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Ever since I can remember, I’ve been a planner. As a kid, I loved laying out Osh Kosh B’Gosh clothes and velcro sneakers for school the next day. These days, everything from date night to deadlines is in my Google calendar. While some may call me “type A,” don’t get me wrong: I love a little spontaneity, particularly when it comes to travel and ice cream flavors. Plus, I’m no longer picking out clothes for the next day, which earns me some points for flexibility…right?
When it comes to major events, whether it’s starting a family or a company, I’m an advocate of planning. Learning more about my fertility has helped me plan when I’d like to have kids. But I can’t help but dive into the logistics, too. What does starting a family in the next three to five years mean in terms of birth control? When should I get my IUD removed? A year before we want to start trying? A month? Once it’s outta there, how long will it take for me to get pregnant? If we’re talking years or months, we may want to shift the plan.
I sat down with Dr. Leah Millheiser, an OB-GYN and Clinical Assistant Professor at Stanford Health Care, to learn more about the logistics (yep, the nitty gritty) of getting off of three popular types of contraception when you’re thinking about starting a family.
But first things first
No matter what form of contraception you’re on, Dr. Millheiser recommends patients begin taking a prenatal vitamin three months before they start trying to conceive. Here’s an example: Say you’re on birth control pills. It’s June 1. You and your partner have decided to start trying to get pregnant in September. So, you’d want to start taking a prenatal now. If you happen to get immediately pregnant in September, you’ll have the nutrients needed to support the baby already well-stocked in your system.
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Oral contraceptives (AKA the pill)
If you’re on the pill, Dr. Millheiser says that for most women, it takes anywhere from zero to six months for ovulation to come back after stopping birth control pills. This can vary from person to person. Quick refresh re: ovulation: Ovulation is when the ovary releases an egg to potentially get fertilized by a sperm. If this doesn’t happen, the egg gets shed along with the lining of the uterus in the form of your period. The point being: Ovulation must occur in order to naturally conceive. The estrogen in most birth control pills works to suppress ovulation, hence pregnancy.
Here’s exactly what to do when you’re thinking about starting a family: “I recommend to stop taking birth control pills three months before you actually want to start trying,” says Dr. Millheiser. Using the example above, this means you’d stop taking birth control pills in June (but start taking a prenatal). Since you want to wait until September to start trying, you could use a backup form of birth control, like a condom, until then. You have three months to try and get your body back to ovulating by September.
“You don’t necessarily know what your individual body will do in terms of getting your cycle back,” adds Dr. Millheiser. “So why not stop taking pills three months beforehand and see what happens?” You could get pregnant immediately in September. At the very least, you’ll be three months ahead of where you’d be if you didn’t stop taking the pills until September.
In 2013, researchers reported that oral contraceptives users experienced a temporary delay in time to pregnancy (TPP—yes, there’s an acronym for that) compared to those discontinuing barrier contraception methods like condoms. “But after that, monthly fertility rates are comparable to those of women stopping other methods of contraception,” says co-author Elizabeth Hatch.
Good news if you’ve been poppin’ that pill for a long time: The researchers discovered that longer-term use of oral contraceptives actually improved the likelihood of pregnancy. Women who had taken the medications for more than four or five years had higher pregnancy rates than those who had used them for less than two years. Here is the doctors’ final conclusion from the official study: “Women who have used oral contraceptives for many years should be reassured as there was no evidence that long-term oral contraceptive use has deleterious effects on fecundability. Both short and long-term oral contraceptive users are likely to experience a transient delay in conception compared with those discontinuing barrier methods.”
The ParaGard is the non-hormonal IUD that relies on copper, which is toxic to sperm, to prevent fertilization. But similar to hormonal IUDs, the ParaGard device itself creates uterine inflammation that works to inhibit egg implantation and pregnancy, should an egg happen to get fertilized. Since the ParaGard is non-hormonal, individuals still menstruate and ovulate when using this IUD. Unlike birth control pills and hormonal IUDs, this means there’s no real “waiting around” to see when your body returns to normal. “Your cycle should just continue after getting the ParaGard removed,” adds Dr. Millheiser.
According to Dr. Millheiser, this means you can probably keep your ParaGard in place until the month before you start trying to conceive. However, make sure to still start taking prenatal vitamins three months before trying to conceive. Like hormonal IUDs, removing the ParaGard will require a trip to doctor’s office.
There aren’t many published studies on pregnancy after removing the ParaGard. Here’s what we did find: In a 2015 study published in the European Journal of Contraceptive and Reproductive Health Care, researchers recruited 69 former IUD users and 42 former non-IUD users. Of the 69 former IUD users, 50 used the ParaGard. All of the women (aged 18 to 35) had recently stopped birth control because they wanted to conceive. After a year, 81 percent of former IUD users became pregnant. Though the results don’t compare pregnancy rates between former hormonal and ParaGard IUD users, nearly 75 percent of the former IUD users had the ParaGard. Therefore, we can assume that many of the former ParaGard users were able to get pregnant in a year.
“People who have been on a hormonal IUD like the Mirena, Skyla, or Liletta tend to start menstruating more quickly again compared to those on the pill,” says Dr. Millheiser. “It usually takes anywhere from one to three months for individuals to resume. Most of my patients say they get their period back after about a month.” (One note: not all hormonal IUD users stop menstruating.)
Dr. Millheiser hypothesizes this may be because birth control pills are a systemic form of contraception while IUDs are a localized form. By swallowing birth control pills, hormones are released into your system (hence the term “systemic”) and get into your bloodstream. IUDs, on the other hand, are devices that sit in your uterus. Some hormones from an IUD may get into your bloodstream, but comparatively little.
It’s important to keep in mind that while some people stop getting periods while using an IUD, ovulation still happens in the majority of cycles. This could be another reason it takes less time for those with hormonal IUDs to get their cycle back on track compared to birth control users. Dr. Millheiser explains that the reason you may not have a period (or only have spotting) is because the hormone progesterone in the IUD causes the lining of the uterus to thin. This means there’s nothing or very little to shed each month. But again, your ovaries still release an egg and ovulate. A hormonal IUD just makes it difficult for sperm to fertilize the egg by creating a thick barrier of mucus in your cervix and preventing the buildup of the uterine lining in your uterus, which is how it works to prevent pregnancy.
Dr. Millheiser still recommends removing a hormonal IUD three months before you start trying to conceive. Getting your IUD removed isn’t quite as simple as no longer taking a pill when that daily phone alarm goes off. Just like when you got your IUD inserted, you’ll need to set up an appointment with your gynecologist to get it taken out. Your doctor will pull on the IUD strings to remove it from your uterus. (I’m personally not looking forward to it.)
The previously mentioned 2015 study revealing that former IUD users and non-IUD users had similar pregnancy rates is also relevant for hormonal IUD users, too. However, only 17 of the women used a hormonal IUD (compared to the 50 who used the non-hormonal copper IUD). But a 2011 report, focused on reviewing the available literature on hormonal IUDs, states, “After removal of the intrauterine system (IUS), normal fertility is regained after a few months, with a near-normal 80 percent of women able to conceive within 12 months.”
Getting actionable insights like this from experts and clinical studies makes me feel like I’m in the driver’s seat of my own life. After talking with Dr. Millheiser, I know to get my Mirena taken out three months before my partner and I want to start trying to start a family. I should start popping a prenatal at this time, too, to properly care for a little one before they’re even there.
I realized that learning this type of information isn’t necessarily just for type A, logistics-obsessed folks like me. Even if I wasn’t much of a planner, knowing is often better than not knowing, guessing, or wondering, especially when it comes to making choices that impact your health and life (and the life of your future baby).
Dr. Jane van Dis is an OB-GYN, co-founder and CEO of Equity Quotient, and Medical Director for Ob Hospitalist Group.