By Dr. Shawna Darou, ND
Steps to recognize Post-Birth Control Syndrome.
Most women are not adequately educated or warned about what can happen to their hormones after coming off hormonal birth control. This includes birth control pills, implants, IUD’s and rings. After coming off synthetic hormones, your ovaries begin to function again, and a whole array of annoying symptoms can show up. It’s true that some people breeze through this transition, but it’s also very common to experience some temporary hormone imbalance as your body adjusts. These body changes are both common, and treatable!
Common Post-Birth Control Syndrome Symptoms:
Here are some of the more common symptoms women experience coming off hormonal birth control:
- Amenorrhea (missing periods)
- Hair loss
- Increased acne (can be severe)
- Weight gain
- Heavy or painful periods
- Change in digestion (bloating, IBS)
The reason there can be so much hormone chaos is because while on hormonal birth control, your natural hormone production is suppressed. When removed, it’s like going through puberty all over again. Every cell in your body and brain is adjusting to new hormone levels, as your ovaries begin to produce hormones again. This transition can be bumpy and symptomatic.
Details about the more common patterns:
These are the common patterns of hormone imbalance coming off hormonal birth control. It’s important to understand what’s happening, and the mechanisms at play so we can treat it.
(1) Post-pill amenorrhea
This is the most common scenario for women who have been on the pill for more than 5 years especially, or who started very young before their cycles regulated. It is not uncommon to have a period missing for 6 months, and sometimes full year. Most of the time, missing periods are because the brain and ovaries are not communicating. Remember that while on most types of hormonal birth control, the ovarian function is fully suppressed, and it can take some time to wake up again. Here we first take a very close look at nutrition, nutrient deficiencies and stress to ensure there are no obstacles, and then use herbs and/or acupuncture to encourage communication between the brain and ovaries.
(2) Post-pill PCOS
Another very common scenario is to have symptoms of PCOS in the months or first years coming off hormonal birth control. This is a form of temporary PCOS, although it shares many characteristics: periods are absent or irregular, there is often significant acne, bloodwork shows a high LH to FSH ratio, and there may be multiple cysts of follicles around the ovaries seen on ultrasound. If your periods were regular before hormonal birth control, but now you have these symptoms, this may be what’s happening. This is a temporary and reversible hormone imbalance. I have also written more extensively about this condition here: https://drshawnadarou.com/2019/02/12/temporary-pcos-explaining-pill-induced-pcos/
(3) High androgens – acne, hair loss and body hair changes
Several birth control pills block androgen expression, and are hence prescribed to treat hormonal acne. The problem is that when you come off them, your body may react to even normal levels of androgens with cystic acne, hair loss and body hair changes. If you are experiencing these symptoms, and your period is regular, we first do bloodwork checking androgen levels (DHEA, total and free testosterone, androstenedione and DHT). Sometimes levels are high, and can be treated, and in other cases the levels are very normal, and we are dealing with increased sensitivity to androgens, much like at puberty. Regardless of the scenario, there are dietary changes that can help, along with herbs and supplements to improve androgen metabolism.
(4) Weight changes
Weight changes coming off hormonal birth control are also fairly normal. For some women this is weight loss (especially if they gained 10-15 pounds on the pill), or it can be weight gain. Weight gain usually indicates an underlying hormone imbalance such as PCOS was being masked by the hormonal contraceptives. Again, testing for hormone levels, checking for insulin resistance, and ensuring that you are clearing and detoxing hormones is where we start.
What you can do to restore hormone balance
Remember that post birth-control syndrome is a real and treatable condition. There are my top strategies to address to ease your body back to hormone balance:
- Test and build up micronutrients – Hormonal birth control, especially birth control pills can deplete several key nutrients: vitamin B6, folate, vitamin B12, zinc and magnesium. These nutrients are all key for an optimally functioning reproductive system, and deficiencies can cause amenorrhea or hormone imbalance.
- Assess your stress levels – Since all of your hormones communicate with each other, chronic high stress can impact hormone regulation, and delay a normal period coming back. It can also increase androgen expression and worsen acne and hair loss. Testing for stress hormones (cortisol and DHEA), and beginning a practice to lower stress can help tremendously with your hormone balance.
- Optimize hormone detox pathways – New and usually increased hormone levels require optimally functioning hormone detox pathways through both the liver and colon. Eating a liver-friendly diet (lots of greens, lemon, turmeric and ginger), minimizing alcohol as you get through this transition, and boosting fibre intake (especially ground flaxseeds) can support hormone balance. There are also many supplements that can target either estrogen or androgen detox pathways, when needed. This may include Indol-3 carbinol, DIM, saw palmetto, turmeric, calcium-D-glucarate, and others.
- Balance blood sugar levels – Imbalanced blood sugar levels, and especially insulin resistance can greatly interfere with hormone balance, especially causing irregular periods and high androgen levels. Eating in a way that supports stable blood sugar through the day, including fat, fibre and protein each time you eat, and minimizing sugar and refined carbohydrates is one of the biggest steps to reduce annoying symptoms coming off hormonal birth control.
- Ensure sufficient carbs and calories – On the flip-side, if you’re not eating enough calories or carbohydrates, it may cause your period to remain absent. In this case, we often find low estrogen levels, and true hypothalamic amenorrhea with low LH and FSH levels. Women need carbohydrates to menstruate, and typically we aim for 150-200 grams per day to get the periods going.
If you’re in the middle of hormone chaos coming off hormonal birth control, or especially if you would like to come up with a plan to minimize these symptoms before stopping, please know that there is so much we can do! As always, it starts with a thorough hormone assessment to understand where the imbalance is coming from, and then a treatment plan that is ‘food first’, along with supplements to restore balance. With patience and correct testing, we can ease through this time with minimal discomfort!
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