Excited to become a mom, Elise, 34, came to see me in my medical practice, so frustrated that getting pregnant wasn’t going at all the way she thought it would. What she felt should have been an exciting time for her and her partner, had become an anxiety-provoking, stressful one. Two years after going off “the pill,” which she’d been on to “regulate her cycle,” since she was a teenager, she’d barely had a regular period – instead she’d go months between scanty periods, then have a major ‘blow out,” then again, nothing for months. On top of it, she was experiencing cystic acne and weight gain, neither of which had been a problem for her before the pill! She was feeling pretty desperate, and worse with each new announcement from a friend that a baby was on the way. She and her husband were in the early stages of exploring fertility treatments.
Together we discovered that Elise had PCOS, the likely cause of her irregular periods that led to her being started on the pill in the first place – but which had never been recognized and diagnosed. A few months of dietary changes, nutrients and herbal treatments, and acupuncture not only returned her cycle and eased her symptoms, but to her delight, Elise became pregnant without having to go through the often arduous process of fertility treatments, as she was anticipating she’d have to.
The introduction of oral contraceptives in the 1960s was a major breakthrough for women, giving us more autonomy, freedom, and reproductive choice. A woman’s choice to go on or off the pill is her own, and I support all women and their choices. To learn more about the potential risks associated with the pill, head over here.
If you, like Elise, have decided it’s time to come off the pill – whether because you’re ready to get pregnant, you're concerned about the potential health risks of hormonal birth control, or you’re ready to try a different form of contraception, have no fear. Most women transition off it without much problem. But if you have come off it – or have heard horror stories about hormone imbalances – it’s still going to be fine! You’re not doomed to a life of hormonal imbalances. With the targeted strategies I walk you through in this article and podcast, you can reset your hormone balance so that you, too, have healthy, natural cycles – not pill imposed ones – and in not too long a time.
Is Post-Pill Syndrome a Real Thing?
To be clear, there is no formal condition known as post-OC or post-pill syndrome, and there is controversy over the extent to which women experience symptoms. I first dropped the term “post-OC (oral contraceptive) syndrome,” in 2008 in my textbook, Botanical Medicine for Women’s Health, as one of the possible causes of irregular periods and other hormonal symptoms in women coming off of birth control.
Statistically, most women – at least 80 percent – regain hormonal balance within three months of stopping the pill. However, it often does take that long, and not all women do find that balance – even as far as 6 months after stopping them. Some women experience a bumpy ride coming off the pill. Like Elise, they’ve experienced delayed return of fertility, acne, heavy periods, no periods at all, cramps, and more. They’ve also likely discovered that conventional medicine has little to offer them.
So what’s really going on? Well, there are a few issues at hand:
- A Gap Between Science and Women's Experiences: There is a known gap between what science demonstrates and what women experience. (For more on how women get sidelined by conventional medicine, check out How Medical Gender Bias is Killing Women and How to Save Your Own Life).
- Recurrence of Old Symptoms: As Elise’s story illustrates, so many stories of women I’ve worked with who come off the pill are actually experiencing a recurrence of old hormonal imbalances. This is not surprising given that 50% of all women on the pill are on it for non-contraceptive reasons – they are usually put on it for irregular periods, acne, mood swings, heavy bleeding, or other symptoms of hormone imbalance that the pill suppresses.
- The Pill Caused Hormone Imbalance: There are a handful, as well, who find themselves unexpectedly and to their dismay – experiencing new symptoms post-pill.
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Common Post-Pill Symptoms
After stopping the pill, here are some of the most common symptoms women have come to me for help with:
Irregular or skipped periods. When menstrual bleeding returns, it’s erratic – or, as Elise experienced, sometimes it doesn’t return at all for quite some time. This may be because periods were irregular before starting the pill or because of a interrupted communication between the ovaries and the hypothalamus (the part of the brain that helps regulate bodily processes).
Heavy menstrual bleeding. This symptom is especially common if you went on the pill to regulate your period or ease heavy bleeding in the first place. That’s because the pill doesn’t address the Root Causes of heavy bleeding. Rather, it limits the growth of the uterine lining and blocks ovulation – resulting in a controlled monthly bleed that is more of a hormonal breakthrough bleed and not quite the same as a normal menstrual period. When you go off the pill, heavy bleeding can return if you had it before, or you can experience it anew as your body establishes its own natural hormone balance.
Ovulation pain and menstrual cramps. Because ovulation is suppressed by the pill, you don’t experience ovulation pain when you’re on it. Birth control pills also suppress both the amount of prostaglandins – the chemical that contributes to menstrual cramps – your body produces, and the amount of bleeding you experience – which combined, means you’re less likely to experience period cramps on the pill, too. But after they can return with a vengeance.
Breakouts. Oral contraceptives reduce the amount of testosterone produced by the body. Testosterone is associated with acne (this is often why teenage boys have more severe acne than teenage girls) and as your levels return to normal, zits can come along with it. Post-pill acne is especially common if you started taking birth control to ease acne symptoms in the first place but I’ve had several patients who’d never experienced acne prior, and discovered the misery of it in their late 20s and 30s after stopping the pill.
Bloating: The progestin in some pills acts as a diuretic, so some women retain fluid after coming off the pill. This resolves over time as you re-establish natural hormone balance, but can initially make you feel puffier, fatter, and can show up as additional pounds on your scale or feeling that your clothes are tighter.
Mood Swings: While the pill itself can initially cause more than usual moodiness, so can going off of it as your body moves away from a carefully controlled daily dose of hormones from the pill, to your own ebbs and flows. This is particularly the case if you had PMS before going on the pill, but can occur regardless. Also, keep in mind that if you’ve been on the pill for years, you’ve changed in those years – and our hormones are very different in our teens, 20s, 30s, and 40s.
Nutrient Deficiency: While not a symptom in itself, nutritional deficiencies can cause a host of symptoms – including hormonal imbalances. They are also a problem for women who come off the pill hoping to get pregnant right away because low nutrient status has been associated with fertility problems, and low nutrients in mom can also mean low nutrients in baby. The pill has been associated with robbing a number of nutrients including B vitamins and magnesium. A recent study also found that vitamin D levels drop soon after stopping the pill. In fact, vitamin D levels were 20% lower in women who’d just come off the pill than in those no longer on it.
Has coming off ‘the pill’ been more difficult that you imagine it would be? (breakouts, bad cramps, irregular or no periods)? Read this article to re-balance your hormones and get back on track naturally.
What the Pill Does to Your Hormones
Oral contraceptives impose a very specific type of hormonal control over the body. While they can regulate our cycles and control many hormonal symptoms, they do so by suppressing our natural cycles of ovulation, menstruation, and hormonal fluctuation. Placebo pills for the last 5 days of the cycle lead to a breakthrough bleed, not a true menstrual period. If you’re on a complete suppressive plan, you may “menstruate” as infrequently as every 3 to 12 months, depending on the type of pill you’re taking – and these too are breakthrough bleeds, not real periods.
You can experience post-pill symptoms whether you’ve been on the pill for a couple months or many years, though in my experience, women who’ve been on for several or more years – and certainly those on it for close to or over a decade, which is incredibly common – are more likely to experience more pronounced hormonal imbalances when they come off the pill.
If you went on the pill to address acne or an irregular cycle, the pill may have simply buried your symptoms. When you come off the pill, there’s a good chance that you’re still dealing with those same imbalances, which may have gotten more pronounced over time because the Root Causes weren’t addressed..
If you went on the pill for birth control, you may not have been suppressing a specific medical condition or symptoms, but a condition or set of symptoms might also have emerged during your time on the pill that were masked by the pill. And if you’re stopping the pill to get pregnant, like Elise you may find that you still aren’t cycling even up to 12 to 18 months later.
The pill’s power to cover up a wide range of symptoms presents another danger to women. Because we don’t feel outwardly uncomfortable, aren’t struggling with PMS, acne, pain, or other obvious symptoms – we don’t know that something under the surface is going on – conditions like PCOS can go untreated. PCOS is a harbinger of metabolic syndrome and Type 2 diabetes in some women, which themselves are harbingers of other chronic conditions, like heart disease or non-alcoholic fatty liver disease, so not getting proper treatment is a big deal.
The good news is that there are ways to use nutrients, herbs, and lifestyle medicine to rebalance your hormones and ease your symptoms when you come off the pill. These are methods I’ve used successfully for over 30 years – first as a midwife and herbalist, and now still as a medical doctor.
Four Step Hormone Reset
If you are coming off the pill, there are many effective ways to balance your hormones and ease symptoms post-pill. Here is my post pill reset plan. I recommend either incorporating all of the steps simultaneously, or pacing it by implementing Step 1 for 2 weeks, adding in Steps 2 and 3 for an additional 4 weeks while continuing Step 1, and if needed, at around 6 weeks on the plan, add in Step 4 while continuing the first three Steps. Some women need 6 to 12 months on the plan for a complete hormone reset – it’s highly variable.
Of course, also get a proper exam and consultation with a midwife, nurse practitioner, or other appropriate licensed practitioner to make sure nothing more serious is going on, especially if it’s more than 3 months since you’ve had a regular cycle, or if you have other concerning symptoms.
Most of the herbal supplements below aren’t appropriate while you’re pregnant, but can be taken if you’re TTC (trying to conceive) – just discontinue when you become pregnant.
Step 1: Dietary and Nutritional Strategies
Do this step for the first 2 weeks of the plan – and then continue this step as a healthy way of life indefinitely.
- Replace missing nutrients. Hormonal birth control pills can deplete the body’s stores of certain nutrients, including vitamins B2, B6, and B12; vitamins C and E; magnesium, selenium, zinc, and folate. Vitamin D levels may also drop after coming off the pill. To replace missing nutrients, emphasize nutrient-dense foods at every meal: dark leafy greens and other phytonutrient-rich vegetables; low-glycemic fruits like berries; pastured and organic animal protein; and beans, nuts, and seeds, and consider taking a high-quality multivitamin and mineral supplement. If tests show nutrient deficiencies, work with your primary provider or nutritionist to supplement enough to boost your levels to an optimal range.
- Balance your blood sugar. Research has linked oral contraceptive use with imbalanced blood sugar and insulin resistance, two factors that wreak even more havoc on hormonal balance while simultaneously setting the stage for a variety of other quality-of-life-diminishing conditions. Keep your blood sugar steady by eating whole, real, foods. Don’t skip meals and make sure each meal includes some high-quality protein, healthy fat, and nutrient-dense vegetables. Prioritize breakfast and make sure it includes healthy protein and fat. Keep sugar and white flour to a bare minimum and skip the alcohol which itself can create hormone imbalance – especially estrogen. Regular moderate exercise also helps keep blood sugar steady and balanced (but over-exercise can have the opposite effect, triggering inflammation and worsening blood sugar imbalances).
- Consider ditching dairy while rebalancing your hormones. Dairy tends to be chock full of hormones and environmental toxins that can act as endocrine disruptors, which doesn’t do our internal hormone balance any favors. Many women find that removing it from the diet, even if just for 6 to 12 months, makes a difference. If you do include dairy in your diet, make sure it is organic and full fat to minimize toxin exposure and maximize nutrition and blood sugar balance.
Quitting hormonal birth control can be a bumpy ride for some women. Learn how to re-balance your hormones naturally with self-care tips, herbs, and supplements in this article.
Step 2: Clear Out Excess Estrogen and Reset Hormone Balance
This step is especially important if you were on a pill that contained estrogen, but is also beneficial for re-establishing healthy hormone balance generally.
- Restore friendly gut bacteria. Healthy gut flora contain bacteria with genes that break down and eliminate estrogen. Together, these estrogen-processing organisms form their own community called the estrobolome. These bacteria play an especially important role in transforming plant compounds called lignans from vegetables and legumes into phytoestrogens, plant hormones that protect the body against the risks of excess estrogen. Keep your estrobolome happy and healthy by eating pre- and probiotic rich foods, taking a high-quality probiotic that contains at least ten billion CFUs from a variety of lactobacillus and bifidobacterium species, eating plenty of fiber, and steering clear of antibiotics as much as possible.
- Support estrogen metabolism. That’s a fancy way to say “send your liver some love!” The liver is in charge of processing and packaging used hormones so they can be eliminated from the body. But most of us are experiencing a combination of exposure overload from environmental toxins and insufficient intake of the nutrients our bodies need to keep liver detoxification functions in top form.
To help support your liver’s natural ability to detoxify, avoid environmental hormone exposure whenever possible by saying no to plastic food containers, BPA-lined cans, health and body care products that contain synthetic fragrances or other harsh chemicals, toxic household cleaners, dryer sheets and fragranced laundry soap, and non-organic food, for example.
The liver loves certain foods, too. Specifically, the liver thrives when we eat brassica vegetables like kale, cabbage, collard greens, broccoli, Brussels sprouts, watercress, and rutabaga. Organic berries, like blueberries, blackberries, raspberries and strawberries, are another liver favorite.
Herbs and Supplements that Support Hormone Detoxification, and improve the ability of the liver to break down and eliminate excess estrogen, are curcumin, schisandra, DIM, I3C, calcium-d-glucarate, green tea extract, and NAC.
- Prioritize “Number Two.” Once your liver has your used hormones and other toxins ready for elimination, you’ve got to get them all the way out of the body. That means having a complete bowel movement at least once a day. Focus on getting plenty of fiber in your diet (aim for two cups of vegetables with at least two meals each day or add in two tablespoons of freshly ground flaxseed to your diet), getting plenty of exercise, and staying hydrated. Improving the health of your microbiome will help with regularity, too. Some of my top herbal go-to’s for getting things moving are herbal bitters blends, dandelion root, yellow dock root, and when in need, a combination of senna and ginger or fennel tea.
Step 3: Reset Your Circadian Rhythm
While getting enough high-quality sleep is important, resetting our circadian rhythms isn’t just about getting more sleep. It’s about re-syncing our sleep-wake cycle with the sun and moon.
Unless you work a night shift, the first important step is to sleep when it’s dark and be awake when the sun is in the sky. You don’t have to fall asleep right when the sun sets (which would be 4:30pm in northern latitudes in winter!), but you can help yourself experience more circadian-level darkness by avoiding blue light (computer and phone screens) and television within an hour of bed or, if you must use a screen, adding a blue-light filter like f.lux. Keep the lights in your house low as bedtime approaches and, if your schedule allows, opt for a relatively early bedtime and a relatively early wake time.
Once you’re getting enough high-quality sleep at night, you can use the moon to help balance your hormones and reset your cycle. It’s a practice called (lunaception) and it’s easy to do.
Sleep in a completely darkened room until the full moon (cover or eliminate all sources of light, including electronic alarm clocks and phone screens that flash midnight text messages). For the three days of the full moon, sleep with your curtains open and your face toward the moonlight. Or if that’s not possible, search out a dim white nightlight for your room. After three days of light, go back to sleeping in darkness until the next full moon.
If you don’t have a regular cycle, count the first day of your last period as day #1. Sleep in darkness from day #1 to day #14, then sleep with the white light for three nights, then return to darkness. Repeat during your next cycle.
Step 4: Add in Targeted Herbs and Supplements
- Herbs and Supplements That Support Hormone Balance. You can support hormone balance with targeted herbal supplementation. Vitex, also called Chaste Berry Extract, regulates ovulation, increases fertility, and improves progesterone. Peony and Licorice Combination supplements have been shown to increase ovulation and improved fertility. Vitamin C improves ovulation and progesterone production.
- Herbs and Supplements for Specific Hormonal Problems and Symptoms: You can also visit other articles here on my website for strategies for specific hormonal imbalances as part of your plan, for example, endometriosis, PCOS, or menstrual pain. You’ll also find podcasts on these topics if you’d rather listen.
Additional beneficial therapies can include acupuncture, a personally tailored herbal plan, and yoga, particularly asanas targeted to improve pelvic and ovarian flow.
We’ve Come a Long Way Baby….and…
Women fought long and hard for access to contraception so that they – and we – could have more control over our reproductive health. The problem is that the pill, while very liberating in many ways, can also have significant and serious unintended consequences. It creates a very specific set of hormonal imbalances that can have short- and long-run consequences. Pill-imposed hormonal changes also mean it can take some time to restore your own natural hormonal cycles after the pill, or establish a new healthy hormonal equilibrium if yours wasn’t in balance in the first place – which may be why you first started the pill.
Decades of experience have shown me that the steps I’ve shared with you in this article are tried and true for resetting your hormones to healthy. It can take time, even with a full-on natural approach – anywhere from 3 to 12 months – but stick with it to get back into your own “natural flow” so to speak – and make sure to let me know how it goes for you!
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