Contraception & Fertility

We are so lucky to live in a time (and place) where we have access to a number of options for contraception. Hormonal options come in many forms and can often help in both preventing pregnancy as well as managing some hormonal symptoms (especially heavy menstrual bleeding and endometriosis). The choice for how we manage our reproduction is so individual, but coming to that decision can be complicated by misinformation on google, instagram, TikTok etc! Many worry about how the pill or IUD will impact future fertility - so let’s clarify!

Hormonal IUDs - levonorgestrel IUDs

These small T-shaped devices are inserted into the uterus and release a small amount of local hormone. They work by thickening our cervical mucous and impairing sperm motility. They impair fertilization and thin our endometrial lining - impacting implantation of the embryo. This is the main reason many experience either a lighter period - or complete lack of period. This thinning, though temporary, is one of the reasons these IUDs are prescribed to help with heavy menstrual bleeding. Once the IUD is removed, the endometrium returns to normal quite quickly - meaning pregnancy could occur pretty much right away. In fact, most studies show rates of pregnancy post-IUD after a year of trying are similar to those who hadn’t been on contraception. 

Copper IUDs

The copper IUDs don’t release any hormones and their primary action is to impair fertilization. Copper ions accumulate in the reproductive tract and are toxic to both the sperm and the egg. There is no impact on ovulation. Copper IUDs impact the endometrium - but differently from their hormonal counterparts. Copper IUDs tend to make periods much heavier (and often more painful). That said, they also tend to have a quick return to normal after removal and, with that, similar return to fertility. 

Oral Contraceptives

“The pill” is the most commonly prescribed form of contraception, with the most common type being the combined pill (with estrogen and progesterone). Progesterone is what prevents pregnancy, while the estrogen controls bleeding. The main way that the pill prevents pregnancy is through prevention of ovulation. High progesterone tells the brain we can slow hormone release, reducing the secretion of hormones that stimulate follicles to develop. No developing follicle means no increase in estrogen, which means no “LH surge” and no ovulation. In most studies, return to fertility isn’t impacted by the pill and many people get their period back within 3 months. 

Of course, there are other forms of contraception, these are just a few of the most common. The main point - and the point made in most studies that look at this - is that your future fertility is not impacted by your use of contraception. Side effects may be different for each person and it can take a few tries to find the right solution for you. Because things tend to return to normal once we stop the contraception, this also means that symptoms you may have had before, may return once you stop. We are always here to support you alongside whatever works best for you, your lifestyle and your fertility goals, as well as providing evidence-based answers to your questions. As naturopathic doctors can’t prescribe birth control, talking to your family doctor or nurse practitioner is a great resource! Don’t let TikTok be where you get your information for decisions around your reproductive health.