Coming off contraception to prepare for pregnancy

Coming off contraception to prepare for pregnancy

Coming off contraception to prepare for pregnancy

Most of us will have made contraception priority number one since we first received the awkward and mildly terrifying sex education lesson in high school. So, deciding to come off contraception can sometimes feel rather nerve wracking. Rest assured, we’ve got you covered, as we take you through the various methods and their implications.

Simply put, contraception prevents pregnancy; if you remove contraception there is a chance that you could fall pregnant after sex. But does the type of contraception that you’re using affect your chances of falling pregnant quickly and are you fertile as soon as your contraception stops?

 

Bringing down the barriers

Condoms, diaphragms, caps or female condoms are all barrier methods of contraception which do not affect your natural hormone levels and will have no impact on your overall fertility. Woo hoo! They also don’t mess about with your menstrual cycle, so there are no delays waiting for your periods to return syou know when to best time getting pregnantYou could fall pregnant from the very first time you have sex without using your barrier method.  

One thing that you may not have considered though, are the implications of underlying sexually transmitted infections (STIs) on your fertility. Barrier methods are the most effective way to protect against STIs. Before you stop using your barrier method, it’s a good idea for you both to have a sexual health screen, so any hidden STIs can be treated now without the worry about impacting on your pregnancy or baby.

 

Pills, pills, pills – UKs most common contraceptive

With so many on the market it can be a little overwhelming, but when you break it down there are only really 2 types: a combination pill or a mini pill. 

The combination (or combi) pill contains progestin (an artificial form of progesterone) and oestrogen, which affects your natural monthly cycle, thickens your cervical mucus, thins the womb lining and prevents the release of an egg (ovulation) each month. If you are planning a pregnancy while on a combination pill, this is what you should do: 

  • Take your pill until you reach the end of your current packet.  
  • Then, during your pill free days, you will have a withdrawal bleed, this isn’t a true period and you will still have contraceptive cover during this week as long as you have been taking your pill as directed.  
  • If after the 7 days gap you do not start a new packet, you do not have any contraceptive cover and could potentially get pregnant. Yey! 
  • The next bleed you have will be your natural period, this can occur anywhere from 2 weeks after your withdrawal bleed and you should allow at least 3 months before your periods begin to return to their natural rhythm.  

The time taken for your cycles to become ‘normal’ again does vary between women. If you are concerned that you still haven’t had a period after allowing at least 3 months, make an appointment with your doctor to discuss this further. It is important to remember though, that although your cycles may seem irregular you could still become pregnant within the very first month of stopping your combination pill.

The ‘mini pill’ contains only progestin, this is a pill that you take every day with no pill free break. It alters the lining of the uterus so the fertilised egg would not be able to flourish and grow. It doesn’t affect your ovulation in the same way the combination pill does, as it doesn’t contain oestrogen. The mini pill is great in that you can decide to stop taking it at any point in your cycle, without having to complete the current packet and it’s possible to fall pregnant within weeks. However, it may take some time for your periods to return to normal and, as with the combination pill, it’s best to wait until your first natural period before you start trying to conceive.

 

In for the long haul - IUDs (intrauterine devices) and IUSs (intrauterine systems) 

More and more women are now opting for longer term contraceptives; something that you don’t need to consciously think about each day or each time you have sex. An IUD is a plastic and copper T-shaped device that is inserted into a woman uterus and remains in place for 3-5 years, providing continued contraception. The copper alters the cervical mucus, which makes it more difficult for sperm to reach an egg and survive. It can also stop a fertilised egg from being able to implant itself.

The IUS is a plastic T-shaped device that releases the hormone progesterone (as synthetic progestin) to prevent pregnancy; it can provide contraceptive cover for 5-10 years. It thickens the cervical mucus, which makes it more difficult for sperm to move through the cervix and thins the lining of the womb, so an egg is less likely to be able to implant itself.

If you have an IUD or IUS and decide you want to try for a baby you will need to make an appointment for their removal at your doctors or sexual health clinic. Just because your IUD or IUS can stay in place for up to 10 years doesn’t mean that you need to wait for the full time before having it removed. Phew! Remove them at any time and your fertility will return to what it would have been without the IUD/IUS very shortly.

 

Under your skin - Implants and injections 

The hormonal implant provides contraceptive cover for 3 years. It’s a tiny device that’s barely visible and is placed under the skin on the upper arm by a nurse or doctor; it releases progestin (a synthetic progestogen) slowly into the blood stream to prevent pregnancy. Once it is removed by a trained nurse or doctor, contraception ceases and you could fall pregnant straight away. 

The hormonal injection is slightly different, in that once you have had your injection you are covered for 8-13 weeks depending on the brand you are using, and you can’t reduce that time. You simply have to wait until the 8-13 weeks is up and then not have your next injection.

 

Pulling off the patch 

Contraceptive patches only provide cover while you are applying it. It releases oestrogen and progestin (a synthetic progestogen) into your bloodstream, similar to the combined contraceptive pill. You either apply a new patch each week with no break or wear a new patch every 7 days for 21 days and have 7 patch free days in which you will have a withdrawal bleed. Ideally you should wait until you finish a cycle of patches and not stop part way through. When you stop using the patch, your fertility will become what it would have been without the patch and you could get pregnant straight away, although it is recommend to wait until you have had a natural period so that you can date your cycle easier.

 

Natural family planning and alternative options 

Here we’re talking natural family planning, the withdrawal method and spermicidal gels. Natural family planning is where a woman tracks certain fertility indicators in her cycle and either avoids having sex during her fertile window or uses barrier methods during these times. This method of contraception doesn’t interfere with your natural hormones and, if anything, it makes you more aware of your natural cycle allowing you to know when you are ovulating so you can time your sexy time to increase your chances of conceiving.  

Spermicidal gels are lubricants that kill sperm so will only be effective for the particular time you use them and provide no ongoing contraception. The withdrawal method is where a man removes his penis before he ejaculates to prevent the sperm from being able to enter the vagina. This isn’t a very effective method of contraception as, in many instances, small amounts of sperm can be released before a man ejaculates or he may not remove himself with enough time.

 

Get yourselves baby body ready 

Whichever type of contraception you use, think carefully about preparing your body for pregnancy – and this applies to the guys too! The NHS recommends waiting until you have had a natural period before you begin trying to conceive so that you can prepare your body by starting your folic acid supplements, quitting smoking and reducing your alcohol intake which will have positive impacts on your fertility. Waiting for your natural period also helps the midwife to date your pregnancy should you fall pregnant straight away. However, if you didn’t wait and fell pregnant straight away, it would not cause any harm to your baby.   

All women should be taking a folic acid supplement while they are trying to conceive and for the first 12 weeks of pregnancy. You should look to start making these changes at least 3 months before you wish to start trying so that when you do decide it’s the right time, you’re both baby body ready. Check out our Couple’s Guide to Getting Pregnant for more information.

 

A little about the author… 

Jo Carey is a pharmacist, medical writer and mother of 2 young boys. Jo has years of experience writing for patients and healthcare professionals. Drawing from personal experiences in her own journey to motherhood she is able to empathise with many couples on their fertility journey and is driven to ensure that all people starting a family feel supported and knowledgeable.

 

REFERENCES 

  1. [Online content] Accessed 19.12.19 http://www.fpa.org.uk/sites/default/files/contraception-patterns-of-use-factsheet-november-2007.pdf 
  2. [Online content] Accessed 13.12.19 https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/   
  3. [Online content] Accessed 19.12.19 https://www.webmd.com/baby/get-pregnant-after-birth-control#1 
  4. [Online content] Accessed 19.12.19 https://www.nhs.uk/conditions/contraception/ius-intrauterine-system/  
  5. [Online content] Accessed 19.12.19 https://www.nhs.uk/conditions/contraception/iud-coil/  
  6. [Online content] Accessed 19.12.19 https://www.nhs.uk/conditions/contraception/contraceptive-implant/  
  7.  [Online content] accessed 19.12.19 http://www.fpa.org.uk/sites/default/files/pdf/FPA%20Contraceptive%20Patch%201033.pdf  
  8. [Online content] accessed 20.12.19 https://www.nhs.uk/common-health-questions/pregnancy/how-can-i-increase-my-chances-of-getting-pregnant/  
  9. [Online content] accessed 20.12.19 https://www.nhs.uk/common-health-questions/pregnancy/why-do-i-need-folic-acid-in-pregnancy/  

{Written on 05.02.20   Reviewed by 05.02.23}