Regaining a healthy cycle after the pill looks different for everyone. Some individuals can come off hormonal birth control and begin cycling regularly right away, others may have a bumpier transition, and some women may not cycle at all for months, or even years.
For the purpose of this article, I’ll be addressing those cases that fall in between, but all pill-users or former pill-users can benefit from the best practices discussed here. By supporting your body through this transition, you can fast track your return to optimal health, and possibly avoid some unwanted symptoms.
How the pill affects our natural cycles
Hormonal birth control works by slowing down or completely stopping your body’s own production of reproductive hormones. Instead of relying on endogenous hormonal production, your body uses the synthetic hormones that the pill supplies.
In a natural cycle, the hypothalamus gland in your brain notices low hormones during your period and tells the pituitary gland (also in your brain) to release follicle stimulating hormone (FSH) to let your ovaries know that it’s time to start making estrogen. When estrogen levels reach a certain point, the hypothalamus tells the pituitary to release a different hormone, luteinizing hormone or LH. This hormonal signal causes the now mature egg to break out of a little sack on your ovary. The little sack, now called the corpus luteum, then starts to produce progesterone, which is the hormone that dominates the second half of your cycle.
When you are on the pill, you are ingesting hormones every day. So, when your hypothalamus scans your body and sees that you have certain numbers of hormones, it tells your pituitary not to do anything. The pituitary no longer has to communicate with the ovaries to stimulate hormone production.
This can mask the symptoms of hormonal imbalances and reproductive disorders, such as PCOS and endometriosis, but it can also atrophy the body’s own ability to produce hormones. A European study actually found that the ovaries shrink during prolonged birth control pill use. (Yikes!)
What to expect when quitting the pill
Everyone is different, but there are some factors that make you more likely to experience unwanted symptoms when quitting the pill. These include:
- Long term birth control pill use
- Starting the pill soon after getting your first period
- Cycle and related health issues prior to starting the pill (irregular cycles, PCOS, endometriosis, hormonal acne)
When you go off the pill, it may take a while for your brain and your ovaries to start talking again. Typically, you’ll go through a few low-hormone months as the synthetic hormones from the pill leave your body and your body learns to make its own hormones. During this transition phase you may experience:
- Breast changes
- Changes in sex drive
- Hair loss
- Heavier or lighter periods
- Irregular periods
- No periods
- Mood changes
- Lack of ovulation
As your pituitary-ovary connection is reestablished, your body will start to make its own hormones and symptoms will subside. If you do not get a period within six months, you should see your doctor.
The top three things you can do to make your transition off the pill easier
1. Eat a balanced diet
The food your put into your body is the most important medicine. You will want to support your body with the right macronutrients: fats, protein, carbohydrates and fiber. Your body needs plenty of healthy fats to build reproductive hormones, so focus on olive oil, coconut oil, avocados, grass fed dairy and fatty fishes. Fiber is also especially important because it plays a role in the detoxification of hormones.
Eat for a wide range of nutrients – plenty of colorful veggies, and your greens, too. The birth control pill depletes the body of important vitamins and minerals, such as B vitamins, magnesium, zinc and selenium. Eat a nutrient-rich diet to help restore vitamin stores. I often recommend targeted supplementation as well to make sure that your body gets enough of the nutrients that it needs.
Incorporate fermented foods into your diet as well. The birth control pill compromises the microbiome, and fermented foods will help to restore the good ‘gut bugs’ and can also help to correct vaginal infections and UTIs if you began to experience them while on the pill.
Managing your stress levels is one of the most important things you can do to
support your transition off of the pill. Stress can interfere directly with reproductive hormone production – exactly what we don’t want during this time! This is partially due to a phenomenon known as pregnenolone steal. This occurs when your body uses the hormonal precursor pregnenolone that would have been used to make progesterone (remember, the hormone that dominates the second half of the cycle?) in order to make cortisol, the stress hormone.
So, take some time to address your stressors. Is there anything that you can delegate or stop doing altogether? Where can you ask for help? Develop techniques to manage stress that arises from situations that you cannot change. This may include breathing techniques or modalities like meditation, acupuncture and yoga.
3. Support your liver
Your liver plays a critical role in supporting your hormonal health, and it is especially important to support this vital organ when you are quitting the pill! This is because your liver detoxifies excess hormones like estrogen, and it has to work overtime when processing all of the synthetic estrogen that you consume while on the pill. (This sometimes results in a dark spot on the liver that is visible in X-rays, and in more extreme cases tumors on the liver.)
You need your liver to help remove the remaining synthetic estrogens in your system (this can be one of the biggest causes of post-pill acne), and to continue to help support healthy hormone production and detoxification.
Aside from limiting your exposure to compounds that the liver has to process, such as synthetic chemicals, alcohol and caffeine, one of the biggest things you can do to support your liver health is to consume bitter foods such as arugula, dark chocolate and herbs. Cruciferous vegetables such as Brussels sprouts and broccoli also contain an important compound for the liver known as SGS (sulforaphane glucosinolate).
A note on trying to get pregnant after quitting the pill
Some women do get pregnant right away after coming off the birth control pill. But, recent studies have shown that it can take couples who have been using hormonal birth control up to twice as long to conceive.
I recommend that my clients wait at least six months after going off the pill to start trying to conceive. Some studies have indicated a correlation between hormonal birth control and preterm delivery and low birth weight.
The pill compromises your health, and a healthy mom means a healthy baby! You want to have a healthy microbiome because baby gets all of his or her good gut bugs from mom, and you need time to replenish important nutrients for pregnancy that have likely been diminished during your time on hormonal birth control. So, take some time to bolster your health first!
It can take some time for a healthy cycle to resume after quitting the pill. If you’re experiencing symptoms, I know that it can be hard when your body seems to be behaving erratically. Trust that your body is actually incredibly logical – it is doing everything that it is doing for a reason. Continue to support your body with good foods, therapeutic supplementation if needed, and good movement – and remember to keep those stress levels down!
Kara Ferreira is a fertility health expert who works with women to troubleshoot their monthly cycles and digestion so that they can feel their best and be their best selves. Read her full bio here.