Missed Period After Stopping Birth Control: What Could It Mean?

Birth control pills are widely touted as the answer to bothersome irregular menstrual cycles. Once you start taking them, you can usually expect some menstrual bleeding during those placebo pills each month. But once you stop taking birth control, it can be confusing if you haven’t gotten your period (and your pregnancy test is negative). But there are a number of possible reasons for a late period, such as stress, obesity, or a thyroid disorder.

We asked experts to explore how birth control pills can affect your cycle and explain the reasons why you may miss your period after going off the pill.

Have you stopped taking birth control pills but still haven’t gotten your period? After stopping hormonal birth control, it can take a few months for your cycle to adjust, and that’s completely normal. In fact, it’s common to experience irregular periods immediately after stopping hormonal birth control, such as the pill.

In a healthy person, the menstrual cycle regulates itself very quickly—often within three to six cycles after stopping birth control. However, keep in mind that hormonal side effects can take longer to clear from your system. It may take several months for your menstrual cycle to return to normal.

This means that if your period is missing for more than a few months, it could be a different problem. Below are the most common things that can cause irregular cycles after birth control.

Minor everyday stresses, like missing the bus or the kids being late for school, shouldn’t ruin your cycle. But if you’re experiencing significant stress from major life events or are stressed out by your daily routine, your cycles may become less regular over time. Stress can affect your hormonal balance, which plays an important role in maintaining a regular menstrual cycle.

Significant weight gain or loss, regardless of your body mass index (BMI), can affect your cycle. But if your BMI is less than 18, you may have secondary amenorrhea. This is when your periods, which normally started during adolescence, stop altogether. If you suspect secondary amenorrhea, contact your healthcare provider.

On the other hand, having a BMI of 35 or higher is linked to a number of health problems, including diabetes, heart disease, and of course, menstrual irregularities. Studies have shown that there is a high correlation between obesity and missed periods. Similar to having too little body fat, high levels of body fat disrupt normal levels of hormones like insulin and sex hormone binding globulin.

One of the most common causes of irregular cycles is polycystic ovary syndrome (PCOS), which is caused by elevated levels of the hormone androgen. While polycystic ovary syndrome is not a curable condition, there are treatments that can help regulate your menstrual cycle and increase your chances of successfully getting pregnant with PCOS, if that’s your goal.

If you’re experiencing irregular cycles or spotting along with symptoms like discomfort during sex and back pain, the underlying cause of your period could be uterine polyps or fibroids. Both look scary, but they’re actually very harmless.

Polyps are small growths on the inner lining of your uterus, called the endometrium. They are usually asymptomatic, but they can cause disruption to your monthly cycle and spotting between periods. Fibroids are lumps found in or on the uterus that can cause painful and heavy periods.

Why can polyps and fibroids cause missed periods? Because both occur in response to hormonal fluctuations, which also regulate your cycle.

Who knew your thyroid gland played such an important role in your menstrual cycle? It sounds strange, but it’s true. Your thyroid hormones directly affect your menstrual period, and too little or too much (in cases of hyperthyroidism and hypothyroidism) can cause your cycles to become irregular or stop altogether.

If you have stopped taking birth control pills and have not gotten your period, you may be pregnant. If you have had vaginal sex or engaged in any sexual activity that introduced semen into or around your vagina, take a pregnancy test to rule out this possibility.

Even if your menstrual cycle hasn’t returned to normal yet, you can still get pregnant after stopping birth control—and no hormonal birth control method is 100% effective.

Still waiting for your period to return after giving birth? Breastfeeding may be a factor. Several studies have shown that exclusive breastfeeding usually results in a few months of amenorrhea (absence of menstruation) immediately after giving birth. However, there is no definitive guide to how long this will last, and there are often no signs that your cycle is ready to start again. If another method of contraception is not used during this time, this can lead to an unintended pregnancy.

To avoid pregnancy while breastfeeding, many people turn to the “mini pill,” a birth control pill that contains only progesterone. According to Dr. Robbins, “The progestin-only oral contraceptive pill is great for breastfeeding parents because progesterone pills don’t interfere with milk supply.”

When your period returns after giving birth, it’s not uncommon for it to be a little irregular if you’re still breastfeeding. However, if your baby has been weaned for a few months and your period still hasn’t settled down, it’s best to see a doctor to check your hormone levels.

When your period returns after stopping birth control depends largely on the reason you started birth control, along with any underlying health problems that were masked by the pills or caused while taking them, says Tsao-Lin E. Moy, LAc, a fertility specialist at Integrative Healing Arts in New York City.

If you had an underlying condition that was causing irregular cycles — like PCOS, hypothyroidism, or endometriosis — you may find that these conditions rear their ugly heads again once you stop taking birth control.

Using hormonal birth control to regulate irregular periods doesn’t address the underlying hormonal imbalance, says Kamryn Chrisman Robbins, MD, an obstetrician-gynecologist at the University of Washington Women’s and Infants Center. “But it can lead to improved quality of life. When a person stops taking hormonal medications, these initial symptoms are likely to return.”

Moy agrees, saying that the underlying condition or root cause is still there and will manifest itself when a person stops taking birth control. To sum it up, if you miss your period after stopping birth control, there’s a reason for it—you just have to find it.