Post-Pill Amenorrhea: It’s Real But How Common?

birth control

Credit: Gnarls Monkey

Unlike over at Fit Bottomed Girls, where I feel like my experience and certifications allow me to speak intelligently on all things fitness, when it comes to pre-pregnancy, rocking a bump and actually becoming a mother to a mini-me, I’m a touch—okay, a LOT—less knowledgeable. So instead of me just assuming that my experience coming off the pill was normal (or not), we talked to an expert for the 411 on post-pill amenorrhea.

Dr. Samuel Wood is a leading endocrinologist and fertility expert who also serves as medical director at the San Diego-based Reproductive Sciences Center. When it comes to getting pregnant, Dr. Wood knows his stuff. (And, yes, we see the irony of his name…)

The 411 on Post-Pill Amenorrhea

  • FBM: How long should you wait after going off of the pill to try getting pregnant for optimal health?
  • SW: There is no health-related reason not to attempt to become pregnant in the month following the discontinuance of birth control pills. In fact, it is routine during in vitro fertilization cycles for women to take birth control pills immediately prior to beginning their treatment cycles. Rather than having a detrimental effect, in many women pregnancy rates are actually improved as a result of oral-contraceptive pretreatment. The only reason why a woman might consider waiting until her cycles have become regular after stopping the pill before attempting to become pregnant is to allow more accurate dating of the pregnancy since it is more difficult to determine exactly when a pregnancy began if conception occurred during a time of cycle irregularity. Given the highly accurate nature of prenatal ultrasound for pregnancy dating, however, this consideration is rarely of importance.
  • FBM: How long can it take to have a normal cycle after going off the pill? Does being on the pill for a few years versus 10+ years change this?
  • SW: The vast majority of women who do not have a history of menstrual irregularity prior to beginning the pill will resume normal cyclicity within one to two cycles after discontinuing the pill. There is such a minimal effect of prior oral contraceptive use that 50 percent of women who attempt to become pregnant after stopping the pill are able to do so within three months. There is some evidence, albeit limited, that women who have taken the pill for many years may have a higher rate of irregularity following the cessation of the pill, with this incidence being as high as 5 percent.
  • FBM: How many women are affected by post-pill amenorrhea? And what is the official definition of post-pill amenorrhea?
  • SW: The official definition of “amenorrhea” (in women who have previously had menstrual periods) is the absence of menstruation for six months. The overall incidence of post-pill amenorrhea is less than 1 percent and is no higher than the incidence of amenorrhea among women who have not been taking the pill.
  • FBM: After how many months without a period should a woman go to her doctor?
  • SW: Although based on the above definition a common recommendation would be to wait six months prior to being evaluated, post-pill amenorrhea for even three months is rare enough that it is prudent for a woman to seek medical advice after that amount of time. If a woman was placed on oral contraceptives because of irregular cycles, it is very likely that she will continue to have cycle irregularity after discontinuing the pill. If she is stopping the pill for the purpose of becoming pregnant, it would be wise to discuss this issue with her gynecologist when she begins to contemplate pill discontinuance.
  • FBM: What is the treatment for post-pill amenorrhea?
  • SW: As noted above, amenorrhea due to oral contraceptive use alone is very rare, and so after a three- to six-month period of amenorrhea, a comprehensive look at all the potential causes of amenorrhea is warranted. Occasionally, however, some gynecologists will seek to “kick start” a woman’s  reproductive system by prescribing clomiphene citrate, a medication used to induce ovulation, for those women who are attempting to become pregnant.
  • FBM: Is post-pill amenorrhea becoming more common?
  • SW: True post-pill amenorrhea is probably less common now than it was in the past because of the wide use of very low-dose oral contraceptives, but it is common enough that women should be made aware of it.
  • FBM: Is post-pill amenorrhea something doctors usually discuss with their patients when discussing the pros and cons of birth control?
  • SW: It is essential that any physician who prescribes oral contraceptives inform their patients about the possibility of menstrual irregularity or amenorrhea in the months that follow discontinuance of the pill. Especially if a woman has never experienced irregular or absent period in the past, it can cause her to have substantial concerns about the possibility of a serious gynecological problem.

Thank you, Dr. Wood! And on that last one, seriously. I went a little nutty waiting…If you’re coming off the pill, be sure to talk to your doctor about what’s normal and what’s not for you! —Jenn


Comments

  1. Heather says

    This was a good article to read, about amenorreah. I never even knew about it. I am on Mirena, and have been for almost 2 years, my periods were normal all last year and now they are very very irregular, and I have never had an irregular period in my whole life. This was very good and interesting to read about, so I will know what to expect if this should occur.

  2. Joy (A Little Bit Fit) says

    Thank you so much for posting this! I had amenorrhea for six months after the pill. It was very unnerving time for me and I had no ideas what was going on. I have never taken so many pregnancy tests in my whole life. I was sure I was going to end up on one of those reality shows “I had no idea I was pregnant.”

  3. Betsy says

    I know ladies who have had this experience – and luckily who went on to have happy healthy kids :)

    I breastfeed my first, and my period just wouldn’t start up again on its own (awesome at first, but not so much when we wanted to try for a second). I had to wean and then wait three months, then I got the “kick-start” drug, and had to wait again (to avoid having twins or triplets – eek!). Sometimes our bodies just aren’t on the same page as we are, hehe.

  4. Stacey says

    Thank you so much for posting this, im 24 and i have been off the pill for almost 5 months now and still no period! I didnt think anything of it since alot of other posts online say its normal and it could take up to a year for it to come back. After reading this and finding out more about post pill amenorrhea i realize i need to have my doctor check me out and hopefully find out whats going on before it becomes a more SERIOUS problem! So again thank you, i have a doc appt this thursday.. wish me luck!! xoxo

  5. Katie says

    What a great and much-needed blog post. Thanks for talking to a doctor and telling us what you learned! I found this post pretty high up in the Google search results for the condition. I was on a low dose pill for 9 years and was “normal” before the pill, but it’s been almost 5 months, so I guess still 2 months away from officially being able to call it post-pill amenorrhea. Ladies- you should definitely go to your doctor about this to have get checked. Many women worry about not having their period, but my doctor said there’s nothing to worry about, for most women, it’s only emotionally troubling.

  6. Katy says

    I’m still so lost about this. I was on Yasmin for 6 years before deciding to go off to see how my body worked on it’s on. Glad I did, I didn’t get a period for 4 months! My gyno ordered blood work stat and put me on 10 days of progesterone to give me a period and to rule out post-pill amenorrhea due to my low weight. I got my blood work back and I don’t show any signs of PCOS, as all tests and hormone levels were normal, but she’s administering an ultrasound to rule it out. However, my LH levels were slightly low so now I’m wondering is it post-pill amenorrhea? All I know is after 6 months and no period, we made the decision to go back on Yasmin because for some reason, I’m not menstruating and that’s not healthy.

  7. Amanda says

    I am 24 years old and had irregular periods. When I was 15 my doctor put me on the bc pill. I was on it for seven years and had regular periods while on the pill. When I went to basic training I went off the pill and had my last period on the pill in Oct 2010. I didn’t have a period for the rest of basic or AIT. When I got back home I waited a few more months and went to my doctor. He had blood work done and my hormone levels are fine. He said to wait a few more months and when I did he gave me a prescription of progesterone to give me a period. I had one in Sept of 2011. I still have not had a period since. I am not overweight, never had one. I do not over exercise and I am not in a great deal of stress, just normal day to day stress. I do not have pain or any cramps or spotting. I am waiting to get medical insurance back to go to my doctor. Can anyone help me?

  8. J says

    Hi All. I am writing this to reassure those of you who need to hear something positive regarding post pill amenorhea. I am 33 years old and was so looking forward to starting a family when I came off the pill. Low and behold, I waited six long months and NEVER got a single period!! NEVER!! However, last week, on my 33 birthday, I got the surprise gift of a lifetime: I AM PREGNANT!!!! While my husband and I remain cautiously optimistic at this point (until the end of the first trimester), we at least know that we have NO PROBLEM getting pregnant. And that is a huge reason to celebrate. I vowed to myself to post about my eventual outcome with this whole ordeal, as I know how incredibly frustrating and worrisome it can feel when your body doesn’t do what it’s supposed to. But rest assured…I NEVER got a period and I got pregnant six months after coming off the pill. What’s more is that I had no idea whether or not I was ovulating (since I wasn’t getting a period). So, my husband and I were not planning at all. I never took an ovulation test or checked my temperature. We were just having fun! I really hope that my post lifts somebody’s spirits. Never in a million years did I guess this could happen to me!!! I am elated and still in shock!!! Wish me luck at my doctor’s appointment next week. I’m still holding my breath!

  9. J says

    Whoops. Forgot to say that I have been doing acupuncture and chinese herbs (with a certified TCM expert) for the past 3 months. Have no idea if my pregnancy can be partially attributed to these things, but I always believe in the potential power of holistic medicine.

  10. Maddie says

    I was on the pill for 10 years. For 12 months I had no period what so ever. While my husband and I continued to have unprotected intercourse we thought I would not be able to get pregnant as it had been nearly a year of trying and still no period in sight. I was thrilled and totally surprised to find out I was pregnant 2 months ago. I had a missed miscarriage at 8 weeks :( Following the miscarriage I had a D and C. It’s been 7 weeks since and I have not started a period. I was hoping I would as my doctor said sometimes a miscarriage can shock your body and help get my cycle to return. I really want to get pregnant but have no idea if I ever will be able to. Has anyone had a similiar problem and if so what was recommended to help induce a period and pregnancy? I also forgot to mention that I was prescribed progesterone for 10 days to induce a cycle a couple months before I got pregnant and that did not work either :(

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