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Did my contraception affect my fertility?
Yvette Smith, MD, MPH posted:
We spend years worrying about unplanned pregnancy, fearing that our contraception efforts might fail; now that we WANT to get pregnant, we worry that that our contraception efforts may have worked too well. Could there be long-term effects of contraception that might be keeping us from conceiving? Let's review them briefly and put your mind at ease.

1. Combined hormonal methods (e.g. birth control pills, the patch and the vaginal ring). These methods are all similar and do not have any long term impact on fertility. We expect your periods to have returned to your normal cycle (whatever that means for you) within 3 months of stopping all of these methods.

2. Progesterone only methods (the progesterone only pill, the 3 month shot, the 3 year implant). We also expect these methods to wear off in 3 months. The shot is a little different in that it is 3 months after the next shot is due (since each shot works for 3 months, this would be 6 months after the last shot). Again, no long term impact on fertility

3. Intrauterine device (IUD). The IUDs currently on the market in the US have a wonderful track record with regards to fertility (which has not the case years ago with an IUD that is no longer available). Although fertility may be present immediately with either of the two IUDs currently available, it would be reasonable to expect the progesterone based IUD to take about 3 months to clear your system as well

4. Diaphragms, condoms and spermicides. These methods are only effective when you use them so fertility is immediately restored when you do not use them. Condoms have the additional benefit of protecting against sexually transmitted diseases as well.

So where are the concerns regarding fertility? Some of these methods protect wonderfully against pregnancy but offer no protection against sexually transmitted diseases, the real villains with respect to fertility.

For most women, the transition from their birth control method to trying for pregnancy should be fairly smooth. Has that been true for you? What bumps in the road have you encountered?
WaterLillie responded:
I have been off the pill since February (6 months) and still do not have a normal cycle. I was on the pill for 12 years, and before I went on the pill, I had regular cycles. I have only had four periods since February (and one was still pill-induced right after I quit taking it). I have even gone 70-some days between periods! This is getting very frustrating in terms of trying to predict ovulation. I am wondering if my abnormal cycles are due to being on the pill for so long?
Yvette Smith, MD, MPH replied to WaterLillie's response:
I would say beyond frustrating! In order to be valid, medical studies have to look at large groups of people. The studies say that being on the birth control pill does not cause irregular periods or infertility. Could you be the exception that makes the rule? Sure, but we'll never be able to prove that.

Generally the pill covers up what your body is doing. It doesn't alter your body's long term process. Eggs aren't saved or used any faster. Things seem to march along in the background along what may be a predetermined course. We simply don't have to watch it while we are on the pill. But when we come off of the pill, we are at a new point in our lives, in your case, a point 12 years down the road.

A couple of things cross my mind at this point. First, is the pattern improving? Was the 70 day cycle immediately after you came off the pill and now the cycles seems to be closing closer to 30 days? People can be very irregular the first month or two off of the pill and then begin to stabilize.

If you haven't done it already, you should see your physician. There are sometimes correctable explanations (e.g. thyroid disease) that can cause irregular periods. Blood work can often sort things out. The pill can cover up these conditions by forcing a regular period even in the face of medical problems.

Age may also be a concern. If you started the pill in your teens, then age is probably not a huge factor. If instead you are now in your late 30's your age may be playing a role in your irregular periods. Again, you want to review these irregular periods with your physician and be sure they understand that part of your concern is trying for pregnancy so they can incorporate that information into your counseling.

How has your health changed in the 12 years? How has your life changed? Have you gained weight? Lost weight? Become involved in a strenuous exercise program? Are you very stressed right now about work, the economy, your personal life? All of these things can play a role in the regularity of periods. Again, review all of these issues with your physician.

Good luck and let us know how you fare.
Emma_WebMD_Staff responded:
Thanks Dr. Smith, birth control is such a common topic. Just a quick poll: What type of birth control were you on before you started to TTC? How long have you been off your birth control?
sammie3960 replied to Emma_WebMD_Staff's response:
I am currently dealing with this issues as well. I was on Yasmin for a few years, and then I switched to Seasonique when I was diagnosed with endometriosis in my early twneties after a laproscopic procedure. In total, I was on birth control before my husband and I decided to start trying to conceive in late June.

It is now early September, and I have had two periods: one, right after stopping the pill (pill-induced) and then one 29 days later. I am now on day 43 of this cycle, and I am still waiting for my period. I have taken two pregnancy tests, and they have both come back negative, so I am pretty positive that I am not pregnant. I know it is early for me to be too worried, but the fact that I have endometriosis makes me feel like I need to do everything I can to get pregnant immediatly in case the endometriosis starts to make it difficult to conceive.

Should I see my doctor to find out if there is anything that I can do to regulate my periods? Should I be on fertility drugs since I do have a condition that may affect my chances of conceiving?
Yvette Smith, MD, MPH replied to sammie3960's response:
I would check in with your physician and share your concerns. Our general advice is to return to the office if your cycles have not regulated within 3 months of stopping your hormone birth control method (pills, patches, ring, shot, implant or intrauterine device) They may want to do some basic hormone testing. They should be able to come up with a plan to help.
ginkotrock responded:
Irregular spotting and short cycles after Mirena I... I am 34 years old and 5 months ago I had the IUD removed as we are ttc our 4th child. I... Posted by Anon_73389 I am 34 years old and 5 months ago I had the IUD removed as we are ttc our 4th child. I had the IUD for 3 1/2 years and bled for the first 6 months then no more cycles for the remaining time I had the IUD. After it was removed I have had my cycle every 28 days but it has been very short, only about 2 days long and I have had random spotting through out the rest of the month. Not sure what is going on. Would like to have another child but with such weird things going on I'm begining to think that is not an option. My prior 2 children were delivered by c-section, perhaps having an IUD put in after c section can have bad results? I'm not sure what is going on but I am concerned that I am no longer able to have children.
Yvette Smith, MD, MPH replied to ginkotrock's response:
I wonder most about the spotting through the rest of the month. Go in and see your physician. They will probably want to do an exam to look for obvious causes of irregular bleeding. They might want to blood work and/or an ultrasound to try to understand your bleeding pattern.
wiza2cute responded:
I really appreciate the info Dr. Smith. It put my mind into a little ease. Here is my question. I had the Mirena for 3.5 years, during that time I had no cycles what so ever. I had it removed on 10/12/2010 and had absolutely no bleeding during or after the removal. I have been getting abdominal cramps that were similar to my PMS cramps prior to the Mirena, but no bleeding what so ever. My husband and I would like to concieve another child, but I am worried is something wrong for not having cycles so far? and why the cramping?? When I had PMS cramps before, they lasted few hours and then I would see my menstural flow but thus far nothing just terrible cramping. I did a pregnancy test as my mind was taking me to tubal pregnancy etc and it was negative yesterday 10/27/10. I would appreciate your input & again thanks for taking time to answer our questions.
karebear_04 replied to wiza2cute's response:
Dr. Smith, thank you for all of your information, but I am still worried about my fertility and if I am ovulating at all. I was on depo-provera for almost 8 years and then switched to birth control pills in 2009. I went off the pills in February 2010 and did not have a cycle until July 2010. Which was irregular as I started another cycle within a week of this one ending. My cycle seems to be coming about every 18 days now, which still seems irregular to me. My OB does not seemed concerned about the length of my cycle, but I am as my husband and I are trying to conceive our first child. I am wondering if an 18 day cycle is normal and if I could ovulate during that time or not? I have tried ovulation predicting tests since August and they all come back negative. I am not using the test correctly? I would greatly appreciate your thoughts on this. Thank you for taking time out to answer questions.
Airy2291 responded:
Dr. Smith I am worried about my fertility and if I am ovulating at all. I was on Depo-Provera for4mos.startedApril2009and did not have a cycle until July 2010. I now have my cycle every 27days. My husband and I would like to conceive a child. We've been trying forA year. I would appreciate your thoughts on this.
Airy2291 responded:
Dr. Smith I am worried about my fertility and if I am ovulating at all. I was on Depo-Provera for4mos.startedApril2009and did not have a cycle until July 2010. I now have my cycle every 27days. My husband and I would like to conceive a child. We've been trying forA year. I would appreciate your thoughts on this.
tonka12 responded:
I had the mirena IUD in place for a little over 4 years, when i went to get it removed the doctor advised me that the strings were not visible. I had an ultrasound and they located the IUD, however, when they went to do the removal they were not able to fish it out.... end result being done by D&C. My husband and are are trying for our second child and i was wondering if the D&C or the birth control would have and effect on conception, and what the expected time frame would be on being able to conceiving afterwards?

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