4 Surprising Ways Birth Control Could Affect Your Future Fertility

What we do know: Hormonal birth control works by several mechanisms, including shutting down brain-ovarian communication to prevent ovulation, altering the cervical mucus, and thinning the endometrial (uterine) lining.

In my own clinical practice, I've had patients who had regular cycles, previous pregnancies, and no signs that fertility would be an issue before starting birth control, only to struggle with regular periods and fertility post-pill. And while we don't have studies to show that birth control will make you unable to conceive or affect your future fertility directly, there are some known issues with birth control that may contribute to difficulty conceiving or maintaining a pregnancy:

It's also important to note that there are women with a history of regular periods who report missing periods within six months of discontinuing hormonal birth control. This symptom has been termed post-pill amenorrhea1.

If you're over 35, are a past or current smoker, have a family history of early menopause, or any condition that increases oxidative stress, then hormonal birth control is one more factor that could contribute to these issues by way of lowering antioxidant protection.

The use of hormonal birth control for five years or more has been associated6 with thinner endometrial (uterine) lining in women undergoing fertility treatments, which could make it more difficult to have healthy implantation and healthy pregnancy. This area warrants further exploration, but the same mechanism that provides protection against endometrial cancer while on birth control may be the cause of this observed phenomenon. It's important to note that in this study the women were already undergoing fertility treatments, so there may be additional factors involved.

I want to be super clear that this is a theory only, but it is worth a mention. Several studies have shown that women on hormonal birth control select for mates with genes more similar to their own—in other words, they potentially select a partner that isn't the most compatible for baby making, which may contribute to difficulty conceiving when coming off of birth control. We don't know that this affects fertility definitively due to the lack of research, but it's definitely an area that warrants exploration.

As a naturopathic physician who helps optimize hormone health after birth control, I advise coming off of birth control a minimum of six months before trying to conceive, with two years being the ideal. This allows time for you to address potential issues masked by birth control, rebuild your nutrient stores, and prepare your body for pregnancy.

Wherever you are on your journey with the pill—whether you're still taking it or have recently stopped—you can begin to implement the following steps to improve your fertility now. It takes 90 days for the egg you ovulate to mature, so what you do today can help your eggs in future cycles.

If you started hormonal birth control for symptoms such as heavy periods, irregular periods, painful periods, intense PMS symptoms, or acne, now is the time to work with your doctor to figure out why you had those symptoms and start addressing the underlying cause.

While on birth control, nutrients such as folate, B12, B6, zinc, magnesium, and others are depleted. These are all important for fertility, a healthy pregnancy, and a developing baby. I advise my patients who are contemplating getting pregnant at any point in the future to take a prenatal while using hormonal birth control. Be sure to avoid prenatals with food dyes, hydrogenated fats, and folic acid (opt for folate or methylfolate instead).

Animal studies5 have shown delayed ovarian reserve depletion when supplementing with CoQ10. We know birth control depletes CoQ10, and this directly affects mitochondrial health. Supplementing with CoQ10 may support better egg quality and pregnancy outcomes.

Load up on more nutrient-dense leafy greens, which are an excellent source of folate, and antioxidant-rich foods like berries, artichokes, and nuts. Healthy fats from avocados and cold-water fish can boost egg health and help keep your ovaries young, too. Even better, make as many of these foods as you can organic since many pesticides are hormone disrupters that may negatively affect fertility. Consider adding royal jelly to your diet as well (it's actually great in smoothies!)—several animal studies have shown that eating this gelatinous substance produced by honey bees can increase egg growth, development, and ovarian hormone production.

Melatonin is not only a sleep hormone but a key antioxidant in protecting your ovaries. Exposure to light at night (especially shortwave blue light from our tech devices) decreases melatonin production, so turning in at a reasonable hour is recommended. Or, at the very least, start wearing some blue-light-blocking amber glasses.

Sounds obvious, but it's a must. Not only does smoking increase your risk of stroke while on the pill, but it also compromises your fertility. Years of data have shown that smoking can make it difficult to become pregnant and lead to early menopause.