By Dr. Shawna Darou, ND
For many women, getting off of hormonal birth control can be a struggle, especially if they have been on the pill for many years. Symptoms that may come up on stopping the pill include: acne, mood swings, lack of or irregular periods, more breast tenderness, very light periods or menstrual cramps. This is often described as ‘going through puberty again!’ The good news is that with a proactive plan, we can minimize this discomfort by addressing the underlying causes.
In practice, I find that optimizing nutrition, weight and activity level and a careful examination of past hormonal balance can help tremendously in bringing your hormones back on track more easily. Treating imbalances in stress hormones and also thyroid function may also be required. Remember that hormonal birth control doesn’t actually regulate your hormones, it just provides a certain level of hormones that create a withdrawal bleed not menstruation. If you had issues with hormone imbalance before going on the pill, they will very likely still be there when you stop.
The two most common issues coming off hormonal birth control are acne and lack of menstruation. Let’s look at each of them more closely:
Acne flare-ups coming off the pill are very common, especially if you have been on a pill that blocks androgens (Diane-35, Tricyclen, Tricycle-Lo, Yaz or Yasmin). When you stop, your skin is simply not accustomed to normal or high testosterone levels, and will react. This may happen even if you didn’t have problem skin before going on the pill.
Lack of menstruation
It can take a while for the brain and ovaries to remember how to communicate again, especially if you started hormonal birth control as a teen before you ovaries had fully matured, or if you have been on hormonal birth control for more than 5 years. The key to determine here is whether there is a hormone imbalance such as polycystic ovarian syndrome (PCOS), or whether it is simply a communication issue (hypothalamic amenorrhea), which can easily be diagnosed through basic bloodwork.
1. If you have been on an androgen blocking pill, initially for your skin, I often recommend a temporary switch to a different pill first. Going off these pills suddenly will almost always cause a flare-up of acne as your skin readjusts to normal exposure of androgens (testosterone-like hormones). This is the case even if you didn’t have bad acne before going on the pill. By first switching to a pill that doesn’t block androgens, we can first treat this hormonal system before also trying to regular your ovary function. There is a large range of supplements that aid in androgen metabolism, such as saw palmetto, zinc and spearmint.
2. Timing is important. Getting off the pill at a time of very high stress, high physical training or lots of travel is not ideal. This can increase the chance of missed periods when you first come off. Stress can stall the communication between the brain and ovaries.
3. If you are very thin with low body fat, are under-eating, or are exercising or training heavily, it may be necessary to gain some weight and increase your overall caloric intake to get a regular period back. When the body is under stress or there is not enough body fat, the link between the hypothalamus and the ovaries can be affected creating what is called hypothalamic amenorrhea.
4. If you still do not have a period after being coming off hormonal birth control for 3 months or more, it’s time for some lab testing to determine if you do have a hormone imbalance. From here we may diagnose conditions such as PCOS, hypothalamic amenorrhea, high androgen levels, high prolactin levels, perimenopause, or others. Once the cause is identified, a thorough treatment plan can be discussed.
5. There are many natural supplements that can help to regulate menstruation. Some of the better known ones include Vitex (chaste berry), Maca and Black cohosh. If the periods are not back normally because of PCOS, we can address this condition through a lower-carbohydrate nutrition plan along with supplements to support ovarian function such as licorice root, peony, N-acetyl cysteine and inositol.
Overall, I can’t emphasize enough the value of having a proactive plan in place before coming off hormonal birth control. This can greatly minimize the symptoms and discomfort, and bring your hormones back into balance more quickly.