Coming Off the Pill: How Soon Can You Get Pregnant?

You have taken the last pill in the pack, and one question is already going round your head: can I get pregnant straight away, or should I wait for my body to 'clear out'? Good news: after coming off the pill, you can get pregnant very quickly, sometimes in the very first cycle.

How long it takes depends mostly on the contraception you were using. Pill, coil, implant, patch, ring or injection: here is what happens with each, what to expect from your periods, and what is worth doing before you start trying.

Does fertility come back straight after the pill?

In the vast majority of cases, yes. The pill blocks ovulation while you take it, but its effect ends with the last dose. British medical sources (Patient.info, reviewed by a GP) find no significant delay in the return of fertility after the combined or progestogen-only pill.

A large study published in the BMJ, run by Boston University's school of public health with nearly 18,000 women in Denmark and North America, adds a useful nuance. On average, it takes about 3 cycles after the pill for fertility to reach its usual level. That is not a period of infertility: the first cycles are simply a little less favourable on average.

Coil, implant, patch, ring, injection: the delay by method

Not every method behaves the same way. Here is what the BMJ study and Patient.info report.

The injection is the only real exception. The authors explain it by its prolonged effect on ovulation. Patient.info adds that this delay, which can reach a year after the injection wears off, does not depend on how many years you used it. If you plan to conceive within the year, talk to the doctor who prescribes it: they can suggest another method in the meantime.

How long you used the method does not matter. After ten years on the pill or two coils in a row, the BMJ researchers conclude that the effect on future fertility is small or nil. What weighs most on the delay is your age when you start trying, as we explain in our article on fertility and age.

Irregular periods after stopping: is that normal?

Yes, at first. The first bleed after your last pill is not a true period but a withdrawal bleed, caused by the drop in hormones. Your 'natural' periods come afterwards. According to Patient.info, your cycle can take up to three months to find its usual rhythm.

During that time, cycles may be longer or shorter. A normal cycle lasts 21 to 35 days, the Quebec guide Mieux vivre points out. If your periods were already irregular before the pill, they may become so again: the pill masked your rhythm, it did not correct it. Our guide to irregular cycles and ovulation will help you find your way.

Do you need to wait before trying?

No, nothing requires you to wait. Patient.info puts it simply: a pregnancy is possible as soon as you stop, and no waiting period is recommended. If your cycles are still irregular, the start date of the pregnancy will just be a little harder to calculate; the first-trimester ultrasound can pin it down.

There is, however, one real reason to hold off a little: vaccination. According to the HAS (France's national health authority), after a rubella vaccine (often given combined with measles and mumps) you should avoid pregnancy for 2 months; after a chickenpox vaccine, effective contraception is recommended for 3 months. If you are not immune, keep your contraception until you have been vaccinated. This is one of the benefits of the pre-pregnancy check-up, described in our guide to preparing for pregnancy.

Folic acid: start now

Folic acid (vitamin B9) lowers the risk of neural tube defects in the baby, such as spina bifida. The HAS recommends prescribing it as soon as you want to conceive and continuing until 12 weeks of amenorrhoea. In other words, the right moment to talk to your doctor or midwife is the day you decide to stop contraception.

The dose is set by your doctor: according to Britain's NICE, it is higher in some situations (diabetes, epilepsy treatment, a previous child with a neural tube defect). Do not pick up a supplement at random from the pharmacy or the herbalist without advice.

How long before you should worry?

The benchmarks are the same as for any couple: see a doctor after 12 months of trying without a pregnancy, or 6 months from the age of 35. If you are coming off a contraceptive injection, the doctor will take that extra delay into account. The month-by-month odds are in our article on how long it takes to get pregnant.

In the meantime, a late period after stopping the pill may also be... a pregnancy. Before you worry, take a pregnancy test.