‘After three years off hormonal contraception, this is what I’ve learnt’
It was my mum finding me crying on the bathroom floor, age 14 and ravaged by period pain, that sparked my career in hormonal contraception. Marching me to the GP, she asked for something which might dial back my monthly agony – a move which saw me leave the surgery clutching a prescription for Microgynon, a combined oestrogen and progesterone pill.
As well as alleviating the pain, this came with another welcome side effect. A couple of years later, when I started having sex, I had no need to hide my pill packet or pretend I wasn’t taking the medication. What began as something to soothe my menstrual symptoms became (handily innocuous) contraception.
For the next eleven years, hormonal contraception was all I knew. First there was that combined pill. I then switched to the progesterone-only or ‘mini’ pill; a better fit for a migraine-sufferer, like me. There was also a brief interlude with the implant, before a return to the mini pill.
I was in a relationship that whole time, so consistency made sense. Plus, I remembered those hideous period pains and knew I never wanted to go back there. Given that the worry of unplanned pregnancy and brutal monthly pain were ticked off my worry list, for a long time, my relationship with my pill was overwhelmingly positive.
Come 2020, when I was 25, though, I started experiencing strange symptoms. On the mini pill, I was used to having one light, manageable bleed every few months. Suddenly however, I was bleeding fortnightly. It was heavy – and accompanied by cramps, too.
My doctor sent me for some scans which ruled out any other underlying issues, before finally suggesting that the pill could be causing the problems (it’s unusual, but not impossible, that the medication can cause nasty symptoms later down the line). As such, they recommended I try something different, contraception-wise.
Weirdly enough, the timing was perfect. I had been consuming a lot of content via my social feeds which cast aspersions on the pill in its various forms; scrolling through TikTok videos from women pinning their skin problems, weight gain and mental health distress on the tablets.
Many attested that once they came off the pill, everything changed: they were healthier and better off. It made me think, what if every negative health issue I’ve experienced – things like my severe anxiety and fatigue – were down to those little packets of neatly foiled tablets?
While some women find that the contraceptive pill does not agree with them, many others use it without issue and find it to be a safe and reliable contraceptive. Always seek medical advice from your GP or sexual health pro and be cautious of medical advice shared on social media
Perhaps I’d meet the real, better version of myself: happier, hotter, calmer. And so, I came off the pill, decided against the coil, and made condoms my (our) primary form of contraception. The constant bleeding stopped almost instantly. We’re using condoms to this day.
I’d be lying if I said I never looked back. In fact, I’ve stolen a glance over my shoulder multiple times. Unsurprisingly, the bliss I naively expected from my no-added-hormone life didn’t come to fruition. My hellish periods returned, for a start, which definitely took me down a few pegs. But there were also some surprising benefits I didn’t expect. Overall? I’m happy with how it’s going.
Of course, every woman’s experience with contraceptives will differ and the thoughts offered below speak to my experience, alone. The problem with (and magic of) female bodies is that we are unique. Dr Nighat Arif, a GP and author of The Knowledge: Your guide to female health – from menstruation to menopause, says that you should be constantly reviewing your contraceptive method to ensure it’s still working for you.
‘If you don’t think your method is quite right, keep a symptom diary and be proactive about making an appointment to chat to your GP or nurse,’ she says. ‘Everyone should be treated on an individual basis, weighing up the risk versus benefit.’
It’s impossible to generalise our experiences. That said, I wished I had a more realistic, balanced perspective about what life would look like after emerging from a decade of hormonal contraception when I decided to stop. Here’s what I learned.
1. My ‘normal’ cycle returned surprisingly quickly
Before coming off the pill, I thought it could take at least a year for my periods to return to a regular cycle. So I was surprised when, after a couple of months, they became regular again. Consultant gynaecologist Dr Priyanka Patel from London Gynaecology says this is the norm – not the exception.
‘Sometimes it can take longer than a few cycles, because all women are individuals and some can be sensitive to the pill,’ she says. ‘But there’s no evidence that it will stay in your system long-term.’
Because of this, if you’re coming off the pill because you want to start a family eventually, and you’re relying on it taking a while, Dr Patel cautions not to assume you have a buffer, as there’s a chance you could get pregnant immediately. Dr Arif notes that cycle regulation can take longer for the injection and implant, but the same point still stands.
2. Condoms are actually fine
After ruling out the copper coil because it can make periods heavier, I briefly considered getting the Mirena coil, which uses localised hormones to prevent pregnancy. I know lots of people who swear by the coil, but I’d also heard tales of how painful (and, in some cases, traumatic) the procedure to insert it can be.
I thought: why should I have to put myself through potential pain for the sake of contraception, while my husband gets to skip along without a care in the world? After more than a decade of me bearing the responsibility for birth control, like I say, we decided to give condoms a go. Sometimes, though, this method gets a bad rep – firstly because the success rate of ‘real use’ is 85%, compared to the Mirena coil which is 99.8%.
But, says Dr Patel, this is because condoms are reliant on perfect use. Many people forget, or don’t use them throughout the entire sexual encounter, or they aren’t put on properly. ‘When used correctly, they have a very high success rate [98%],’ she says. ‘In couples who are good at using them, it might be the best method.’
Then there’s the stereotype that men simply won’t want to use them, and that doing so could destroy your sex life. I, for one, haven’t found this to be the case – and, in fact, Dr Arif cites a study that found that the majority of men weren’t bothered about using condoms. ‘In most committed relationships where there is good communication and consent, men feel empowered that they are also part of preventing pregnancy.’
Plus, with so many thinner, lubricated condoms available now, it really doesn’t impact enjoyment as much as you might think. (Of course, it goes without saying that condoms are the only method that doubles as STD protection).
3. My rhythm was different
When I got back into a ‘normal’ cycle rhythm, it was one I didn’t recognise from all those years ago. My cycle had previously been around 28 days. Now, it’s 22-25. My periods now last longer (five days instead of three), and I have noticed pain around ovulation, too.
When I ask Dr Patel about this, she reminded me that, often we’ve been on birth control so long, we don’t really remember exactly what our cycles were like before, or perhaps we notice different things now. But, also, she says, ‘women’s cycles change over time anyway, so there’s no evidence that the pill would’ve caused this.’
4. My anxiety didn’t magically disappear (shock!)
From all the TikTok videos I watched, my biggest hope was that the severe anxiety (and occasional depression) that had plagued me since my teens was actually down to the pill. Sadly, no such luck – I still get heart palpitations, random overwhelming feelings of doom and catastrophising thoughts as frequently as ever. What I did notice, though, was that my capacity to feel joy expanded.
In positive moments, I felt happiness and excitement more deeply in my bones. ‘There’s no doubt that hormones can affect mood,’ says Dr Patel, ‘and lots of my patients have come off the pill to find their mood has improved.’ But this isn’t everyone’s experience; for some, it can work in reverse.
Then there’s also the fact there are so many other potential causes of better mood, from diet to sleep, so I can’t say for certain that my improved sense of wellbeing was down to coming off the pill. Still, if you’re struggling with low mood, it could be worth exploring.
5. My libido went up
My biggest surprise was that my sex drive shot up. Drastically. While I had generally only experienced desire responsively, suddenly I noticed I was capable of that out-of-the-blue horniness I thought only men experienced.
This might be because some data suggests that high progesterone levels can suppress libido. But, again, Dr Arif says, ‘libido is a very difficult one to measure because it’s as much about mood and experiences as it is about physical symptoms.’
Dr Patel explains that libido is influenced by many complicated factors as well as age, general health and medications and that there is no clear evidence of an association between use of the combined pill and libido. Some studies, she says, have found an increase in sexual desire in those taking it; others have found a decrease.
6. The pill could be masking gynaecological issues
Being confronted with my painful periods led me to seek answers about whether there was anything more worrying going on. Thankfully, blood tests and scans didn’t suggest anything was amiss, so I’ve been prescribed stronger painkillers for my periods which have really helped. But for many women, their period or PMS problems could be signs of something else, like PCOS or endometriosis.
‘I understand concern about whether the pill could be masking symptoms,’ says Dr Patel. ‘But even if the painful periods were being caused by endometriosis, for example, the combined pill is a good first line treatment for this condition.’
For more information about contraception, Dr Nighat Arif recommends checking out the resources on Brook.