"I Took Birth Control Pills for Menstrual Cramps—Why Can't I Get Pregnant After Stopping Them?" ... What Did Follow-Up of 1,167 Women Reveal? [Smart Wellness]

[Financial News]  "Does taking birth control pills for a long time cause infertility?"
A, 28, has an irregular menstrual cycle and severe menstrual cramps. She has been taking oral contraceptives for three months under a doctor's prescription to regulate her menstrual cycle by controlling ovulation and reduce inflammatory substances that cause menstrual cramps. The medication has been effective for A, but people around her have expressed concern, saying, "I've heard that taking hormonal medication for a long time can make it impossible to get pregnant later" and "It will make you gain weight and cause your skin to break out."
Many people view oral contraceptives merely as 'medication to prevent pregnancy,' but obstetrics and gynecology specialists also use them as prescription drugs to treat menstrual cramps, heavy menstrual bleeding, premenstrual dysphoric disorder (PMDD), and moderate acne. To mark World Contraception Day on the 26th, we examined some of the most common myths and facts about oral contraceptives.

Oral contraceptives suppress ovulation by regulating estrogen and progesterone, the female sex hormones. In this process,they prevent the endometrium from thickening, which is the key mechanism behind their use in treating menstrual cramps.
Menstrual cramps occur when prostaglandins, inflammatory mediators released as the thickened endometrium is shed, cause the uterine muscles to contract forcefully. Birth control pills keep the endometrium that will be shed thin, significantly reducing prostaglandin production. As a result, cramping pain and excessive bleeding are noticeably alleviated.
Geum Ji-hyun, a professor of obstetrics and gynecology at Hanyang University Medical Center (HUMC), said, "Nonsteroidal anti-inflammatory drugs may be used first to manage the symptoms of dysmenorrhea, but for women who do not achieve sufficient relief or need contraception, a prescription fourth-generation combined oral contraceptive may be considered." She continued, "Oral contraceptives containing ethinylestradiol and drospirenone may help improve lower abdominal pain, back pain, headaches, nausea, and other major symptoms of dysmenorrhea."

There is also a widespread myth that taking oral contraceptives for a long time causes permanent infertility because the medication's contraceptive effect remains in the body.
However, according to a large-scale global study that followed 1,167 women who stopped taking oral contraceptives because they wanted to become pregnant, 89% became pregnant within two years of discontinuing the medication. This figure is not statistically different from the average fertility rate among women, which ranges from 85.2% to 94%.Even after taking birth control pills for several years, most women regain a normal ovulatory cycle within a few months of stopping them.Professor Geum also added, "Contrary to the concerns of many women, oral contraceptives are not medications that directly affect fertility." She continued, "Rather, oral contraceptives can help normalize the endometrium thickened by hormones and regulate menstrual flow and cycles. They may also help manage menstruation-related conditions such as endometriosis."
Reports of weight gain or acne after taking birth control pills are misconceptions stemming from the characteristics of older second-generation contraceptives and differences in individual constitutions. Some progestins used in older medications had androgen-like effects that increased sebum production, while estrogen sometimes caused temporary swelling by causing the body to retain water.
However, fourth-generation contraceptives used today have diuretic effects that promote water excretion and antiandrogenic effects that suppress sebum production. In a study in which 1,067 women aged 18 to 35 took a fourth-generation combined oral contraceptive for one year, no significant weight gain was observed.
Oral contraceptives are sometimes used to treat acne. In a study on treating moderate acne with a combined oral contraceptive containing ethinylestradiol and drospirenone, the total number of acne lesions decreased by an average of 79.9% compared with before treatment after participants had taken the medication for six cycles.
Professor Geum cautioned, "It is difficult to generalize that birth control pills inevitably cause weight gain or acne. The ingredients and characteristics vary among oral contraceptives, and individual responses also differ, so people should choose a formulation suited to them based on the purpose of use and their health status."

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