No period after coming off the pill? What's going on and what to do

You've stopped the pill. Maybe you want to try for a baby, or just don't want to take hormones anymore. You wait for your period, and it doesn't come.

I know where you're at. When I first came off the pill, my period didn't come back for eight years. Here's what's normal after stopping, whether "post-pill amenorrhoea" (also spelled amenorrhea) is real, what might be going on underneath, and when to see your doctor.

The bleed on the pill isn't a period

On the combined pill, the bleed you get in your pill-free days is a withdrawal bleed. It happens because the hormones from the pill drop, not because you've ovulated. So while you're on the pill, it's hard to tell what your own cycle would be doing.

What's normal after you stop

• You may have a withdrawal bleed within a few days or weeks of stopping.
• Your first natural period often follows about a month after that.
• Your cycle can be irregular for a few months while it settles. The NHS suggests allowing up to three months for your natural cycle to get going.

The good news: experts say there's no significant delay in fertility coming back after you stop the pill.

Is "post-pill amenorrhoea" real?

You may see the term post-pill amenorrhoea online. When researchers looked at women whose periods stopped after coming off the pill, they found the same range of causes as in women whose periods stopped without it. In other words, the pill usually isn't the cause.

More often, the pill has been hiding something that was already going on, or that started while you were on it. Two common reasons are hypothalamic amenorrhoea (HA), where your brain pauses your cycle because of too little fuel, too much training or too much stress, and polycystic ovary syndrome (PCOS, now called PMOS). You can read more in my post on hypothalamic amenorrhoea.

In my case, my period stayed away while I was under-eating, training hard and under a lot of stress (even if it didn't feel like it at the time). Once I changed those and a few other things, it came back.

When to see your doctor

• If there's any chance you're pregnant, take a pregnancy test first.
• If you haven't had a period three months after stopping the pill, book in with your doctor. Don't wait years hoping it will sort itself out.
• See your doctor sooner if you notice milky discharge from your nipples, headaches or changes in your vision, hot flushes, new hair growth or severe acne, or pelvic pain.

Your doctor may suggest hormone blood tests, sometimes a pelvic ultrasound, and a bone density scan if your period has been gone for six months or more. My post on why periods stop covers the other common causes.

What you can do in the meantime

• Keep a simple record. Note any bleeding, plus signs your cycle may be starting up again, like wet, stretchy discharge, a higher sex drive or tender breasts. Start getting in touch with your body and pay attention to what it's doing.
• Look at fuel, training and stress. Are you eating enough, regularly? Are you training hard most days? Are you getting real rest?
• Think about contraception. You usually ovulate about two weeks before your first period comes back, so you can get pregnant before you've had one. If you don't want to get pregnant yet, make sure you protect yourself.

Your next step

Book in with your doctor, and download my free guide to take along. If your doctor rules out other causes and you think HA might be part of it, you can book a free 30-minute call with me to chat more.

This post is general information, not medical advice. Please see your doctor about your own situation.