Contraception, or the prevention of conception, enables couples, especially women, to avoid unintended pregnancies, plan their pregnancies according to their priorities and ambitions, or avoid subsequent pregnancies. When used effectively, several techniques can assist people in managing their choices for pregnancy and reproductive health. Making an informed decision requires a thorough awareness of these techniques, possible adverse effects, and the discontinuation procedure. We spoke to Dr Pruthviraj MO, Consultant - Obstetrics And Gynaecology, Manipal Hospital, Varthur and Whitefield, who explained birth control cessation, its types, factors for discontinuation, and fertility restoration.
Types of Birth Control Methods
According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development, various forms of contraception exist, each suited to specific situations. The most suitable birth control method varies based on factors, such as an individual's overall health, age, frequency of sexual activity, number of sexual partners, future childbearing desires, and family history of certain diseases.
Dr Pruthiviraj listed the types of birth control methods as follows:
- Abstinence: Refraining from sexual activity
- Calendar method: Avoid intercourse during ovulation or fertile window
- Coitus Interruptus or the withdrawal method: Withdrawing before ejaculation
- Barrier Methods: Condoms, cervical cap, sponge, diaphragm
- Oral Pills: Combined oestrogen and progestin pills or progestin-only pills
- Subdermal Implants: Etonogestrel or levonorgestrel implants
- Injectable: Depot Medroxyprogesterone Acetate (DMPA) is administered every three months
- NuvaRing: Hormonal vaginal ring
- Spermicides: Chemical agents to kill sperm
- Long-Acting Reversible Contraception (LARC): Intrauterine devices (Copper-T or levonorgestrel) or hormonal implants
- Irreversible Methods: Vasectomy for males, tubal ligation for females
Factors Affecting Birth Control Effectiveness
Here are some factors that affect your birth control effectiveness, as listed by the expert:
- Calendar Method: Effectiveness may be reduced due to irregular menstrual cycles
- Withdrawal Method: Risk of pregnancy if semen comes in contact with the vagina or external genitalia
- Barrier method: Improper technique of using the barriers (condoms, cervical cap, sponge, diaphragm) or damage (tears or holes before use)
- Oral pills: Missed doses
- Subdermal implants, NuvaRing, Injectable: Duration of use, hormone release rate, other medical conditions or medications, and body weight and composition
- Intrauterine devices and implants: Improper placement or shift in the position
Reasons for Discontinuing Birth Control
Here are some reasons for discontinuing birth control listed by Dr Pruthviraj:
- Copper IUD: Irregular bleeding, pain, infection, expulsion, perforation
- Oral Pills: Nausea, vomiting, breast pain, weight gain, abnormal lipid profile, abdominal pain
- Condoms: Reduced sensation, risk of breakage leading to unintended pregnancy
- Spermicides: Increased risk of vaginal and urinary infections
- Injectable DMPA: Irregular bleeding patterns
Understanding Fertility and Birth Control
“Birth control pills are of two types, namely Progestin-Only Pills (POP) or combined pills. Irrespective of combined or POP, these pills regulate hormone levels to prevent ovulation”, said Dr Pruthviraj.
He added, “Combined pills prevent pregnancy by suppressing FSH and LH release, the gonadotropins inhibiting follicle maturation and ovulation (release of egg), without which there would be no fertilisation and hence no pregnancy. Progestin-only pills act by thinning the endometrial lining, reducing the chance of implantation.”
Potential Timeline for Fertility Restoration
After stopping birth control, individuals should be aware that they may become fertile again relatively quickly, especially if using non-hormonal methods or progestin-only contraceptives. “However, it may take longer for fertility to return after discontinuing certain hormonal contraceptives like combined oral pills, as the body needs time to readjust hormone levels and resume regular ovulatory cycles”, said Dr Pruthviraj.
- Combined Pills: Ovulation may resume within 1-3 months, with a high likelihood of pregnancy within a year
- Progestin-Only Pills: Ovulation may resume within weeks, potentially leading to faster conception
How Birth Control Affects Fertility
Dr Pruthviraj highlighted, “Birth control techniques can thin the uterine lining, change the consistency of cervical mucus, or suppress ovulation. The body returns to its normal reproductive processes and fertility after cessation of birth control.” The timeframe for fertility restoration may differ based on things like the kind of birth control taken and personal physical and medical characteristics.
Pregnancy Planning
It's critical to understand the possible effects of prior contraceptive use on fertility and reproductive health for anyone thinking about getting pregnant. Speaking with a healthcare professional can assist people in creating a customised conception plan that addresses all underlying fertility issues, optimises timing, and ensures overall reproductive health.
Couples encountering challenges with infertility can engage in discussions with a fertility specialist to explore diagnoses and available treatment alternatives, as stated in the University Reproductive Associates (URA).
[Disclaimer: This article contains information provided by a registered healthcare professional and is for informational purposes only. Hence, we advise you to consult your expert before using or stopping birth control methods.]