issues should improve once you go off the pill—if it was actually to blame.
8. You might still have side effects with your new method. (Sadly, it turns out there is no perfect birth control.)
If you're going off the pill and still need a birth control method, there are a number of other options to choose from. "I usually just go through the whole list of contraceptives and try to decide with my patients what they’re looking for based on their goals and their response to the pill,” Dr. Kickham says.
Regardless of the new method you're choosing, sadly, no birth control is perfect. Since both the patch and the vaginal ring contain a combination of estrogen and progestin, you might have similar side effects with these that you had on the pill, like breast tenderness and nausea.
The birth control shot, which injects progestin every three months, is associated with irregular bleeding and weight gain, as well as osteoporosis. Another of its biggest drawbacks is the inability to take the hormones back out once they're injected. Unlike the pill, the hormones will not metabolize out of the system until after the three months.
The implant, which is a matchstick-sized rod placed in your arm for up to three years, also releases only progestin. Since both the shot and implant don't release estrogen, you might miss out on some of its perks. For instance, you won't have the benefits of more regulated periods, reduced acne or protection against reproductive organ diseases, like endometrial cancer.
Though it has its own cult following, even the IUD—a T-shaped device placed in the uterus—is also not without fault. The ParaGard, which does not release any hormones and works for up to 10 years, is associated with heavier and crampier periods. The hormonal IUDs, Mirena and Skyla, release progestin and last for three to five years. Unlike the ParaGard, they may lighten your period and actually get rid of it entirely. But on the flip side, IUDs don't provide the benefits linked to estrogen.
As with the pill, experts say you should stick with your new birth control method for at least three months as long as you're not experiencing any severe side effects, since it can take that long for your body to adjust.
Bottom line: It may take some trial and error to find the birth control method that works best for you. Next up for me: I'm giving the Mirena IUD a shot. Maybe one day there will be a perfect birth control that works for everyone—perhaps even one that's remote-controlled. Until then, it's all about weighing the costs and benefits, finding the best personal fit—and being aware that side effects can crop up both when you start a method and when you stop.
Readers, what's been your experience of going off the pill? Please share in the comments below.
Veronica Thomas is a master's candidate at the Harvard School of Public Health studying health communication and maternal and child health.
Note: This post was slightly expanded on Sept. 2, 2014 to include more information on the rare but serious risks of combination pills and on the osteoporosis risk of the birth control shot.
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