Are you really at risk from your hormonal contraception?

Andrea isn’t alone; a 2018 study from Contraceptive Reproductive Medicine reported that “fertility after termination of contraception remains a big concern for women”. But what is the risk? 

“The only contraception that can affect fertility is the injection, which can delay your return to baseline fertility by up to 12 months. Women should be counselled for this before they start,” explains Dr Yarlett. After stopping all other forms of hormonal contraceptives, your fertility should return within three months, she says. 

“After six months, if your cycle hasn’t returned to normal, we would start to investigate. The really important thing is that it’s your baseline fertility that is restored, meaning the same fertility you had before using contraception. If your cycle doesn’t regulate or you don’t become pregnant, it’s not likely the contraceptives’ fault but more that there was an underlying women’s health issue that hormonal contraception was either masking or treating,” adds Dr Yartlett.

According to research, contraceptives can actually improve fertility for certain women, like those with endometriosis, where the lining of your uterus grows outside of your womb. “Going on combined oral contraceptives after having surgery to remove endometriosis tissue can stop it from growing back and causing problems with fertility,” Dr Yartlett explains. 

When should I stop taking hormonal contraception?

Rachel* has just gone back on hormonal contraception at the age of 39. “With PCOS and endometriosis, I needed some control and regularity in my life. I had to get the contraceptives from an online pharmacy as my GP felt I was too old so I am a bit worried, but I don’t know what other option I have,” she says. 

In general, hormonal contraception is fine to take until our 50s, says Dr Yartlett. “If you are fit and healthy with no medical or family history you can continue combined contraception until you are 50 and be on progestogen-only up to 55,” she says. “It’s actually a really good option for many people experiencing peri-menopause symptoms, so it’s not something to be dismissed.”

However, there are individual risk factors to consider as we age. “We may have discussions with you about the risks and benefits of certain contraceptives like the injection, which can affect your bone density. After the ages of 50 and 55, research suggests that the risk of being on it starts to outweigh the benefits, as the chances of cardiovascular disease and blood clots increase naturally and the likelihood of pregnancy massively declines. It’s a very individualised decision requiring in-depth discussions and health checks with your doctor,” says Dr Yartlett. 

What to do about hormonal birth control? 

For so many women, years on hormonal contraception help them get through life without pregnancy and pain. But it’s not that clear-cut for many women. The biggest and most real risk seems to be to women’s mental health, which is a huge problem when mood disorders are largely dismissed. 

Whether or not this makes you want to come off or avoid contraception is personal. “You should have a check in with a doctor after three months on contraception to talk about any problems, rather than persevering, and you can always book further assessments if you require,” says Dr Bowring.