A 37-year-old nulligravid woman taking Yaz (drospirenone and ethinyl estradiol) for years with oligomenorrhea wants to conceive, what steps should she take?

Preconception Planning After Long-Term Yaz Use

Stop Yaz immediately and begin attempting conception without delay—fertility returns rapidly after discontinuation of combined oral contraceptives, and at age 37, time is a critical factor for successful conception. 1

Immediate Steps Upon Yaz Discontinuation

• Discontinue Yaz now if pregnancy is desired, as combined oral contraceptives containing drospirenone and ethinyl estradiol do not cause delayed return to fertility 1
• Studies show 57% pregnancy rate at 3 months and 81% at 12 months after stopping similar low-dose combined oral contraceptives 1
• Begin folic acid supplementation immediately at 400-800 mcg daily (or continue if already taking the levomefolate in certain Yaz formulations) to reduce neural tube defect risk 2

Understanding Your Oligomenorrhea

Your irregular, light periods while on Yaz are medication-induced and do not reflect your underlying fertility status. 3

• The 24/4 regimen of Yaz (24 active pills, 4 placebo days) intentionally creates lighter withdrawal bleeding, not true menstruation 4
• Critical concern: Your oligomenorrhea before starting Yaz years ago needs evaluation, as this may indicate underlying ovulatory dysfunction that could affect conception 5
• Women with pre-existing menstrual irregularities may have conditions like polycystic ovary syndrome or other ovulatory disorders that require assessment 5

Fertility Evaluation Timeline

Do not wait to seek fertility evaluation given your age and history:

• At age 37, fertility declines significantly, and evaluation should begin after 6 months of unsuccessful attempts (not the typical 12 months for younger women) 5
• Immediate baseline assessment recommended: Day 3 FSH, AMH (ovarian reserve testing), and confirmation of ovulation through mid-luteal progesterone or ovulation predictor kits 6
• If you had oligomenorrhea before Yaz, consider earlier evaluation—potentially before even attempting conception 5

Optimizing Conception Attempts

For couples with regular 28-day cycles attempting conception:

• Have intercourse every 1-2 days starting soon after menstruation ends 6
• Use urinary ovulation predictor kits to detect the LH surge, then have intercourse when detected and continue for 2-3 days 6
• The most fertile days are cycle days 8-19 6
• The 6-day fertile window is characterized by slippery, stretchy cervical mucus 6

Critical Monitoring After Yaz Discontinuation

Track your menstrual cycles carefully after stopping Yaz:

• If regular cycles (26-32 days) resume within 2-3 months, this suggests normal ovulatory function 5
• If oligomenorrhea persists beyond 3 months post-Yaz, seek immediate fertility evaluation—this likely represents underlying ovulatory dysfunction, not medication effect 5
• Persistent irregular cycles make fertility awareness methods unreliable and suggest need for medical intervention 5

Common Pitfalls to Avoid

• Do not assume you are infertile based on years of contraceptive use—Yaz provides 99% contraceptive protection, so lack of pregnancy while using it means nothing about your fertility 4
• Do not delay evaluation thinking you need to "wait for your body to normalize"—at 37, every month matters for fertility outcomes 5
• Do not rely on withdrawal bleeding patterns on Yaz to predict your natural cycle—these are pharmacologically induced and artificially light 3, 4

Additional Preconception Optimization

While attempting conception:

• Optimize any chronic medical conditions (hypertension, diabetes, thyroid disorders) before pregnancy 5
• Achieve healthy BMI if overweight or obese, as this improves fertility and pregnancy outcomes 5
• Discontinue any teratogenic medications and ensure all medications are pregnancy-compatible 5