Coming off the Pill
I often work with folks coming off hormonal birth control, looking to switch to fertility awareness as their method of contraception. What surprises many people is that it can take time for their hormones to balance after coming off. Unfortunately there is little emphasis put on the fact that hormonal birth control interrupts the communication between our brain and ovaries, and many people are surprised that it can take time for their hormones to balance after coming off. Thankfully, I see a huge improvement in the restoration of regular cycles when folks prepare their bodies ahead of time or while they’re coming off.
Choosing birth control is a personal decision, and coming off it is a similarly personal decision. Whether you're still on hormonal birth control, or it's been several months since you've come off, this post will outline some things to think about when it comes to your cycles and practical ways to support your hormones.
When will my period come back?
There seems to be a big variation in how long it takes for cycle regulation after coming off the pill. Some people see their cycles return to normal as soon as they cease their method of hormonal birth control. For others, it does take a little longer.
There are handy cycle parameters we can keep track of to monitor our hormone health, especially when coming off hormonal birth control. These include:
Ovulation
Luteal phase length
Cervical mucus production
Menstrual quality and length
Cycle length
There seems to be variation between different people, and you won’t really know how your body is going to respond until you do come off. When we look at the research, in a study done in Germany in 2002, a group of 175 women who had come off the pill, compared to 284 women who had never been on hormonal birth control. For 57 % of the women who came off birth control, their cycles regulated after the first cycle. For the rest of the women, it took up to 9 months for their cycles to regulate.
What accounts for this huge variation? My theory is that personal difference plays a part, as well as what your cycles were like before you went on hormonal birth control. This will be a big piece in how your cycles look when they come back. Think back to what your periods were like before you went on hormonal birth control. What was their average length? Were your periods heavy and painful? Did you ovulate every month? Did you have irregular cycles? If you had signs of hormone imbalance before you went on hormonal birth control, chances are that this medication masked the issue, rather than treating the root cause. This means that when you come off the pill those symptoms might come back, and could even be more intense.
If your period doesn't return right away, be patient. It may take months for your cycles to regulate. If you're not getting your period, it means you are not ovulating. This is because your period is triggered by ovulation, not the other way around. Remember that your body was not ovulating for a period of time, and the hormones that are responsible for the events in your menstrual cycle were not active. Your body needs to remember the pathways for ovulation and menstruation to occur.
Tracking your cycle with charting, either on paper or in an app, is a great way to measure how your cycles are healing following coming off hormonal birth control. Make sure to note bleeding length, quality and symptoms, cycle length and cervical mucus quality.
What about acne?
Depending on what type of hormonal contraceptive you were on, you might see a reduction or an increase in acne post-pill. The relationship between hormonal birth control and acne involves a couple factors. The main reason that your acne may go away while you're on the pill is because synthetic estrogen suppresses androgens, which reduce sebum production and acne. Factors such as what type of hormonal contraceptive you were on, and the amount of progestin in the medication will impact whether acne is exacerbated or gets better after coming off. When you come off the pill, and your own natural hormones begin to take over, your skin may over produce sebum and your acne may get worse. It's important to note that acne may get worse before it gets better.
Try to hang in there for several months as sebum production regulates and you should see a reduction in acne. Research has shown that hormonal birth control impacts your gut microbiome, and you can support your body in reducing acne by learning about and nourishing of your gut microbiome. Eating diverse, organic, and fermented foods and only using antibiotics if absolutely necessary are a couple ways to begin nourishing your gut microbiome.
Vitamins & Minerals
Research into the impact of hormonal birth control has shown significant nutrient deficiencies for women who are on oral contraceptives. If you are on hormonal birth control or you have recently come off, supplementing and getting these essential vitamins and minerals is really important, and will help ease some of the rockiness after coming off. For healthy ovulation and menstruation, and healthy overall cycles, having sufficient vitamin and mineral levels is crucial.
Vitamin B2 - found in beef, salmon, mushrooms
Vitamin B6 - found in avocados, bananas, sweet potatoes
Vitamin B12 - found in liver, eggs, shellfish
Vitamin C - found in bell peppers, kiwi, citrus fruits, strawberries
Vitamin E - found in sunflower seeds, almonds, avocado, spinach
Zinc - found in oysters, lentils and hemp seeds
Selenium - found in brazil nuts, tuna, shiitake mushrooms
Magnesium - found in spinach, pumpkin & squash seeds, brown rice, almonds
Blood sugar balance
Another concern for women who are on hormonal contraceptives is the effect these medications have on blood sugar stabilization and insulin resistance. High insulin stimulates the ovaries to produce testosterone, impeding ovulation and regular cycles. Studies have shown a side effect of oral contraceptives is poor glycemic regulation. If you are on hormonal birth control or have recently come off, and you have signs of insulin resistance or absent periods, it might be something to look into. Exercising regularly, avoiding refined sugar and white flour, and eating regular meals that fill you up and keep you satisfied are some great ways to start balancing blood sugar.
Knowledge is power
In an ideal world, doctors would disclose comprehensive information regarding the side effects of hormonal birth control. Not only the serious life-threatening side effects, but the more subtle and common side effects such as nutrient deficiency, long-term hormonal imbalance, acne, weight gain or mood changes.
If you are reading this and you are on hormonal birth control, don't despair! The suggestions that I have made are not only for if you have come of hormonal birth control, but if you are currently on it. Making changes with this knowledge in mind can decrease some of the side effects and make the transition easier if you do decide to come off.
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References
Palmery MI, Saraceno A, Vaiarelli A, Carlomango G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. 2013 Jul;17(13):1804-13.
Zimmerman Y, Eijkemans, MJC, Coelingh Bennink, HJT, Blankenstein MA, Fauser BCJM. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis.Human Reproduction Update. 2014 Jan; 20(1): 76–105.
Cycle characteristics after discontinuation of oral contraceptives.
Gnoth C, et al. Gynecol Endocrinol. 2002.
Khalili H. Risk of Inflammatory Bowel Disease with Oral Contraceptives and Menopausal Hormone Therapy: Current Evidence and Future Directions. Drug Saf. 2016;39(3):193-7. Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future?. Gut Pathog. 2011;3(1):1. Published 2011 Jan 31. doi:10.1186/1757-4749-3-1 Cortés ME, Alfaro AA. The effects of hormonal contraceptives on glycemic regulation. Linacre Q. 2014;81(3):209-18.