Do hormonal contraceptives affect my future fertility?

Hormonal contraceptives are preparations that have been used for years as regulators of the female menstrual cycle, since they block the natural ovarian activity of women and establish an artificial cycle.

This hormonal action, initially designed to prevent pregnancy, has many other possible effects:

  • Anovulatory effect, so they have a contraceptive effect if used properly.
  • They allow the regulation of the cycle in women with irregular cycles.
  • They facilitate the control of bleeding and pain in women with heavy or painful periods, since artificial cycles generated by contraceptives tend to cause softer periods.
  • Control of pre-menstrual syndrome in women with severe symptoms such as nausea, vomiting or headaches that become disabling for their daily life. These are minimized or even disappear when the hormonal fluctuation of the menstrual cycle is vanished.

It is important to evaluate a woman’s fertility before she starts using contraceptives, since once she starts her treatment, the cycles will be regular but not indicative of maintained fertility.

It is not uncommon to find patients who have had regular cycles for years, thanks to the use of contraceptives, and who find themselves in amenorrhea (lack of periods) or oligomenorrhea (few and irregular periods) once they stop treatment to try a pregnancy. This loss of fertility, masked by contraceptives, will become apparent when suspending them and will reveal the existence of an existing problem in the woman, not caused by taking the drug.

In this case, in order to establish a reproductive prognosis, we must take into account the woman’s age, the regularity of the cycles at the suspension of medication and, fundamentally, the determination of the ovarian reserve.

Contraceptives are anovulatory, but the fact that there is no ovulation does not mean that fertility will be prolonged or that it will disappear. The recovery of fertility is usually obtained after suspending its use, in a variable period of time, depending on each woman and with a fertility level corresponding to the age of the woman at the time of suspension.

Some studies refer to a delay of 3 to 6 months in the appearance of ovulatory cycles after the use of contraceptives, although the most frequent is that the pregnancy arrives in the first year after stopping their use, in women under 35 years of age.

The most frequently used hormonal contraceptives are:

  • Contraceptive pill, which can contain different hormones and in different doses, allowing it to be adapted to each patient.
  • Monthly injectable hormonal preparations.
  • Vaginal ring.
  • Transdermal patch.
  • Subcutaneous progesterone implants.

If after stopping contraceptives the cycles are not reestablished and there is no suspicion of pregnancy, it is advisable to have a gynecological consultation to determine if there is a different problem.

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