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If there’s one thing I’ve learned from talking with women about hormonal birth control, it’s that being on it has its challenges. Some women go through years of trial and error and side effects before landing on a method that works for them. It’s the tradeoff we make for peace of mind, relief from PMS symptoms, or any of the many other reasons to go on birth control.
Lately, though, I’ve also been hearing about the challenges of going off of hormonal birth control. Some women are rejecting it because they want to start families. Others are simply done putting their bodies through the wringer. Which begs a shift in the conversation: What happens to our hormones after birth control?
It's something I'm already wary of even as the host to a very low-dose IUD, as I've heard more and more anecdotes of post-BC fallout. One former colleague told me that after being on the pill for a decade, it took two years for her body to feel normal again, for her period to regularize. "I wish I had just never taken the pill in the first place," she lamented.
With this in mind, I reached out to two medical experts (one an OB/GYN and the other a naturopathic doctor) for advice on recalibrating one's hormones after ditching the synthetic variety of birth control. Fortunately, there are things you can do to help the process go more smoothly.
Meet the Expert
- Anate A. Brauer, MD, FACOG, is a board-certified reproductive endocrinologist with extensive experience treating all medical and surgical aspects of infertility. She serves as SGF New York’s IVF Director and is on the advisory board of the Young Survival Coalition, which helps young patients with cancer build families.
- Tara Nayak is a naturopathic doctor and hormone specialist focusing on the treatment of complex chronic diseases. She currently serves as adjunct faculty for the Maryland University of Integrative Health.
How the Pill Impacts Your Hormones
A normal, pill-free menstruation cycle involves a chain reaction of hormones (primarily progesterone, estrogen, and follicle-stimulating hormone, or FSH) to prepare the body for the possible implantation of an embryo. The ovaries grow eggs, the uterine lining thickens, and the body undergoes ovulation or the release of the egg for potential conception. Our hormones facilitate this entire cycle, and the pill essentially throws in roadblocks so that ovulation can't occur.
"Hormonal contraception containing estrogen suppresses the brain from making FSH, and therefore prevents an egg from growing and ovulating," explains Brauer. That's why when you bleed on the pill, it's not a "real" period—it's called "withdrawal bleeding" due to the swift drop in the hormones you're taking during that time of the month.
Birth control pills are available in several options that affect your hormones differently. The traditional pills contain 21 days of active hormone pills and seven days of placebo pills. During this seven-day window of taking placebo pills, you will have your period due to the drop in hormones. There are also extended-cycle pill options for those who don't want to have their period each month due to heavy bleeding or premenstrual symptoms. With this birth control pill cycle, you take the active hormone pills for three months, followed by one week of low-dose estrogen or placebo pills, so you have just one period every three months. There is also an option in which you take the active hormone pills continuously for the entire year, so that you won't have a period.
When Will Your Periods Return to Normal?
Because the pill stops your body from producing those hormones that cause ovulation and menstruation, it may take some time for your periods to return to normal after you stop taking it. Most women will have their period a couple of weeks after stopping the pill; however, it can take up to three months for some women. If you don't get your period after three months, you may have post-pill amenorrhea. If this happens, it is essential to follow up with your doctor.
A lot of factors will influence how your body reacts to coming off the pill: "The response to coming off birth control is largely dependent on the individual's unique body, including genetics, microbiome, metabolism, stress levels, diet, and more," says Nayak. "As the synthetic drug forms of hormones clear out of a woman's system, the hope is that the brain and ovaries will resume their natural rhythmic signaling cycle and ovulation and periods will resume naturally and normally."
But if you've been on the pill for a long time, you might have forgotten what "normal" looks like for you. "For example, I see many women who state that their periods have been irregular ever since they stopped the pill, but on [looking at] further history, it turns out that they have been on the pill since a young age and went on the pill to control their irregular cycles," says Brauer. "So really, the irregular cycles were not a side effect of the pill; rather, stopping the pill unmasked their irregular cycles. The same goes for menstrual cramps, another common reason women go on oral hormonal contraception."
So if symptoms like mood swings, cramps, and heavy or irregular periods persist after you stop hormonal birth control, it could simply be your body's natural menstruation process starting up again. You might consider some home remedies to downplay some of these effects—or if they're really debilitating, it might be worth paying your doctor a visit to ensure that something else isn't at play.
Possible Withdrawal Symptoms
Some women don’t notice any major symptoms when stopping the pill, while others report more severe side effects. First, the good news: Some women will see an increase in their libido and sex drive after stopping the pill. (This is due in part because being on the pill can cause vaginal dryness). Others, however, may notice an increase in PMS symptoms.
"Some women find that the side effects of shutting down their body's internal hormonal signaling system through the use of synthetic hormones lead to a crash-and-burn-type response once the hormonal birth control is stopped," says Nayak. "Many women have reported mood swings, as their brains are not yet used to coping with fluctuations in hormones. Other symptoms of a possible natural hormonal imbalance after birth control pills include acne, decreased libido, depression, anxiety, abnormal periods, PMS, and more."
Because the pill shortens the duration of periods, you may also notice that your periods are heavier and last longer than they did when you were on the pill. However, one side effect you won't have to worry about is weight gain after stopping the pill. Research has shown that the pill has little effect on weight gain or weight loss.
Brauer notes that some women might experience hot flashes. Again, if any of these symptoms persist after a few cycles, check in with your doc to ensure that your hormone levels have returned to normal. But in the meantime, you might help facilitate the process with some of the home remedies below.
Watch Your Diet and Stress Levels
Research has shown that taking oral contraceptives like the birth control pill can reduce your body's levels of nutrients, including magnesium, zinc, folic acid, B-vitamins, vitamin C, and vitamin E. It is important to make sure you maintain a healthy diet both while you are taking the pill and once you stop it.
Your endocrine system is responsible for releasing hormones into your bloodstream. Anything from sugar to alcohol can throw your entire endocrine system out of whack, so if you're looking to find balance, it might be worth sticking to veggies, protein, and whole grains for a time. "One of the main staples of any protocol addressing the weaning off of synthetic hormones is the need for a plant-forward diet," says Nayak. "[This includes] cruciferous vegetables, particularly dark and leafy greens such as collard greens, kale, spinach, broccoli, etc. These contain phytochemicals that aid in the detoxification of hormones in your gut."
Proper digestion is also important. "If you're not moving your bowels every day, you're not eliminating the hormones your body is trying to detoxify from," says Nayak. Eating a veggie-rich diet free of processed foods can help with this, as can ensuring you're getting a daily dose of probiotics.
The stress hormone cortisol can also directly impact the production of sex hormones, so it's important to consider anything that might be causing unnecessary anxiety in your life.
Help curb your cortisol levels by logging in gentle workouts, spending time outdoors, and getting enough sleep.
It Doesn't Hurt to Plan Ahead
If you know you want to go off birth control in the near future, you can help kick-start the hormonal process now, says Nayak. "I usually tell the women I work with to prepare to come off of birth control by putting in place foods, herbs, and nutrients that will support the detoxification of the synthetic hormones, as well as support the return to natural production and cycling of the body's hormones," she says. "When preparing ahead of time, the transition can go smoothly, and one can avoid major symptoms and side effects."
An important note to keep in mind: If you stop the pill because you're planning on getting pregnant, experts say it is perfectly fine to start trying right away. If you aren’t ready to get pregnant, make sure you have planned with another birth control option, as you can begin ovulating soon after stopping the pill.
In either case, start filling up on cruciferous veggies now, as well as eliminating stress from your life as best you can. Some supplements and herbs like maca, ginkgo, and St. John's wort have also been shown to help support hormonal balance and alleviate PMS symptoms, though you should check with your doctor before including them in your routine for the first time.
Know When to Get Extra Help
You shouldn't have to suffer just for the sake of getting your hormones back on track. "I would advise giving your body two full menstrual cycles to see if it normalizes," says Nayak. "If not, it's time to seek support!"
If your period has not returned after three months, your doctor can test you for underlying medical conditions, including PCOS or thyroid disorders, and get you the treatment you need. If PMS symptoms persist, your doctor can advise on the next steps to take, whether it's prescribing a medical intervention or another lifestyle change.
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