jennielowellMD

Thank you for this great review. As an obgyn I have one comment regarding telling women to stop their birth control for 3-6months before conception. I don’t think this is always medically wise and certainly not always medically necessary. For instance, for women with polycystic ovary syndrome, I tell them to stay on their oral contraceptive pills up until the second they are ready to conceive. We know that women with PCOS, because of changes in sex hormone binding globulin (SHBG) production that positively effects their hormones, often have a ‘honeymoon’ phase of 3-4 months after coming off the pill where they are most likely to spontaneously ovulate and conceive. After this ‘honeymoon’ phase is over and SHBG goes back to normal, they will likely go back to irregular ovulation and cycles. Not to mention, if women are having very irregular cycles where they aren’t regularly ovulating and shedding their lining, this can lead to endometrial hyperplasia ( a precursor to endometrial cancer). Staying on your birth control until you are ready to conceive protects from endometrial cancer and may lead to better chances of getting pregnant in the few months you come off of it.

In addition, for my women with terribly painful menses, due to endometriosis or other, I want them to be pain free as long as possible- don’t come off your birth control that is working to keep you pain free and free of heavy bleeding (which can lead to anemia), until you are ready to get pregnant! If your birth control is suppressing endometriosis, this is a good thing! Don’t come off of a med that is suppressing your endometriosis until you want to get pregnant.

Also, many women want to enjoy life (ie hot tubs, alcohol, saunas, travel, attending big life events, etc) without worrying about exposing a potential fetus to these things. Stay on your birth control until you are ready to conceive to not worry about becoming pregnant before you are ready.

With all pills, IUDs, nuvaring, the birth control patch, and nexplanon- fertility should resume to normal within a month, if not less depending on where you are in your cycle when the method is stopped. The one exception to this is depo provera, where it can take 6 months to resume ovulation. That may be the one exception to considering birth control cessation far ahead of conception attempts- but here you might also consider switching from depo provera to another more reversible method until you are ready.