Transitioning From Hormonal birth control

The transition from a synthetic hormone cycle to a natural hormone cycle is unique for every person. We cannot know how long it will take for the body and the cycle to “reset.” When a menstrual cycle is balanced, a hormonal feedback mechanism is in place which prepares the body for ovulation and pregnancy, even if the cycle is not clock-work 28 – days. When taking artificial hormones, this feedback mechanism is shut down so ovulation and pregnancy cannot occur. Therefore, time and patience are needed while waiting for the cycle to return to normal. This transition typically takes 2-3 months or cycles, but it can also take as little as two weeks and sometimes as long as six months. This “reset” is unrelated to the length of time that the hormones were used.

How Do Hormonal Birth Control (HBC) Methods Work?

They do the following: 

• Prevent the release of pituitary hormones in the brain (GnRH, FSH, and LH) 
• Repress the feedback mechanism between the brain and the ovaries
• Create an inhospitable, biochemical environment in the vagina for sperm to survive (sperm cannot enter, swim or survive in the body because a woman’s natural secretions cannot support sperm)
• Prevent the growth/build-up of the endometrial lining (for pregnancy)
• Prevent ovarian follicles from developing (so there is no egg released, no ovulation and no chance of fertilization)
• Keep the cervix closed, like a gate, so sperm cannot reach the uterus and beyond
• Most gynecologists compare HBC to a state of “pregnancy” while other fertility researchers and professionals liken HBC to a state of “menopause.”
• Cause a fake, artificial bleed (not a true menstrual bleed) during the week break before starting a new pack pills/patch/vaginal ring.

What’s Important To Know Before Going Off HBC

1. Regardless of how long someone took HBC, they cannot know in advance when the menstrual cycle will “re-set.” If the cycle was relatively regular (every 24-35 days) before using hormones, the cycle should be regular afterward.
2. Switching from HBC to a natural cycle and natural methods is not just a technical decision; it requires psychological preparation. It involves adjusting personal values and priorities,  e.g making a conscious decision that using the easiest and most convenient method is no longer acceptable and the “price” I am willing to pay for eliminating the side effects of HBC is by finding the time and energy to learn FAM from a professional.  Most people typically choose HBC because they are easy, convenient, and simple to use. When switching to FAM, one’s values need to shift towards health, naturalness, and a desire to “be in charge”  (LINK to Values Exercise). Going off hormones means you are no longer “available” for sex 24/7. Preparing for this change is important for both partners in a relationship. If a couple devotes time and conversation to prepare for the change, their chances for success will be higher.  Before coming off hormones, a couple needs to discuss and responsibly plan for the transition. Until a person can actually implement FAM, other methods will be necessary (LINK non-hormonal Birth Control methods). During the fertile phase of the cycle, for example, two methods of contraception are necessary if a couple wants a close to 100% rate of effectiveness. Using only one method, like a condom, is not safe or effective enough (if it breaks you can be 100% pregnant).
3. When a FAM client/student starts to observe and chart her fertility signs, she will know on a daily basis what her body is communicating and whether she is fertile or not. Likewise, before transitioning from hormones to a natural cycle, it is super important for a couple to purchase and gain experience with other methods before they start to use them in “real-time.” Methods like condoms, withdrawal, spermicides, sponges, and diaphragms are all possible options but these methods will not be effective enough until the couple receives proper instruction  in their use, and until they accumulate a bit of experience, skill, and of course, confidence. Having safe and protected sex is especially important during the transition and the learning phase. 

Conceiving After HBC

When coming off hormones for the purpose of getting pregnant- it is recommended to wait and allow the body to experience a few regular and normal cycles before trying to conceive. Since long-term use of HBC can cause nutritional deficiencies (affecting absorption of vitamins and minerals), a simple blood test (total blood count or TBC) is recommended as is taking a prenatal vitamin with folic acid for at least 3 months before conceiving. A person coming off hormones who is charting her fertility signs will know if and when her body is ovulating and if and when her cycle has hormonally “re-set.” Having this knowledge, control, and peace of mind is a great advantage to learning FAM. 

Coming Off HBC With A History Of Irregular Cycles

If someone experienced irregular cycles e.g. every six weeks or every three months before using HBC, she can expect to have irregular cycles again once she stops taking hormones. It is often the case that long and irregular cycles are a sign of a common hormonal imbalance (like PCOS (polycystic ovarian syndrome, which may soon be renamed as MRS-Metabolic Reproductive Syndrome). If charting reveals that someone is not ovulating and her cycles are not balanced, then a diagnostic workup is recommended (blood tests, hormone tests and ultrasound). These tests can  help confirm the source of the problem. Those who don’t experience a monthly cycle within 3-4 months post-HBC, should consider the advantages and disadvantages of FAM if they are interested in contraception. Consulting with a certified fertility awareness educator can help clarify this situation.

Learning FAM While Using HBC

For people weighing their options and not completely sure if FAM will work for them, it is completely appropriate and even recommended to learn FAM while using HBC. In that way, the couple is protected and has peace of mind.  Even with the absence of ovulation signs (which HBC prevent), one can still learn about FAM, practice charting basal temperature and secretions as a way to “test the waters” and get a feel for how the method works. Having a direct experience with charting brings a person closer to understanding not only how the method works but also what to expect once she starts to use the method. Participating in a workshop and receiving one-on-one personal follow-up makes it possible to weigh the method’s suitability on a very practical level, and this can be a critical and wise step towards deciding whether FAM is the right option. If someone who is sexually active stops using HBC before completing the FAM workshop- she is prone to relationship stress and risk (of a surprise pregnancy), especially if she does not have other methods to rely on at her bedside. 

In summary, it is important to know what to expect during the transition from HBC to a natural cycle and to implementing FAM. We can never know in advance how long the transition will take and there are definite advantages to learning FAM even while still using HBC. If there is a history of irregular cycles, it is important to be emotionally prepared for the possibility of having 2-3 month-long cycles, or a situation in which ovulation does not occur.  This translates into hormonal imbalance. In such a case, there are diagnostic tests that can confirm or rule out a number of underlying causes and there are many treatment modalities within natural/complementary medicine that can help the body “reset.” Having this vital information at your finger-tips will make the decision-making process easier and manageable. If there are other health and sexual health concerns related  to going off HBC, consulting with an experienced FAM teacher is highly recommended.