How to recover after coming off the birth control pill
I am often asked about how to balance hormones after coming off the oral contraceptive pill or other synthetic hormone products. Women are concerned about:
- Their periods not returning. This is called post-pill amenorrhea.
- The return of hormonal problems like PMS, acne, PCOS or endometriosis after stopping the pill
- New symptoms, like acne, hair loss, period pain or irregular periods starting because of synthetic hormone withdrawal, metabolic changes or nutrient deficiencies from talking the pill
- Optimizing fertility and getting ready to conceive
The first important thing to know is that it’s normal to wait a few months for ovulation to occur and the first period to arrive. The hormonal control centers of the brain, the hypothalamus and pituitary gland, need to reestablish their communication with the ovaries for the first time in potentially, years. Medically, it is considered normal for a 6-9 month wait for the period to return. Naturopathically, I would start investigations if it hasn’t arrived after 3-4 months, if periods were regular before stopping the pill.
The following are some tips for nutritionally restoring hormonal vitality after coming off synthetic hormones.
1. Re-build nutritional reserves
Not many people realize that the pill depletes the women of many nutrients. The synthetic hormones can reduce the absorption of nutrients, increase their excretion and can cause greater oxidation so that the body needs to use more antioxidant nutrients. Nutrients that have been shown to be depleted by hormonal contraceptives include vitamins B2, B6, B9 (folate), B12, C and E; coenzyme Q10; and the minerals magnesium, selenium and zinc.
When coming off the pill, eat a varied diet of healthy whole-foods to increase and rebuild stores of nutrients. I usually also recommend a quality multivitamin (including a good amount of folate) to speed up the repletion process and minimize post-pill side effects. If planning on getting pregnant, I recommend taking a prenatal multi for 3 to 4 months before you plan to conceive. Often it can also be useful to supplement zinc separately, which is an important mineral for hormonal regulation and treating acne.
2. Support the liver
The liver detoxifies synthetic hormones, any excess estrogen and their metabolites in the body. Here are some tips and tricks to support the detoxification systems in the liver:
- Eat plenty of cruciferous vegetables (kale, broccoli, cauliflower, brussels sprouts etc.) – daily if possible. They have lots of compounds useful to the detox processes. Taking broccoli sprout powder is an option for boosting cruciferous veggies in the diet.
- Foods high in sulfur such as eggs, onion, garlic and the cruciferous family (above), also provide compounds that support liver detox.
- Eat plenty of fiber, which will bind to detoxed hormones eliminated from the liver in bile, and support their elimination. You can obtain fiber from plenty of fruit and vegetables, whole grains, legumes, and soaked chia seeds and psyllium husks.
- Eat some quality protein every day. Different amino acids that make up protein are required for both phase 1 and phase 2 liver detoxification pathways.
- Consider including some liver support herbs. This can be as simple as drinking herbal teas like milk thistle, dandelion or schisandra berry. A naturopath or herbalist can also recommend specific supplements or formulate a herbal tincture for your needs.
3. Support gut health
We know that hormones affect our microbiome. Being on the pill, for example, is known to increase the chance of developing a vaginal yeast infection. We also know that an altered microbiome in the gut can affect our ability to detoxify hormones. We can support a healthy population of gut bugs after coming off the pill by eating a gut microbiome friendly diet (blog on this to come soon), and by taking targeted probiotics and prebiotics. Some probiotic foods to encourage gut health include natural yoghurt, kombucha, kefir, sauerkraut and kimchi.
Once excess hormones are detoxified, they leave our body via our stool. If we aren’t passing stool regularly enough, they can be reabsorbed. It’s important to drink enough water, move your body and get enough fiber in your diet to help prevent constipation. We are aiming for at least one number two motion per day.
4. Address the stress
Hormone balance can be upset by negative influences on the hypothalamic-pituitary-adrenal axis. That is, anything that can cause us stress! Psychological stress is only one component. Other things that can stress the body and affect hormone balance are not getting enough sleep, very low body fat, obesity, not eating enough calories or enough carbohydrates, over-training, inflammation from poor diet or chronic health conditions, even poor self esteem.
In order to get hormones back into their natural rhythms, make stress management a priority. Can stop spreading yourself thin by saying “yes” too much? Can you turn off your TV, laptop and phone earlier at night and get a good night’s sleep? Can you allow yourself to do more relaxing and restorative exercise rather than smashing your body with hard training?
Herbal adaptogens can also help the stress response. Licorice root is great for the adrenals and easy and delicious to drink as a tea. Other great adaptogens include withania, rehmannia, rhodiola, tulsi and Siberian ginseng. I like to include herbs like these in personalized herbal tinctures for hormone balancing.
I have a lot more to say about stress management for hormone regulation, keep an eye on the blog.
5. Protect against post-pill acne
Synthetic estrogen used in the pill works well for treating acne because it suppresses sebum production in the skin. It is normal to get some acne in a rebound effect while withdrawing from the synthetic hormones. This is usually worst around 3-6 months after stopping the pill. In addition to the important steps above, here are some suggestions for easing the spots. If you had acne before going on the pill, you can start these treatments three months before coming off it to help with the rebound effects.
- Zinc is a common deficiency for people with acne, and we know that the pill depletes zinc. A zinc supplement, delivering about 30mg of elemental per day, can be used to replete zinc stores.
- The hormones in the pill can cause insulin resistance. Studies have shown that diets that promote good blood sugar balance can help with acne. It’s best to cut down on sugar in the diet (apart from a couple of pieces of whole fruit per day), and stick to a whole-food, low GI diet. Getting quality protein and fat with each meal helps to keep blood sugars stable and helps to eliminate sweet and carby cravings.
- Dairy products can increase hormonal and inflammatory causes of acne. Trialing a dairy-free diet can give answers about whether dairy products are a trigger for your acne.
If your period does not return..
It’s time to investigate further. Work with a health professional to check hormone levels and rule out other causes. Sometimes, missing periods are due to hormonal or body structural reasons, but it’s important to also look at thyroid issues, gluten intolerance and nutrient deficiencies. Sometimes it takes a bit of extra detective work to find out the issue, but it is worth it – for your fertility and health.