A question we often hear is whether there are negative consequences for fertility from long-term use of hormonal contraceptives like the pill. This is a very reasonable concern since most women spend most of their years prior to menopause trying not to get pregnant. Contraception is a tremendous health benefit for women, as well as a social benefit, allowing individuals to delay and plan pregnancy around educational and career goals.
The good news is that contraceptives (the pill, the patch, the vaginal ring, IUDs) do not negatively impact future fertility. Hormonal birth control methods like the pill, patch and ring contain very low levels of hormones (ethinyl-estradiol and a progesterone-like medicine) that work primarily by affecting mucous within the cervix to make it too stiff for sperm to penetrate, enter the uterus and tubes and cause fertilization. Stopping ovulation, or release of an egg, also can occur, especially with higher dose methods (the Depo Provera shot, for example). The return to baseline fertility is rapid once the pill, patch or ring is stopped (or an IUD is removed) and generally we don’t recommend stopping them far in advance of trying for pregnancy. Decades of careful contraceptive research have shown them be safe and don’t cause infection. However, women should still protect themselves against sexually transmitted infections; contraceptives (except for condoms) aren’t really effective for this.
The flip side of this good news is that the pill (and patch and ring) don’t protect a woman’s fertility – they don’t delay the effects of age on fertility, save eggs or change a woman’s underlying pattern of menstrual bleeding (which can be a bother with fertility all on its own). We know age, prior infections, prior surgery on the reproductive tract or menstrual disorders can interfere with becoming pregnant. These are good things to talk to your doctor, midwife or nurse practitioner about.