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Birth Control Can Prevent You From Knowing Your Fertility Health

By disrupting your natural cycle, contraception may be masking underlying issues.
Britany Robinson
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Britany Robinson

When I decided I wanted to get pregnant, the first step was to remove the copper IUD I'd had quietly nestled inside of my uterus for the previous five years. It was time to try putting a baby in there instead.

For half a decade of dating, sex and falling in—and out—of love, my IUD had allowed me to basically ignore my period. I knew I wasn't pregnant, and I was never too concerned about the timing—my period came and went regularly, much as it had before the tiny device was inserted. That all changed when it came out.

Suddenly, I was paying a lot of attention to the timing and duration of my cycle, trying to identify the day I would ovulate and when to have sex. I noticed that my cycle and the length of my periods were getting shorter and shorter.

My doctor assured me that it was normal to see temporary changes in menstruation after discontinuing any type of birth control—even nonhormonal ones. But a shortening cycle can also be a sign of premature ovarian aging. And mine was now abnormally short. Six months after my IUD was removed, I was barely bleeding for a day and my cycles were 25 days long.

When I finally spoke to a fertility specialist about this, she confirmed it was a reason to be concerned. Paired with a very low AMH (a hormone that's indicative of your ovarian reserve), my diminishing period was likely a sign that the quantity and quality of my remaining eggs were much lower than average for women my age.

Because copper IUDs can cause your periods to be heavier and longer, mine may have been masking this symptom. The fertility specialist suggested a more proactive approach to getting pregnant, which included further testing, supplements, acupuncture and tentative plans to begin intrauterine insemination (IUI) if a positive pregnancy test didn't happen soon.

A couple of months later, I got pregnant without resorting to expensive interventions. I feel incredibly lucky that it worked out for my partner and me that way.

But I wonder how many women consider the way birth control masks our natural cycles, and the important signals we can miss—even more so with hormonal options. The birth control pill, IUD, implant and patch are all proven to have no long-term impacts on your ability to conceive once discontinued—but what about how they might disguise our fertility health and related issues while using them?

How birth control works

The hormonal birth control pill prevents pregnancy by preventing ovulation (the release of an egg) and by thickening cervical mucus, which makes it difficult for sperm to make contact with an egg if ovulation does occur.

Those tiny pills contain either progestin or a combination of progestin and estrogen. The bleeding you experience during the week of placebo pills is what doctors call "withdrawal bleeding." Your uterus sheds its lining because you've stopped taking the hormones.

"You're only seeing a reflection of what those hormones [in birth control] are doing to your body," as opposed to a natural cycle, explained Asima Ahmad, M.D., M.P.H., a board-certified reproductive endocrinologist and OB-GYN, and chief medical officer at Carrot Fertility.

With hormonal IUDs, the hormones are released inside your uterus, where the IUD is placed, and most of the effect of IUDs is local. With a nonhormonal IUD (Paragard is the only brand available in the United States), it's the copper wrapped around the small piece of plastic that prevents pregnancy. Copper ions are directly toxic to sperm, likely causing an inflammatory response in the tissue of the uterus, which interrupts sperm's ability to swim, preventing them from reaching an egg (although some researchers disagree with the notion of inflammation).

With a nonhormonal IUD, ovulation continues to occur naturally. But for some women, the copper IUD does cause an increase in uterine bleeding and cramps. For most, these side effects fade. But for some, heavier periods can persist. My doctor told me I likely would have noticed my cycle getting shorter sooner had I not been experiencing a heavier period caused by my IUD.

Overall, research has shown the ways in which hormonal and nonhormonal birth control prevent us from getting pregnant have no lasting impact on our hormones or our fertility. A three-year study of oral contraceptives with more than 3,000 participants found that although there can be a delay in fertility after discontinuing use, there is no long-term effect on women's ability to conceive.

What you might miss on birth control

When Hayley Merrick stopped taking the pill, her periods stopped, too.

"I discovered that my hormones were totally out of whack due to stress," she said. The withdrawal bleeding she experienced while on the pill mimicked a normal period, so she didn't notice an issue until she stopped taking it.

Merrick worried that not having her period was a sign she wouldn't be able to conceive. "I felt disconnected from myself and my body. I felt frustrated that symptoms I'd had on the pill, such as headaches and extremely painful acne, were put down to 'just side effects' by my doctors." Turns out, those were all pointing to a hormonal imbalance.

Learning about her hormones led Merrick down a path of reconnecting with her body and her cycle—an approach she calls "cycle awareness." Her period returned, and she's now mom to a 2-year-old.

Stephanie Seitz, N.D., who specializes in women's health, told me most women don't realize they're not seeing a natural cycle when they're on hormonal birth control. While there is no harm being done to your body by experiencing withdrawal bleeding instead of natural menstruation, women should be aware of this and how it relates to their fertility health.

She sees many patients who were prescribed hormonal birth control to help alleviate heavy cycles or bad cramping—"But it's not really getting to the root cause." While birth control can offer much-needed relief for certain symptoms, it might mask more serious issues.

"Let's say you're quickly bleeding through a super tampon—that isn't normal," Seitz said. "So, let's get to the reason why this might be happening." It could be a fibroid, which might eventually impact your ability to conceive if it's blocking a fallopian tube or changing the shape of your uterus in a way that prevents sperm from moving through.

"If you go on the pill, your period automatically gets better, but the fibroid is still there," Seitz said.

It is common practice for women to be prescribed hormonal birth control to treat symptoms related to endometriosis, functional hypothalamic amenorrhoea or polycystic ovary syndrome (PCOS). Treating the symptoms doesn't always address the issue, although it's worth noting that in many cases, managing symptoms and improving quality of life is sometimes the best way.

Women can learn a lot about their health when they pay attention to their periods. Our cycles are a reflection of not just our ability to conceive, but also the hormones that affect many other aspects of our health. For example, estrogen plays a role in regulating metabolism, insulin sensitivity, glucose metabolism and body weight. But low estrogen likely wouldn't be detected or treated if you're taking a synthetic version.

It's important to understand that alongside the many benefits of birth control, a window to our fertility and general health is closed when our natural cycles are disrupted.

Getting pregnant after birth control

Plenty of women use birth control for decades, then stop taking it when they're ready to start a family. Maybe it takes a few months for their cycle to return to its natural state—the amount of time varies from person to person—but eventually they're able to conceive without issue. Their birth control did its job and they go on to have healthy pregnancies.

But many of us are met with surprises after discontinuing the pill or having an IUD removed—especially those who have been using birth control for many years.

Ultimately, when and if to take birth control is a matter of weighing the pros and cons, and these will be different for everyone, depending on your overall health and when/if you want to have kids. These choices are especially important if you think you might want to have kids in the near future.

Do you think there might be issues with your cycle or your fertility health? If so, it's a good idea to address these before starting birth control. If you're already on birth control, ask your doctor how you might address these concerns and whether or not discontinuing birth control would help to get a better understanding of what's happening.

If you hope to get pregnant in the not-so-distant future, you'll want to factor in the time it takes for your cycle to find its natural groove after going off birth control. You might be able to conceive immediately the first month after birth control. Or it might take much longer and some extra time should be factored into your plan.

If you're 38 and want to have three kids, for example, that time might be more consequential. This is why, if you're undecided or waiting for the right time, it's so important to check in with yourself and your doctor regularly on where you're at with that decision. If you do decide you want to get pregnant in your 30s or 40s, when time is of the essence, keeping tabs on your cycle and your overall fertility health can help you be more proactive.

A woman's ability to safely prevent pregnancy until she's ready is so important. Looking back, I don't think I would have changed my decision to get an IUD. I'm grateful for that tiny, powerful device, and the fact that I was able to prevent pregnancy until I knew it was something I wanted. But increasing awareness about fertility health should go hand-in-hand with birth control, for anyone who might want to become pregnant someday.