The Lowdown on Hormonal Birth Control & Fertility

Hormonal birth control is a powerful tool that can significantly impact a woman's menstrual cycle and overall reproductive health. Often prescribed for more than just preventing pregnancy, hormonal contraceptives can manage a range of symptoms associated with periods and treat conditions like PMS and endometriosis. It can also preserve fertility and prevent cancer. Yep, so there are a TON of perks to birth control. However, understanding the full implications of birth control, especially regarding fertility, is crucial for anyone considering starting a family. Let’s explore how hormonal birth control manages period-related symptoms and conditions, its effect on hormone level assessments, and the reasons why it is important to stop taking birth control months before trying to conceive (TTC). We will also weigh the pros and cons of birth control to provide a comprehensive understanding.

Managing Period Symptoms and Conditions with Hormonal Birth Control

Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a common condition that affects many women during their menstrual cycle. Symptoms can range from mild to severe and include mood swings, bloating, headaches, fatigue, and breast tenderness. Hormonal birth control, particularly oral contraceptive pills (OCPs), can alleviate these symptoms by regulating hormone levels and providing a consistent hormone dose throughout the cycle. By preventing ovulation and stabilizing estrogen and progesterone levels, birth control can reduce the severity and occurrence of PMS symptoms.

Endometriosis

Endometriosis is a painful condition where tissue similar to the lining inside the uterus grows outside the uterus, leading to severe pain, heavy periods, and potentially infertility. Hormonal birth control can help manage endometriosis by suppressing the menstrual cycle, which reduces the growth of endometrial tissue and the associated pain. This can also preserve fertility by minimizing endometrial tissue growth. Continuous or extended-cycle birth control pills, hormonal IUDs, and contraceptive injections are often used to manage endometriosis symptoms effectively. When coming off OCPs, you can expect the painful periods to resume.

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. It is characterized by irregular menstrual periods, excess androgen levels, and polycystic ovaries. Birth control pills can help regulate menstrual cycles, reduce male hormone (androgen) levels, and clear up acne, which is often associated with PCOS. By providing a regular dose of estrogen and progestin, OCPs can mitigate some of the symptoms of PCOS and improve overall menstrual regularity. It can also reduce cancer risks. Those with PCOS are at greater risk for endometrial cancer due to abnormal menstrual cycles. By having a bleed each month, the risk for endometrial cancer can be reduced.

Heavy Menstrual Bleeding

Heavy menstrual bleeding, or menorrhagia, can be debilitating and lead to anemia if not managed properly. Hormonal birth control, including OCPs, hormonal IUDs, and contraceptive patches, can reduce menstrual flow by thinning the lining of the uterus and decreasing the duration and intensity of periods. This makes hormonal birth control an effective treatment for women suffering from heavy menstrual bleeding.

The Challenge of Checking Accurate Hormone Levels on Birth Control

While hormonal birth control offers numerous benefits for managing period-related symptoms and conditions, it presents a significant challenge when it comes to assessing accurate hormone levels. The synthetic hormones in birth control can mask the body's natural hormone production, making it difficult to obtain a true picture of hormonal health.

When on birth control, the body's natural hormone production is suppressed, and the hormone levels in the blood reflect the synthetic hormones from the contraceptive rather than the body's own hormones. This can lead to inaccurate readings of key hormones like estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). For women experiencing menstrual irregularities or infertility, this can complicate the diagnosis and treatment process.

Masking Signs of Infertility

One of the significant concerns with hormonal birth control is that it can mask underlying signs of infertility. Birth control works by preventing ovulation, altering the cervical mucus to prevent sperm from reaching the egg, and thinning the uterine lining to prevent implantation. While these mechanisms effectively prevent pregnancy, they can also hide potential fertility issues.

For example, women with conditions like PCOS or hypothalamic amenorrhea may not ovulate regularly or at all. When these women are on birth control, the synthetic hormones create a regular withdrawal bleed that can be mistaken for a regular menstrual period. This can give the illusion of normal menstrual function when, in reality, ovulation may not be occurring. As a result, underlying issues with ovulation and fertility may go unnoticed until after discontinuing birth control.

The Importance of Stopping Birth Control Before Trying to Conceive

Given the potential for hormonal birth control to mask signs of infertility and disrupt accurate hormone level assessments, it is important to stop taking birth control several months before trying to conceive (TTC). Most healthcare providers recommend discontinuing birth control 3-4 months before attempting to conceive to allow the body's natural menstrual cycle to resume and to provide a clearer picture of reproductive health. I usually recommend coming off closer to 6 months before TTC for clients who have a history of endo, PCOS, are older than 30, or have some concerns about infertility.

Reasons to Stop Birth Control Before TTC

1. Restoring Natural Hormone Balance: Stopping birth control allows the body to resume its natural hormone production, which is essential for regular ovulation and a healthy menstrual cycle. This period of adjustment helps in identifying any underlying hormonal imbalances or reproductive issues that may need to be addressed.
2. Tracking Ovulation: Understanding and tracking ovulation is crucial for increasing the chances of conception. Without the influence of synthetic hormones, women can use methods like basal body temperature charting, ovulation predictor kits, and monitoring cervical mucus to identify their fertile window accurately.
3. Diagnosing Fertility Issues: Discontinuing birth control provides an opportunity to diagnose and address any underlying fertility issues. If a woman does not resume regular menstrual cycles or experiences irregularities within 3 months after stopping birth control, it may indicate conditions such as PCOS, thyroid disorders, or other hormonal imbalances that require medical attention.
4. Preparing the Uterine Lining: A healthy uterine lining is essential for the implantation of a fertilized egg. Birth control pills thin the uterine lining, so stopping birth control allows the lining to thicken and become more receptive to implantation.

Pros and Cons of Birth Control

Pros of Birth Control

1. Effective Pregnancy Prevention: When used correctly, hormonal birth control methods are highly effective in preventing pregnancy, with success rates exceeding 99%.
2. Regulated Menstrual Cycles: Birth control can help regulate menstrual cycles, making periods more predictable and manageable.
3. Reduced Menstrual Symptoms: Hormonal contraceptives can alleviate symptoms such as heavy bleeding, severe cramps, and PMS, improving the quality of life for many women.
4. Management of Reproductive Health Conditions: Birth control is often used to manage conditions like endometriosis, PCOS, and acne, providing relief from symptoms and preventing disease progression.
5. Convenience: There are various forms of hormonal birth control, including pills, patches, injections, and IUDs, allowing women to choose the method that best suits their lifestyle and preferences.

Cons of Birth Control

1. Side Effects: Hormonal birth control can cause side effects such as nausea, weight gain, mood changes, and breast tenderness. Some women may experience more severe side effects, such as blood clots, especially if they have certain risk factors.
2. Masking Underlying Issues: As discussed, birth control can mask underlying reproductive health issues, delaying diagnosis and treatment.
3. Hormonal Interference: The synthetic hormones in birth control can interfere with the body's natural hormone production and regulation. Some birth control methods, like Depo-Provera shots, stay in your system longer.
4. Limited STI Protection: Most hormonal birth control methods do not protect against sexually transmitted infections (STIs), so additional protection, such as condoms, is necessary to prevent STIs.
5. Discontinuation Adjustment Period: After stopping birth control, it may take 3 months for the body to resume its natural menstrual cycle and fertility, which can be frustrating for women eager to conceive.
6. Vitamin and Nutrient Depletions: Some hormonal birth control can cause certain deficiencies that can negatively affect fertility.

Conclusion

Hormonal birth control offers significant benefits for managing period-related symptoms and conditions such as PMS, endometriosis, and heavy menstrual bleeding. However, its impact on hormone level assessments and the potential to mask signs of infertility highlight the importance of careful consideration when planning to conceive. Discontinuing birth control 3-4 months before trying to conceive allows the body to restore its natural hormone balance, track ovulation accurately, and diagnose any underlying fertility issues. While birth control remains a valuable tool for many women, understanding its pros and cons is essential for making informed decisions about reproductive health and family planning.

Navigating the complexities of hormonal birth control can be challenging, especially when considering its implications for future fertility. Working with a fertility consultant who is a nurse practitioner can provide invaluable guidance. A skilled nurse practitioner can help you weigh the pros and cons of your birth control method, determine the optimal time to discontinue its use based on your symptoms, and address any fertility concerns. By setting up a free consultation call, you can receive personalized advice and support tailored to your unique needs and reproductive goals.