A missed period after getting off the pill can be expected as your cycle regulates itself again. But how many is too many? Here are a few reasons why you may not be getting your period on the regs quite yet.

By Christin Perry
September 30, 2019
Illustration by Sarina Finkelstein; Getty Images (1)

Birth control pills are widely touted as the answer to a pesky irregular cycle. Once you start taking them, voila—things even out and you get your period as soon as those placebos start each month. Doctors sometimes prescribe birth control pills as a way to balance hormones and kick-start your body into a more predictable cycle. What's more, some studies indicate they can actually boost your fertility, partly because they can decrease your odds of fertility-inhibiting conditions like endometriosis.

But while those same studies indicate that normal fertility can return immediately after stopping birth control, what happens when that's not the case? We asked experts to weigh in on how birth control pills can affect your monthly cycle and explain the reasons why you might miss periods once you stop taking it.

How Birth Control Affects Your Cycle

Even if you've been taking birth control pills (or using other forms of hormonal birth control, like injections) for years, it's not likely that you'll have trouble conceiving once you stop taking them. But it might take a few months for things to return to normal.

"The time it takes for a woman's menstrual cycle to regulate will vary depending on the reason she went on hormonal birth control, along with any other underlying health issues that were masked by hormonal birth control or developed during use and aging," says Tsao-Lin E. Moy, a fertility specialist who uses natural and integrative forms of medicine. "In a healthy woman the cycle can return pretty quickly, often within 3 to 6 cycles. But hormonal side effects may take longer to clear out of the system."

On the other hand, if you had an underlying medical condition that was causing irregular cycles, like PCOS, hypothyroidism, or endometriosis, you can be sure that those conditions will rear their ugly heads again as soon as you stop taking birth control.

“Using a hormonal method of birth control to regulate irregular periods doesn’t solve an underlying hormonal imbalance," says Dr. Camaryn Chrisman Robbins with Washington University Women & Infants Center. "But it can lead to improved quality of life by regulating cycles and promoting endometrial health. When someone stops using hormonal medication, it is likely those original symptoms will resume.” 

Moy agrees, saying, "the underlying condition, or root cause, is still present, and will express itself when a woman goes off birth control. Many women believe that since they have a period on birth control, that they have achieved a normal cycle, but that is not the case. It is a mock cycle as the natural hormonal process is being suppressed by creating an imbalance."

But that doesn’t mean birth control doesn’t help with some of these conditions. Robbins says, “hormonal contraceptives that contain both estrogen and progesterone are often used to treat symptoms of endometriosis and PCOS, like acne and excess hair growth.” 

Sum this up to say that if you're missing your period after getting off birth control, there is a reason behind it—you just have to find it. Here are the most common things that might be causing your cycle to be off track so you and your doctor can address them.

Stress

Small, daily stressors like missing the bus or getting the kids to school late shouldn't wreak havoc on your monthly cycle. But if you're experiencing significant stress from major life events, or you're finding yourself stressed out of your mind from your daily grind, your cycles may become less regular over time. That's because stress can affect your hormone balance, which plays a crucial role in maintaining a regular cycle where an egg is produced and the uterine lining is shed if the egg isn't fertilized.

Low body weight

Dramatic weight gain or loss, regardless of your starting BMI, can always impact your cycle. But if your BMI is less than 18, you may experience what's called secondary amenorrhea. That's when your period, which started normally when you were a young teenager, stops altogether. Unless you are a competitive athlete, this is typically a good indicator that it's time to check your diet and lifestyle and ensure you're making healthy choices to get on the road to a higher body weight.

Obesity

On the flip side, having a BMI of 35 or higher is linked to a host of medical issues, including diabetes, heart disease, and of course, menstrual irregularities. Studies have found an exceptionally high correlation between obesity and missed periods. Similar to being drastically underweight, having a high level of adipose tissue in the body causes disruptions in normal hormone levels like insulin and sex hormone-binding globulin.

Polycystic Ovary Syndrome (PCOS)

One of the most common causes of irregular cycles is polycystic ovary syndrome, which is caused by increased levels of the male hormone androgen. Interestingly, obesity often seems to go hand-in-hand with PCOS, with some studies indicating that nearly 80% of patients with PCOS also have a very high BMI. While PCOS is not a curable condition, there are treatments that can help regulate your menstrual cycle and increase your chance of successfully getting pregnant.

Uterine polyps and fibroids

If you're experiencing irregular cycles or spotting along with symptoms like pain during intercourse and lower back pain, it's possible the root cause of your missed period is uterine polyps or fibroids. Both sound scary, but they're actually pretty harmless; polyps are simply small overgrowths in the lining of your uterus called the endometrium.

Typically symptomless, polyps can cause disruptions to your monthly cycle and spotting between periods. Fibroids are growths found in or on the uterus that can cause painful, heavy periods. Why can polyps and fibroids cause you to miss your period? Because both occur in response to fluctuations in hormones that also regulate your cycle.

Thyroid Imbalance

Who knew your thyroid played such a huge role in your menstrual cycle? It seems strange, but it's true. Your thyroid hormones directly impact your periods, and too much or too little (as in the cases of hyperthyroidism and hypothyroidism, respectively) can cause your cycles to become irregular or stop altogether.

Breastfeeding

Considering that nearly 50% of moms in the US breastfeed for 6 months or more after baby is born, it's important to understand how breastfeeding affects menstruation. Numerous studies have shown that exclusive breastfeeding leads to a few months of amenorrhea (not having a period) immediately following birth. But there's no definitive guidance on how long that lasts, and often, there aren't any indications that your cycle is gearing up again. This can lead to an unplanned pregnancy if no other method of birth control is used.

To prevent this, many women turn to a “mini pill,” which is a progesterone-only birth control pill. According to Dr. Robbins, “A progesterone-only oral contraceptive pill is excellent for parents who are breastfeeding because progesterone pills do not interfere with milk supply. Estrogen has been shown to decrease the volume of milk, especially in early lactation. Many methods of contraception are safe to start any time after giving birth, and women can resume an estrogen-containing contraceptive after they stop lactating.”

Once your period does return after giving birth, it's not unusual for it to be a bit irregular if you're still nursing. But if your baby has been weaned for months and your period still hasn't regulated, it's worth a trip to your doctor to have your hormone levels checked.

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