Many women come to me in clinic with cystic acne, irregular or missing periods, scanty periods, heavy periods, painful periods and even issues conceiving after coming off the pill or hormonal contraceptives. Not all women experience this, however it is a common post-pill effect and can last from anywhere between 6 months to 2 years.
First, I want to address that the pill & hormonal contraceptives have served a great service over the years by giving women freedom of reproductive choice. In our modern society however, many women are prescribed the pill at a young age, without understanding the risks, how the pill works or natural alternatives. Not to mention, the pill has become an easy ‘band aid’ solution for many hormone imbalances, such as PCOS & acne.
Let’s quickly debunk a few myths we are told:
No, the pill does not ‘regulate’ your cycle. It shuts down ovulation
The pill and other types of hormone birth control do not contain progesterone, even if it’s a progesterone-only method. It contains progestins which are similar but act very different within the body and can impact every system, not just the reproductive system.
If you are on the pill, you are not getting a ‘period’ each month. It is a pill bleed induced by stopping the contraceptive drug.
The pill does not cause the body to behave as if you are ‘pregnant’. The hormone pattern more closely resembles menopause.
The Hormonal IUD will still impact the entire body and is not just localized to the ovaries, contrary to what some of us may have been told.
If you weren’t informed about the side effects of taking the pill, here’s a list of potential risks (this list is incomplete).
Depression
Weight gain & metabolic syndrome (the pill can cause weight gain, insulin resistance and elevated cholesterol)
Blood clots, stroke & increased cardiovascular risks
Headaches & Migraines
Hormone imbalances
Autoimmune conditions (could potentially exacerbate IBD & lupus)
Reduced thyroid function (studies show it is associated with reduced thyroid hormone levels)
Nutritional deficiencies (depletes zinc, folate, selenium, magnesium, B12, B2, Vitamin C & E)
Why does the pill cause so many hormonal issues?
When you are on hormonal contraceptives, it has a certain control over your hormones and not by way of ‘balancing’ or ‘regulating’ your hormones, but by shutting off our natural cycles and ovulation and providing synthetic hormones in its place. When you stop taking the pill, your body can go through a withdrawal period and you can experience a temporary surge in androgens as a ‘rebound effect’. During this time, you can commonly be mistakenly diagnosed with PCOS. If you have been on hormonal contraceptives for a long time or since you were young, your body may not have found its cyclical rhythms yet.mWhether you have been on it for a long time or a short time, it can take awhile for the communication pathways between your ovaries and hypothalamus to become balanced again and restoring ovulation can also take some time, for a number of reasons.
Many women first go on hormonal contraceptives due to hormone issues such as heavy periods, acne, painful periods and irregular periods. The pill doesn’t fix these issues, it just offers a bandaid so that you no longer have to experience it. Now that you have come off the pill, those symptoms are likely to return until you address the cause of what is driving these symptoms. The pill can also make any hormonal imbalances or conditions, such as PCOS, worse which means you may even experience exacerbated symptoms.
One last thing I want to mention is that our periods and natural cyclical rhythms is like a report card each month to let us know how our health is because healthy periods and regular ovulation is a good sign that we are balanced. If you have been on hormonal contraceptives, you don’t get this beautiful monthly report card so many symptoms or conditions that could arise while you are on hormonal contraceptives could be covered up by the control of the synthetic hormones.
What if I am on hormonal contraceptives for acne & hormone balance?
Hormonal contraceptives can improve acne and symptoms associated with PCOS & endometriosis however, this is usually either a temporary fix or a band-aid solution. The Pill or any hormonal contraceptives, doesn’t get to the cause of any hormonal conditions and why they are occurring. For example, acne can be a sign of elevated androgens, dietary triggers, blood sugar dysregulation, environmental toxins, gut issues, stress & poor detoxification capacity. I understand that acne can have significant effects on us emotionally and period pain can be debilitating, but hormonal contraceptives will not heal these issues and you will eventually have to deal with the underlying issue, which in many cases gets worse with long term use of hormonal contraceptives.
Coming off Hormonal Birth Control - Your Hormone Reset Plan
Step 1: Dietary & Nutritional Strategies (you can begin this prior to coming off hormonal contraceptives)
Replace Depleted Nutrients
The pill depletes key nutrients that are important for many different biochemical reactions including ovulation, thyroid function, energy production, detoxification processes & much more. Replenish the lost nutrients through a high quality Magnesium, zinc & Bs supplement & by consuming a diet rich in nutrient dense foods at each meal; bright berries, leafy greens, free range eggs, organic nuts & seeds, variety of different vegetables, soaked legumes, grass fed, free range animal proteins, & clean purified or spring water.
Ask your GP for some blood tests to evaluate your levels & work with a holistic practitioner to interpret these results and supplement to boost your levels where needed. It can take up to 3 months or longer for nutrient levels to return to optimal (depending on how depleted you are).
Focus on Balanced Blood Sugars
The pill can cause insulin resistance and disrupt blood sugar regulation. This is bad news for hormone balance as insulin (the hormone that brings glucose into cells), can have a huge impact on hormone balance, particularly in those with PCOS or post pill PCOS. Keep your blood sugars balanced by focusing on whole foods from nature and minimizing sugars, processed foods and artificial sweeteners (which actually can still impact and contribute to insulin resistance). Don’t skip meals and keep your meals balanced with a good quality protein source, vegetables, plenty of fibre rich foods (which is great for hormones - we will get to that later!) & healthy fats (don’t be afraid of fats - our hormones need them!). For now, skip the alcohol and make sure to exercise regularly as this can improve insulin resistance and blood sugar regulation (but don’t overdo it).
Ditch the Dairy (for now)
Many women find by ditching the dairy, their hormone symptoms improve. This is a result of a few factors. Firstly, dairy increases insulin-like growth factor 1 (IGF-1), a hormone that increases insulin and can therefore stimulate androgen production. Secondly, dairy containing A1 casein is an inflammatory protein and can stimulate mast cells, resulting in increased histamine secretion. Histamine can be a common cause for many women with PMS, headaches, ovulation pain, heavy periods & irritability. Real grass fed butter should be fine as it doesn’t tend to contain casein. This is the same for goat or sheep dairy which contain mostly A2. Dairy can also contain a lot of hormones & environmental toxins, further burdening the reproductive system with more hormones, toxins & inflammation. If you are to consume dairy, make sure it is grass fed, organic and full fat to reap the benefits from the vitamins & minerals. Dairy is not going to impact everyone, so for some this will just be a short-term ditch.
Step 2: Focus on Good Gut Health & Clear out Excess Hormones
Optimise digestive function: The pill can disrupt the gut and significantly impact our healthy gut flora. Within our gut flora, we have living bacteria that play an important role in hormone balance by breaking down and eliminating oestrogen. These organisms collectively are known as our estrobolome. Not only is our estrobolome important for regulating oestrogen, it also can transform lignans found within legumes & veggies, into phytoestrogens, powerful plant hormones that are protective against excess oestrogen. If you are experiencing gut issues, you may benefit from a gut healing protocol. If not, keep your gut happy and nourish all of these beneficial species by eating a variety of fibre rich foods, prebiotics and probiotic rich foods. Where possible try to steer clear of antibiotics as this will diminish your microbiome diversity.
Make sure you are going to the toilet daily: Daily bowel motions are crucial for flushing out toxins (including excess oestrogen). Our body goes through many different biochemical reactions each day and these processes can create toxic byproducts that we need to get rid of. We also need to get rid of anything our body no longer needs such as excess oestrogen. Now, combine this with our intake of foods, dietary and lifestyle toxin exposure and I'm sure you are starting to see why we need to flush out these toxins and byproducts daily! If you aren’t having a regular stool, look at increasing fibre through plenty of vegetables, legumes, whole grains & fruits. Increase fluid intake, try to move daily & eat some bitter greens and veg to further promote healthy motility. If you still aren’t going daily or requiring laxatives often, it might be time to chat to a holistic health practitioner to evaluate what is causing your delayed bowel motions and to support regularity.
Support liver detoxification: It’s time to send our liver some love so that we can metabolize oestrogen more efficiently and balance our hormones! The liver has many roles to play, particularly when it comes to hormone balance as it’s in charge of processing used hormones so that they can be eliminated through our excretory organs. The liver has many other jobs though, including excreting other toxins we are exposed to daily. The process of detoxification requires key nutrients for it to function. Insufficient nutrient intake/depletion and overburdened liver due to environmental toxins/chemicals can cause the liver to not be in top form. This is where supporting the liver can be a huge benefit for long-term hormone balance.
Here’s a few ways you can do that:
Avoid environmental toxin exposure where possible (BPA-lined cans, plastic bottles/containers, toxic skin care/hair care products, synthetic fragrances in perfumes, toxic household cleaners, fragranced soaps and non-organic produce.
Eat organic where possible or check out the clean 15 and dirty dozen list on EWG
Eat Brassicas such as broccoli, brussel sprouts, collard greens and cabbage to support detoxification pathways.
Berries are another liver favourite - just try to purchase organic!
Bitter foods are also great for the liver such as dandelion leaves & dandelion root tea
Herbs & supplements to support the liver & hormone detoxification:
As a Naturopath, I love to prescribe herbs and nutrients to further improve detoxification and liver function. Depending on the individual, some great herbs include Schisandra, St Mary’s thistle, Globe artichoke, Dandelion root, DIM (a broccoli extract), Calcium-D-glucarate, NAC, green tea and curcumin.
This is always individualized so please don’t self prescribe as some herbs/supplements may not be right for you.
Step 3: Support your Stress Response & Circadian Rhythm
Sleep & Circadian Rhythm: This step is right up there with number one because our sleep and being aligned with our circadian rhythm is crucial for happy hormones. This doesn’t always equate to more sleep though, but focusing on quality 7-8 hours of sleep and aligning with the moon and sun (our circadian rhythm). Our hormones are closely linked to our circadian rhythm and to explain this relationship further, we will need a whole new post, so for now, let’s focus on what we can do.
Stress & HPA axis dysregulation: Stress and Hypothalamic-pituitary adrenal (HPA) axis dysfunction is another factor that can impact our hormones significantly. Stress impacts your hormones in a few different ways but to keep it short and to the point, here’s a quick run down:
Impacts thyroid function which can interfere with reproductive hormone pathways
Can lower Luteinizing hormone (LH) and progesterone
Can suppress ovulation
Here are a few things you can do to improve HPA axis regulation and your stress response:
Prioritise 8 hours of sleep
Take a walk barefoot in nature
Practice breathing deeply and consciously
Don’t skip meals, keep it consistent and balanced
Opt for gentle exercise during times of severe stress
Start a daily meditation or mindfulness practice
Take time out for yourself.
Magnesium & adaptogen herbs can be a great addition
Step 4: Advanced Troubleshooting - adding in specific herbs & supplements to balance your hormones.
In many clients I see, to restore balance we need to gently stimulate and open up pathways through specific herbs & nutrients. Chaste tree is a beautiful hormone herb that can promote ovulation, progesterone production and lower prolactin. Peony and Licorice is a great combination to reduce androgens and promote ovulation and hormone balance (particularly in post-pill PCOS & elevated androgens). Zinc and vitamin C are important nutrients to support ovulation and reproductive function.
It is important not to self prescribe herbs as many over the counter supplements can be adulterated, not in the correct dose or are simply not the right herb/nutrient form for you.
There are a number of amazing hormone balancing herbs and choosing the right one for you will depend on a number of different factors, including your past history, symptoms and what hormones or pathways are out of balance.
If you would like to discuss an individualised treatment plan, please reach out and contact me here or make a booking by clicking here.
A Final Word…
After coming off hormonal contraceptives, some women’s periods return straight away while others may take a long time or you may experience more post-pill symptoms compared to others. We are all different and depending on what your hormones were like prior to the pill is important to consider because if you had hormonal symptoms prior, including acne, it very likely these symptoms will return or become worse, until you heal the root cause.
It can take time to restore balance, even if you are working at it full-on. Allow yourself anywhere from 3-12 months. Be patient with yourself, you will regain hormone harmony with the right approach, consistency and by addressing the root cause.
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