If I've learned anything in speaking with women about their experiences with hormonal birth control, it's that a very small minority have nothing of consequence to report. Even the "good" stories are often preluded by years of trial and error and debilitating side effects before landing on a method that seemed the least troublesome. That's not to mention the psychological toll, especially for teenage girls who are still made to feel ashamed or humiliated for practicing autonomy over their bodies in our supposedly progressive culture—or even talking or asking about it, for that matter.
But lately, I've found that many women in my circle have started to reject hormonal birth control altogether—in some cases, in the interest of starting a family in the near future, but most are simply done putting their bodies through the ringer after doing so for the entirety of their adult lives. 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, especially 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 totally normal again, for her period to regularize. "I wish I had just never taken the pill in the first place," she lamented.
But that's the sacrifice—the impossible decision—many of us face in order to have peace of mind, regulate painful PMS symptoms, or any of the other reasons to go on birth control, of which there are many. It's all enough to face without also considering the aftermath. With this in mind, I reached out to a few experts for their advice on recalibrating one's hormones after ditching the synthetic variety—and fortunately, there are a few things that can help facilitate the process. Keep reading for their input.
First, a reminder on how the pill impacts your hormones in the first place.
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 releasing of the egg for potential conception. Our hormones facilitate this entire cycle, and the pill essentially throws in roadblocks so that ovulation can't take place.
"Hormonal contraception containing estrogen suppresses the brain from making FSH, and therefore prevents an egg from growing and ovulating," explains Anate Brauer, MD, a Greenwich-based ob-gyn and fertility specialist. That's why when you bleed on the pill, it's not a "real" period—it's actually called withdrawal bleeding due to the swift drop in hormones you're taking during that time of the month.
When you go off the pill, it's helpful to think back on what your period was like beforehand.
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 Tara Nayak, ND. "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."
Meet the Expert
Tara Nayak is a naturopathic doctor and hormone specialist with a focus on the treatment of complex chronic diseases. She currently serves as adjunct faculty for the Maryland University of Integrative health.
But if you've been on the pill for a very long time, you might forget 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 in fact 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, it could simply be your body's natural menstruation process. 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.
That said, you might experience some withdrawal symptoms.
"Some women find the side effects of shutting down their body's internal hormonal signaling system through the use of synthetic hormones leads 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, weight changes, depression, anxiety, abnormal periods, PMS, and more."
Brauer notes that some women might experience hot flashes as well. 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.
Start by scrutinizing your diet and stress levels.
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."
Digestion is 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 actually 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 own hormones," she says. "When preparing ahead of time, the transition can go smoothly and one can avoid major symptoms and side effects."
So 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 are also shown to help support hormonal balance and alleviate PMS symptoms, though you should check with your doc before including them in your routine for the first time. And on that note…
Know when it's time to get extra help.
You shouldn't have to suffer just for the sake of getting your hormones back on track. If symptoms persist, your doctor can advise on next steps to take, whether it's prescribing a medical intervention or another lifestyle change. "I would advise giving your body two full menstrual cycles to see if it normalises," says Nayak. "If not, it's time to seek support!"
Cleveland Clinic. Birth control options. Updated April 12, 2019.
Duke University Student Affairs. Dear birth control pill, where's my period?! Updated November 9, 2015.
Cleveland Clinic. 6 things that can happen when you stop taking the pill. Updated August 7, 2019.
Rachdaoui N, Sarkar DK. Effects of alcohol on the endocrine system. Endocrinol Metab Clin North Am. 2013;42(3):593-615. doi:10.1016/j.ecl.2013.05.008
Herrera AY, Nielsen SE, Mather M. Stress-induced increases in progesterone and cortisol in naturally cycling women. Neurobiol Stress. 2016;3:96-104. doi:10.1016/j.ynstr.2016.02.006
Cleveland Clinic. How to reduce cortisol and turn down the dial on stress. Updated August 27, 2020.
Dietz BM, Hajirahimkhan A, Dunlap TL, Bolton JL. Botanicals and their bioactive phytochemicals for women's health. Pharmacol Rev. 2016;68(4):1026-1073. doi:10.1124/pr.115.010843
Johns Hopkins Medicine. Premenstrual syndrome (PMS).