The first time I stopped taking the pill after breaking up with a long-term, live-in boyfriend, I assumed nothing much would change except that I’d stop having to stress about forgetting to pick up my prescription. Then, my next period came. The main thing I remember now is the volume of blood. Carrie-at-the-prom levels of blood. Waves-pouring-out-of-the-elevator-in-The-Shining amounts of blood. Rick-Grimes-after-a-Walking-Dead-killing-spree kinds of blood. You get the picture. I seriously thought I might be hemorrhaging.
I wasn’t, and the bleeding lessened as time went on. But it turns out this is a not-uncommon occurrence after going off the pill, according to Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology at Yale University School of Medicine. And a deluge of blood is not the only thing that can happen.
Read on for everything you need to know about the unexpected side effects of going off the pill.
Any heavy bleeding (if you had it before) will come back.
I didn’t specifically go on the pill to curb those seriously heavy periods I’d had since junior high (though some people do start taking it for just that reason). But when I started taking it, I was thrilled to notice that not only was my flow much lighter, but my periods were days shorter, too.
That’s because the pill suppresses ovulation (as do the contraceptive ring and patch); when you stop taking those little tablets, ovulation resumes, and so can any fluctuations or quirks that accompanied your unfettered menstrual cycle in the past. “If people had funky periods before the pill, they may go back to the funky things that happened,” Dr. Minkin says.
You might feel much more interested in sex all of a sudden.
True, there is something totally liberating about being on the pill. You know you can hook up any old time you want to without having to worry about getting pregnant or even stopping to find a condom (if you’re with an exclusive partner you trust, of course). But physiologically speaking, birth control pills can significantly decrease the level of testosterone in your system, leading to a drop in your overall desire for sex, according to a 2006 study published in the Journal of Sexual Medicine. So, when you stop the pill, you might notice an increase in libido. In some women, it’s a very noticeable increase, whereas in others the effect isn’t strong enough to register.
Your breasts may feel swollen and tender.
“When you’re on the pill, one of the nice things is that it controls your progesterone and estrogen levels,” Dr. Minkin says. When you’re ovulating again, though, progesterone and estrogen are allowed to flow freely through you once more, preparing your body each menstrual cycle for the possibility that you might become pregnant. Part of that is getting your boobs ready to produce and release milk — and a common side result is a painful, or at least noticeable, tenderness or soreness. Experiencing this doesn’t mean you’re knocked up, necessarily. But it does reflect that your body is ready to kick into action if you do get pregnant.
Or you might feel bloated all over.
If you feel like you’re puffier or more gassy after going off birth control, you’re not necessarily imagining things. “The progestin in some pills, drospirenone, is a diuretic,” Dr. Minkin explains. “It gets rid of fluid weight.” These pills include popular brands such as Yasmin and Yaz. It stands to reason, then, that once you’re no longer popping drospirenone, you’re potentially more likely to retain water. (Awesome.) If that’s you, it might help to follow the standard advice docs give for combatting bloating: Hydrate often (but with flat water, not carbonated, which can cause gas) and cut back on salt and artificial sweeteners, which can make the bloat worse.
You learn ovulation cramps are a thing.
Ever noticed a little ache, pang, or sharp pain on one side of your lower abdomen in the middle of the month? It’s called mittelschmerz, which, in German, means “middle pain.” Clinically speaking, it’s a feeling that’s caused during ovulation when the egg emerges from its follicle. (Quick primer if you need it: You have two ovaries, one on each side of your uterus, and they take turns dropping an egg each month.) I now get this sometimes, and it’s freaky but also kind of cool to know what’s happening.
The other thing that can happen (and may feel similar) is the development of an ovarian cyst. These fluid-filled sacs can form on the outside of one of your ovaries after you ovulate; most of the time they cause no symptoms. But if the cyst is large enough, you may feel some pelvic pain before your period starts or right before it ends. The good news is: Ovarian cysts usually go away on their own.
Since the birth control pill stops you from ovulating, these are only things you’ll experience once you’ve stopped taking it.
Your skin might break out for a while.
Bad news if you were prone to zits before you went on the pill: They’ll probably reappear when you go off of it. “When you’re on the birth control pill, your ovaries aren’t making significant testosterone,” says Dr. Minkin. “Testosterone can be skin-unfriendly” — which, she adds, is “why guys get more zits than girls, generally.” So you may notice your skin gets worse when you stop taking the pill. This is especially true for people who were on one of the only three birth control pills approved by the U.S. Food and Drug Administration (FDA) to treat acne — Estrostep, Ortho Tri-Cyclen, and Yaz.
Your menstrual cramps will return.
Some women are lucky enough never to suffer from period cramps (which can occur when the muscles of your uterus contract to help shed its lining, and are totally different from mittelschmerz). Women who do get cramps usually get to kiss them goodbye after going on the pill. That’s because taking it causes your body to produce less of the hormone-like substances called prostaglandins, which are responsible for those painful uterine contractions. Stop taking the birth control pill, and you’ll start ramping up production of prostaglandins again — and likely ramping up that monthly pain, too.
And actually, your periods in general might become more erratic.
“The pill tends to produce regularity,” Dr. Minkin says. That tends to mean regular timing of your periods every month (both in terms of when they start and how long they go) and consistent flow each period. Go off of the birth control pill, and you could experience the opposite of this, especially at first: erratic period frequency, unpredictable differences in how many days each cycle lasts, and unexplained spotting between periods. These irregularities often go away the longer you’ve been off the pill, but they don't always.
On top of that, it’s not abnormal for your periods to change over time. So after some time on the pill, you might notice new things once you’re off it because the pill was basically masking those changes. That's why when a patient wants to stop taking it, Dr. Minkin often asks, “Do you remember how crummy your periods could be? I want you to stop the pill, use condoms, and see what your period is like. If it’s terrible, just [go back to] the pill.”
Your mood may feel off for a bit.
Dr. Minkin says that some patients do complain about moodiness after quitting the pill. And this makes perfect sense when you think about it. On top of a sudden hormonal change, suddenly dealing with cramps, bloating, and PMS again is enough to make anyone a little testy. (However, that’s not universally true; other women experience annoying mood changes while on the pill, in response to an influx of progesterone, Dr. Minkin says.) Plus: The prostaglandins that are tamped down by the pill can also lead to bloating, diarrhea, and general abdominal discomfort, which are all great triggers for feeling like general crap.
You might develop fibroids.
Fibroids are benign tumors that grow in and around the walls of the uterus. Though no one’s 100% sure why they grow, they can be genetic and may be hormone-driven. According to Dr. Minkin, it’s totally possible that you could have a fibroid that is kept in check by being on the pill; go off the meds, and that fibroid could start rearing its ugly head.
Many times, fibroids remain small and show no symptoms, but sometimes they can cause issues such as heavy bleeding or painful periods. They can also get as big as a grapefruit (or bigger). If you’re displaying common signs of a fibroid, talk to your gynecologist; he or she can order an ultrasound to check. If you have one, the doc will talk to you about the best treatment, which could be a hormonal medication (like, yes, birth control) or a minor surgical procedure to remove the fibroid.
Pregnancy is an immediate possibility.
Fertility is hard to predict, but the perception persists that it can take a while before you’re totally fertile again after going off the pill.
The truth, however, is that while it may take some time to get pregnant (regardless of the birth control method you've been using), pregnancy should be considered an immediate possibility as soon as you stop taking your pill, Dr. Minkin says.
This is exciting if you're currently trying to conceive, but if you’re not, do not go sans birth control for even a second after you’ve dropped your pack. Condoms are a good option in the immediate aftermath, but you might also want to consider a long-term option, such as an IUD, if you’re years away from wanting kids.
The bottom line: It's good to be prepared, either way.
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