One thing many of my clients have asked me a lot recently is “how do I come off the pill?” What to expect, what to do. Many of them are anxious about symptoms, nutrient deficiencies and other issues. Please note I am using the terminology “the pill” to refer to any form of hormonal birth control (HBC).
Others worry about when their fertility will return, and whether they need to think of alternative contraception. Additionally, if you want to conceive, the pill is known to cause deficiencies, so you really want to make sure you get the into a good place at the very least 3 months before you want to conceive so you can ensure you eggs are at their optimal health for a healthier embryo.
Coming Off The Pill Side Effects
Coming off the pill is be necessary if you are trying to get pregnant, however, if you are coming off either for fertility or to work on the root cause of your period problems, the various signs and symptoms of issues you had before going on the pill such as irregular periods, acne, hirsutism (facial hair) and PMS could come flooding back.
The pill masks these symptoms by putting our menstrual cycle on pause, rather than cures them, so when you come off, the root issues are still there.
What Happens With Your Body When You Come Off The Pill
What happens to your body when you come off the pill or any kind of hormonal birth control, depends on what birth control you were on.
If you were on a birth control that suppressed ovulation, then your body will try to start up ovulation again. This might take some time for it to do properly, so you might have longer cycles, eg longer than 35 days. As your body prepares to ovulated, your follicles produce oestrogen to stimulate cervical fluid production and the growth of the endometrial lining.
Oestrogen is also responsible for 300 processes in the body. So all these processes could potentially change. Noticeable effects are you may start to observe cervical fluid or “discharge” in your knickers, spotting.
You will also start producing progesterone post ovulation which is your body’s natural calming hormone and up-regulates and nourishes the thyroid. This is what causes the basal body temperature (BBT) to rise once ovulation has been established. The thyroid is also responsible for energy levels so you may notice these changing too.
Speaking of the thyroid, which can be the victim of auto-immune disease such as Hashimoto’s Thyroiditis, there is also some thought that the pill and hormonal birth control can increase the occurrence of inflammation and auto-immune disorders. Whilst intuitively, you may think that these will be solved by coming off the pill, whilst that may be true, it might be that these changes are permanent or will need investigation or support that you weren’t expecting when you come off the HBC.
If you were on the pill for acne, you may have been put on a sebum reducing pill. However, our bodies are very good at feedback and re-regulating things so they will up-regulate sebum production to what it thinks the right level should be. It can take time for the body to re-regulate this post pill and we might end up with rebound acne for a while.
Whilst we are on some hormonal birth controls, Testosterone can be reduced, due to the increase in Sex Hormone Binding Globulin (SHBG). There can also be a surge in androgens again post birth control until your body self regulates efficiently again and the ovaries kick in and SHBG lowers again. This will eventually sort itself out, but it can be frustrating to start with.
Testosterone helps us with muscle mass, bone mass, repair of reproductive tissue and libido. However, in some people, it can cause acne, hirsutism and other symptoms of Polycystic Ovarian Syndrome (PCOS).
In some people, it can take a while for their cycles to restart. Whilst we are on the pill, our SHBG levels rise to help mop up and reduce sex hormones in the body. I have written a post on this here.
Hopefully this is obvious, but depending on what type of hormonal birth control you are on, the symptoms could match any of the above in any combination, or you might be lucky and have none at all.
What Happens With Your Emotions When You Come Off The Pill
When your oestrogen and testosterone levels rise, your sense of energy, extroversion and risk taking behaviours can rise too. I have had some clients say to me that they didn’t realise how numb they had been feeling before.
However, it can be common for it to take a while for our cycles to get to regular lengths, we might have more oestrogen creating oestrogen dominance for a while, which is where our oestrogen is too high in comparison to progesterone in the later part of our cycle, and create symptoms such as PMS, moodswings and anger.
A good indicator that this might happen would be if it happened before you came off the pill. If you aren’t sure if you had PMS, ask the people who are close to you. I am amazed how many people tell me they don’t have PMS and then their partners tell me they do.
Anger, libido and energy can also be raised by the temporary boost of testosterone post pill.
Some people might just experience mood swings or low mood for a while too. If you are experiencing emotional symptoms, it is worth keeping a record and seeing if there is a pattern, whether the symptoms are getting better or worse. And don’t forget that not all emotions are due to your hormones or the pill. If you are in a bad situation at work or in your personal life, those feelings may be valid, so do talk to your support networks.
Tips For Coming Off The Pill
However, there is no need to despair, there are things you can do now, even before coming off the pill to help your hormones and menstrual cycle, even if you do hit a few road bumps on the way.
1. Start Charting Your Menstrual Cycle For Coming Off The Pill
When you first come off the pill, it is difficult to know what to expect and it is different for everyone. It can take a while for your cycle to return and get into a healthy cycle again, if you start charting your cycle using a symptom-thermal method such as the Sympto-Thermal Method of Natural Family Planning (NFP) or Fertility Awareness Method (FAM), you will start to see the signs of fertility returning and if there are any issues, have a better idea of what is causing them.
There are many signs of your cycle returning. It can be obvious ones such as some form of bleeding or spotting, cervical fluid returning or getting a fertile pattern or a change and basal body temperature rising.
There are also more subtle signs such as changes in mood, energy, creativity, ability to concentrate, libido, and sociability. You may also find that if you had hormonal or period symptoms before you were on the pill, and maybe you went onto the pill to manage, that they bounce back as birth control didn’t cure the problem.
However, if you are aware of the potential for all these things to happen, you can watch out for them and take steps to mitigate certain issues returning.
There are many ways to chart your cycle from the formal Sympto-Thermal Methods I mentioned before, such as FAM and NFP, but there are also apps and charts for charting how you feel, and the more subtle symptoms.
I truly feel that one of the most important things about coming off the pill is reconnecting and becoming aware of your body again and all its idiosyncracies.
There are a number of charts and books out there, but most people find they need to learn from a teacher or video. I run webinars on this periodically and have a course available on my online courses site.
2. Start Thinking About Your Nutrient Levels
The pill often causes issues with levels vitamin C, vitamin E and a number of B vitamins such as B2, B6, B9 and B12. Minerals that tend to be deficient in women coming off the pill after a long time are selenium (brazil nuts and oysters are a great source), magnesium (dark leafy greens, nuts and seeds) and zinc ( grass fed pasture raised red meat, poultry, nuts and seeds).
If you are looking at incorporating more nutrient dense foods into your diet such as the ones listed above and incorporate more vegetables into your day, especially dark green leafy and cruciferous vegetables which help with oestrogen metabolism as well as are rich in vitamins A, C, K and some b vitamins but also colourful vegetables as well which offer a range of different micro nutrients.
Just be careful to make incremental changes, as it takes time for your gut bacteria to catch up and no one wants sudden on set of bad gas!
Whilst you can take supplements, you can’t out supplement a bad diet. Rather than think purely in terms of calories, I like to think of things in terms of nutrient density. If you were to compare 200 kcal of various foods, you would get very different amounts of nutrition, especially micronutrients.
For example, you could have a slice or pizza or a small cupcake for 200kcal, or a whole heaped plate of salad with lots of bright vegetables, fruits, with some protein and fats.
Aside from the second dish looking more Instagram worthy, it will contain many more nutrients and be far more filling than the pizza and cake (which are fine in a well balanced diet). I can’t say I have ever known anyone to mindlessly eat through a bag of kale, or a bunch of raw carrots, but I can attest to mindlessly munching my way through junk food snacks!
For people who are looking to supplement, I do recommend either getting a personal assessment or testing done where possible, as sometimes, supplementation can do more harm than good. Some of my favourite brands are Thorne Research and Designs for Health.
3. Eat Good Quality Fats
These are essential for brain health, the brain is 60% fat and a necessary part of the hormonal and endocrine cycles. Cholesterol is needed for hormone production, and good quality fats such as mono and poly unsaturated fats raise HDL levels, bringing down your overall cholesterol number. My favourites are avocado, coconut, olive oil, nuts, seeds and oily fish.
4. Start Researching Your Birth Control Options
Depending on the reason you came off birth control, you may need to think of this with different levels of priority. It is so important if you are active to think about what contraception is right for you. Start exploring different options and if you have a partner, talk to them about alternatives you can try together.
If you have come off birth control due to the side effects and are wanting to deal with your hormonal health, then you can start researching non hormonal methods such as condoms (the only way to also prevent condoms), Sympto-Thermal Charting (which does take around 3 months to learn properly and should be done with a teacher), withdrawal (which requires discipline), tubal ligation (which is fairly invasive surgery) and vasectomy. There are some devices that help you with sympto-thermal method type charting but use an algorithm such as the Daysy Fertility Monitor.
If you came off brith control to conceive, it is still something to discuss with your partner and midwife long term as fertility can return sooner than you think after birth, and even if you are practicing the Lactational Amenorrhoea Method (LAM) for birth control, this is only valid for 6 months postpartum.
5. If You Have An Underlying Health Problem, Look Into How You Want To Work With It
One of the stressful things about coming off the pill is when you were on it for an underlying condition such as PCOS, endometriosis, fibroids, cysts, painful or heavy periods.
There are lots of things that can be done to manage these conditions without drugs or surgery such as working on your nutrition, Fertility and Womb Massage Therapy, acupuncture and reflexology.
This blog is an introduction to that, which will give you an idea if that is something that interests you. If you want to get a plan in place, or work with me, you can book here.
6. Learn To Love & Reconnect With Your Body Again
This is an important aspect that is overlooked as in some women, the feedback mechanisms that work to tell our body what to do, don’t kick back in after the pill. I have found that this can cause emotional turmoil in some women.
Some things that can help include charting your cycle, reconnecting with your period and spending time getting comfortable in your body again. I love charting my cycle, there is a free guide here to charting your cycle (under my old branding The Healthy Womb) on the emotional side, and I have a course on how to start learning the Sympto-Thermal Charting Method.
You may also experience some detox symptoms so it is really important to understand that and accept them for what they are rather than just think you have major period issues returning or PMS.
So, now you have a good starting point for what to do when you come off the pill. I understand that if you went on it for period symptoms, that it can be scary to come off, but I can tell you: as someone who had the most severe PCOS symptoms, I can assure you it is possible, but I had to invest in expert help to get me there.