How soon does ovulation return after stopping hormonal birth control?

Understanding what to expect when stopping hormonal birth control (HBC) can be helpful for both those looking to switch to a non-hormonal method and those who want to conceive. In this analysis, the NC° Research Team set out to answer a common question among those who stop HBC: how long does it take for the menstrual cycle to get back to normal?

How was the analysis done?

Over 14,000 Cyclers were included in the analysis. They had stopped HBC shortly before they started using Natural Cycles, were below the age of 40, and had logged at least nine cycles in the NC° app. Only cycles with temperature data on more than 70% of the days were included. 

The main focus was cycle length and timing of ovulation, meaning which cycle day (CD) ovulation happened. The first cycle after stopping HBC was compared to later cycles and to those of Cyclers who hadn’t used HBC. The first cycle after HBC was counted from the day Cyclers stopped HBC to their first period (not counting the withdrawal bleed).

What were the results?

Cycle length after HBC

The first cycle after HBC was, on average, longer than the following cycles. It also varied more in length, meaning that some Cyclers got their period back much earlier and others much later than the average.

In the first cycle after stopping HBC, there were slight differences in median cycle length depending on the type used: 31 days for Cyclers who had been on the pill, hormonal IUD, or vaginal ring, 32 days for mini pill users, and 32.5 days for those coming off the implant.

In the second cycle, the median cycle length stabilized for all HBC types. At that point, it was similar both to how it looked in later cycles and to the median cycle length for Cyclers who hadn’t used HBC.  

Return of ovulation

More than 80% of Cyclers had their ovulation detected by the NC° app in the first cycle after stopping HBC. In the second cycle, ovulation was detected in more than 90% of cycles, and this remained stable going forward — same as for the group who hadn’t used HBC previously. 

Timing of the first ovulation

Though most ovulated in their first cycle off HBC, the timing of that first ovulation still varied quite a bit. Less than 10% of Cyclers ovulated within the first two weeks after stopping HBC. Within two months, around 70% of Cyclers had ovulated, and this increased to 85% by the three-month mark. Close to 95% of users had their ovulation return within the first six months. 

The type of HBC also influenced when ovulation returned. Those who used the vaginal ring saw a slightly slower return of their ovulation compared to the other methods — less than 5% ovulated within the first two weeks, 71% within two months, and 96% within six months. For the hormonal IUD, 11% ovulated within the first two weeks, 76% within two months, and 98% within six months, and these numbers were similar for the pill, mini pill, and implant. 

Ovulation also generally happens later in the first cycle. The different HBC types had slightly different medians — CD19 for the hormonal IUD, CD20 for the pill and vaginal ring, CD21 for the mini pill, and CD23 for the implant. However, it’s important to note that there was a lot of variation here as well, and many ovulated much later or earlier.

The timing of ovulation followed a similar pattern to cycle length in later cycles. By the second cycle, the median ovulation day had stabilized to CD17 in all ovulatory cycles for all HBC types — the same as for Cyclers who hadn’t used hormones.

Summary

This analysis shows that for most people, their menstrual cycle gets back to normal pretty quickly after stopping HBC — usually by the time their first period returns. However, there’s also a lot of variation between individuals, both in the timing of ovulation and cycle length. Our bodies are different and adjust at different speeds. The first ovulation can happen within a couple of weeks for some or take several months to return for others, but the majority will get their ovulation back within the first six months.

Since the first ovulation can happen early, this also highlights the importance of using another method of birth control right away if you’re looking to prevent pregnancy after stopping HBC.