The contraceptive pill consists in blocking ovulation thanks to different hormones which will act on the hypotalamic-pituitary axis, the cerebral axis of control of the ovaries, themselves at the origin of the various hormonal secretions of the ovulatory cycle. This action is reversible as soon as the pill is stopped, regardless of its duration of use. However, sometimes we observe a “laziness” when the activity of the hypotalamo-pituitary axis and the ovaries resumes (1). This phenomenon varies greatly among women, regardless of the duration of the pill taking. Some will regain ovulation as soon as the cycle after stopping the pill, while in others, it will take a few months for the resumption of a normal cycle with ovulation.

Previously, some gynecologists recommended waiting 2 or 3 months after stopping the pill in order to obtain better ovulation and uterine lining. However, these deadlines are not medically founded. No study has been able to show an increase in the frequency of abnormalities or miscarriages, or of multiple pregnancies in women who became pregnant when the pill was stopped (2). It is therefore advisable to stop the pill from the moment you want pregnancy. Likewise, it is not medically justified to take “breaks” while taking the pill in order to preserve fertility.

It happens that the pill, which induces artificial rules by a withdrawal bleeding (via the drop in hormones at the end of the pack), has masked ovulation disorders, which. will reappear when you stop taking the pill. The most common causes are hyperprolactinemia, polycystic ovary syndrome (PCOS), anorexia nervosa or premature ovarian failure (3).

One of the big worries of women about the pill is its possible effect on fertility, especially if it is taken continuously for many years. Scientific work is however quite reassuring on the subject.

A study (4) carried out within the framework of Euras-OC (European program for active surveillance on oral contraceptives) and involving 60 women taking oral contraception showed that the month following stopping the pill, 000 % of them were pregnant. This figure corresponding to that of natural fertility, it tends to prove that the pill does not affect fertility and the chances of pregnancy. This study also showed that the duration of taking the pill also had no impact on the chances of pregnancy: 21% of women who took the pill for less than two years became pregnant within a year, compared to 79,3% among women having used it for more than two years.

If there is no delay between stopping the pill and the start of conception trials, it is however strongly recommended to consult your gynecologist, general practitioner or midwife before stopping the pill. for a pre-concept consultation. This consultation, recommended by the Haute Autorité de Santé (5), includes:

• an interrogation on the medical, surgical, obstetrical history
• a clinical examination
• a cervical dysplasia screening smear if it is more than 2 to 3 years old
• laboratory tests: blood groups, search for irregular agglutinins, serology for toxoplasmosis and rubella, and possibly screening for HIV, hepatitis C, B, syphilis
• folic acid supplementation (vitamin B9)
• catch-up vaccination for rubella, pertussis, if they are not up to date
• prevention of lifestyle risks: smoking, alcohol and drug consumption