Coming Off the Pill

Hormonal oral contraceptives, commonly referred to as “the Pill”, are the most prescribed birth control method in the UK. If you’re using the Pill, you might want to get off it for different reasons:

• You’re having side effects you can’t put up with
• You want to switch to another type of pill or contraceptive
• You want to get pregnant

It’s important to follow a step-by-step approach to avoid added side effects and/or unwanted pregnancies.

How to stop the contraceptive pill in 5 steps:

1. You can choose to come off the pill at any time
2. Once you’ve decided to stop, you should finish your current pack before stopping. If you are using a pill pack that has sugar pills to take in your period week, you should stop at the end of the active pills, and leave the sugar pills.
3. If you still want to be protected from unwanted pregnancies, you should start using a different type of contraception as soon as you stop taking the Pill
4. But, for some types of contraception, other different types of Pill or the hormonal coil for example, they won’t start working right after switching from the Pill
5. So, you’ll need to use a third type of contraception, like condoms, to protect against pregnancies between your current Pill and your new contraceptive

Stopping abruptly can cause irregular bleeding, which can be difficult to control. Your GP or local sexual health clinic can give extra help if you want to stop.

When to stop the Pill during your cycle:

• Once you’ve decided to stop, you should finish your current pack before stopping 
• Once you’ve reached the end of your pack, just don’t start another one

Deciding to stop the Pill. You could decide to stop the Pill if you:

• want to switch to another pill with different active ingredients: if you don’t mind taking the Pill every day, but you’re getting side effects with the form of pill you’re currently taking
• want to try another contraceptive method: if you find it difficult to remember to take the Pill every day, or you’ve had side effects, you might want to try a different contraceptive
• want to get pregnant: you can get pregnant right away after stopping although for most people it can take a few weeks before they get a period. There is no evidence that getting pregnant right after stopping the Pill is bad for you or your baby
• started the pill to treat another condition: you might have started the Pill to improve a hormone-related condition, like acne, hirsutism, or female pattern hair loss. If it hasn’t worked properly, you might want to stop
• are over 50 years old – if you are taking the combined pill, you should change to a different type of contraception or pill after you turn 50. This is because the combined pill is less safe for women over the age of 50

Stopping the mini pill is very similar to stopping the combined pill. Like with the combined pill, you should:

• finish your current pack of pills
• not start your next pack
• also consider new contraceptives to avoid unwanted pregnancies

The main difference in coming off the mini pill is that the effects wear off even faster. The mini pill is different from the combined one in that it contains less hormones and does not stop ovulation. Instead, it thickens the mucus of the lower part of the womb to prevent sperm from reaching the egg. When you come off the mini pill, these changes are reversed faster than the changes caused by the combined pill.

When you come off the Pill, the levels of hormones in your body will start to change again. It’ll take some time for them to come back to their natural level, but your chance of pregnancy will steadily increase as soon as you start missing doses of the Pill. If you don’t want to conceive you should use another contraceptive method.

If you want to get pregnant, you may want to talk about it with your online doctor or GP. They might advise you to take folic acid supplements, and suggest lifestyle changes for the health of yourself and your future baby.

Different pills contain different hormones. When you come off the Pill, you can experience side effects that change in type and intensity depending on the hormones involved. These side effects might include:

• weight loss
• increased appetite

You may also see that the other benefits of the Pill go away. This means that things related to your period may go back to how they were before you started the Pill, including:

• how heavy your periods are
• how painful they are
• your PMS symptoms
• mood swings

If you keep getting side effects of the Pill, or if your period doesn’t come back for more than one month, you should see your GP or gynaecologist.

What happens if you miss a pill? Forgetting a pill isn’t the same as coming off it completely, but it can have some similar effects.

Any side effects you get after stopping the pill usually don’t last more than a few weeks. The most common side effects are:

• unwanted pregnancy
• heavy bleeding, painful periods, hot flushes, and feeling irritable, especially if you’ve already had any of these before starting the pill
• mid-month twinges, mild cramping, and vaginal discharge when you ovulate
• irregular bleeding, especially if you stop taking the Pill suddenly
• losing any improvements to acne, hirsutism, and other hormone-related complaints that you got while taking the Pill
• increased appetite
• weight loss

• Your period should come back two to four weeks after stopping the pill
• In some cases it might take longer, because it’s natural for the period cycle to be different in length for different people
• The first period you get after coming off the pill can be irregular, but the timing of your menstrual cycles should go back to normal within roughly three months
• If you notice no period at all a month after stopping the pill, you should see your GP or visit a sexual health clinic. Even though it could be your period is just very late, it’s better to be safe and talk to a doctor

They’ll first try to find out if you might be pregnant. 

If they rule that out, they’ll consider other possible causes of amenorrhea, which is the medical term for when you don’t get periods (for reasons other than pregnancy, menopause, or medication). The most common causes of amenorrhea are:

• stress
• sudden weight loss
• being obese or very overweight
• premature menopause 
• extreme physical exercise
• a gynaecological condition called polycystic ovary syndrome (PCOS)
• other conditions, like heart disease, uncontrolled diabetes, and thyroid problems 

If you want to switch to another contraceptive, which might be another Pill or not, you should consult your GP or sexual health clinic.

The idea that you must wait until the start of the next period to start taking the new contraceptive pill is a myth.

If you don’t want to get pregnant, you should use another kind of contraception straight away. Remember that for some other types of contraception you can start straight away and you need to use a third type of contraception in between. If you wait to use at least one other type of contraception right after stopping the Pill, it creates a “contraceptive gap”, during which it is more likely you could get pregnant. 

The following rules provided by the https://www.reproductiveaccess.org/wp-content/uploads/2014/12/switching_bc.pdf will help you to avoid such situation:

• No gaps: if you switch from one oral contraceptive to another, it’s better to avoid breaks and start the new pack as soon as the previous one is finished
• Overlap method: if you switch from the Pill to contraceptive patches, a vaginal ring, or an intrauterine device (IUD) an overlap of 2 to 7 days is required to avoid a drop in hormone levels. Your GP or gynaecologist can advise you on how much overlap you need, which will depend on the next contraceptive you choose
• Back up method: if your doctor advises you to have a break when you switch to your new contraception method, you should use extra protection, e.g. condoms