My periods while on OCP since the IUD removal has been extremely light. Will it affect my fertility?

Question

Hi doctor,

I am 33 years old. I have removed my IUD before two months as I am planning for pregnancy. I am taking an oral contraceptive pill since IUD removal as I do not want to become pregnant immediately. But I am concerned about my periods after taking the pill and IUD removal. My periods last for a day and I need only two tampons. My period was typical before using IUD and it stopped completely while having IUD for three years. Before having it, I was taking OCP and so periods were regular. I am using hormonal contraception since my teenage and so I am not sure whether I have my periods regular or not. I am concerned about these light periods. Does it indicate an abnormal endometrial function or any other abnormality affecting my fertility?

Answer 1

Hi,

Welcome to icliniq.com.

I am explaining the actions of estrogen-progestin contraceptive and Levonorgestrel IUD (intra-uterine device) affecting fertility. The combination of OC (oral contraceptive) suppresses basal FSH (follicle-stimulating hormone) and LH (luteinizing hormone). They reduce the ability of the pituitary gland to synthesize gonadotrophins when it is stimulated by hypothalamic GnRH (gonadotropin-releasing hormone). So ovarian follicles do not mature and so little estradiol is produced. There is no midcycle LH (luteinizing hormone) surge. Ovulation does not occur and corpus luteum does not form and progestin is not produced. This means that it interferes and blocks the negative and positive feedback of the HPG (hypothalamic-pituitary-gonadal) axis.

Also IUD (Mirena) contains Levonogesterel. It reduces FSH and so there is less follicular activity, less estradiol production and there is an absence of LH surge. This causes a local inflammatory reaction inside the uterine cavity. The blockage of HPO is reversible as far as you stop taking COC (combination oral contraceptive pill) pills. The estrogen and progesterone levels will fall and so the HPG axis will start functioning normally and your cycle will become ovulatory again. So change in the quantity of bleeding is not important if your cycle is ovulatory. If you have amenorrhea for more than six months after discontinuation of OC, you need to have an evaluation. So it is normal to have changes in the menstrual cycle after using IUD.