Getting Off Of Birth Control - How To Avoid Post Birth Control Syndrome
For many of us, we are not strangers to birth control have been using hormonal birth control methods for years or even decades. Birth control is prescribed for an array of purposes, including contraception, managing dysmenorrhea (heavy or painful periods), regulating irregular periods, alleviating the symptoms of endometriosis and polycystic ovarian syndrome (PCOS), and clearing acne. Please note that for all-intensive purposes in this blog that “the pill” is inclusive of all forms of birth control, with the exception of the copper IUD and other natural, non-hormonal forms of contraception. Some of the most common questions women ask us about birth control are:
Are there any dangers to taking birth control long-term?
What type of symptoms should I expect if I come off birth control?
How can I manage symptoms and rebalance my hormones after getting off birth control?
The pill works to prevent pregnancy by releasing artificial forms of the sex hormones estrogen and progesterone (known as progestin), that mimic the hormones produced by the body endogenously, or naturally. The infiltration of these exogenous hormones (meaning externally-made or not natural ) inhibit ovulation, thereby preventing the release of an egg that could potentially be fertilized by sperm. These hormones also thicken the cervix lining to block the sperm’s entrance and essentially make the environment unsuitable for fertilization and pregnancy. “Combination pills” contain both artificial estrogen and progestin, while “minipills” only contain artificial progestin.
The pill may do a great job of preventing pregnancy (in fact, it’s 97-98% effective in use and 99.9% effective in theory) but in doing so it has some significant side effects on the body that your OBGYN may not have informed you of upon prescription.
Taking birth control for reasons other than contraception does not actually address, nor resolve the root causes of the aforementioned issues. The pill does a great job of pacifying symptoms, which slows or stops the issues for an allotted period of time, but this approach frequently leaves disorders such as endometriosis and PCOS undiagnosed.
When adequate time is not taken to perform research or run labs, the root cause of such irritants like irregular periods, intense cramping, and hormonal acne is left undetermined.
As with any drug, it is important to understand the side effects or long-term effects that may accompany use. This is especially important for women who want to come off of the pill in order to become pregnant, to alleviate unexpected side effects, or to avoid long-term repercussions as the fertility process can be intimidating and arduous for some.
Individuals who have experienced side effects such as hair loss, acne, amenorrhea, headaches and/or migraines, anxiety, depression, mood swings, digestive distress, bloating, leaky gut, inflammation, imbalanced blood sugar, and weight gain or loss while taking or trying to come off of birth control should know they are not alone. We call these symptoms Post Birth Control Pill Syndrome, or PBCPS for short, and you do not need the entire list to quality.
After months or years (and even decades, for some) of feeding your body artificial hormones, it only makes sense that it would struggle to transition out of that smoothly and back to homeostasis. After all, hormones regulate everything from sleep to sex to mood to digestion.
Whether you are coming off of the pill because you are looking to become pregnant, have had negative side effects while taking it, are wary of the long-term effects of hormone therapy, or for other personal reasons, Team DLW is here to help make the process more seamless by explaining the effects the BCP has been shown to have and ways to combat these potential side effects naturally through nutrition, acupuncture, and naturopathic medicine.
Nutrient Depletion Caused by the Pill and Other Hormonal Birth Control
One of the most important things you can do while coming off of the pill is to restore the nutrients that were depleted while taking the prescription. Birth control pills have been shown to cause malabsorption and lessen the binding capacity of specific nutrients to their receptor sites on target tissues.
It has also been shown to cause an increased excretion rate of both water-soluble and fat-soluble nutrients such as folate (B9), B12, B2, B6, zinc, selenium, magnesium, vitamin A, and vitamin E. Ensuring there are enough of these nutrients through proper diet and supplementation is essential whether you are pursuing a pregnancy or simply aiming to optimize your well-being.
Lab work can be helpful in determining your micronutrient levels. It is wise to get labs run before coming off of the pill so a baseline and properly plan for the changes ahead can be established. From there, specific nutrient-rich foods can be incorporated into your diet. This can look different for everyone, but some foods to focus on as a general rule include:
Green, leafy vegetables: Kale, spinach, collard greens, cabbage, romaine, beet greens, watercress (containing vitamin A, vitamin C, vitamin E, magnesium, various Bs, iron).
Nuts and seeds: Almonds (magnesium, zinc, vitamin E), Brazil Nuts (selenium), cashews (magnesium and zinc), flaxseeds (magnesium), hazelnuts (vitamins B3, B1, zinc, vitamin E), pine nuts (vitamins B3, B2, B1, magnesium, zinc, vitamin E), and pumpkin seeds (vitamin A, vitamins B1, B2, B3, magnesium, zinc), sunflower seeds, vitamin E, magnesium, selenium, vitamins B1, B5, B6, folic acid).
Whole grains: Oats (selenium, magnesium, vitamin B1), amaranth (magnesium, vitamins B2, B3, B5, B6, folic acid, zinc, vitamin E) quinoa (magnesium, vitamin B2, vitamin E, magnesium, zinc), barley (selenium, magnesium, vitamin B3), whole-wheat breads and pastas (look for 100% whole grain on the label rather than “multigrain” or “7-grain”, contains vitamins B1, B2, B3, B5, B6, vitamin E, folic acid, zinc).
Beans and legumes: Soybeans (vitamins B1, B2, B6, vitamin E, folic acid), adzuki beans (vitamins B1, B2, B3, B6, zinc, folic acid), chickpeas (folic acid, magnesium, zinc).
Wild-caught fish: Cod (selenium, vitamin B12, B6, niacin), halibut (selenium, vitamin B12), mahimahi (selenium, vitamin B12, niacin), salmon (potassium, selenium, vitamin B12), tuna (selenium, vitamin B12, niacin).
Fruits: avocado (vitamin E, B vitamins), berries (vitamins A and E), cantaloupe (folic acid, vitamins B3, B5, B1), cherries (vitamins A and E), dates (vitamins B3, B6, B2, B1, magnesium, folic acid, selenium).
Additionally, many women find they deal with impaired gut function as they come off of the pill and of course there is an array of hormonal imbalances that come into play when someone is transitioning off of birth control.
Gut Imbalances Related to the Pill
If you have experienced digestive issues such as bloating and increased appetite, symptoms of anxiety and/or depression, or acne while on the BCP or while trying to come off of it, there’s a reasonable answer as to why. The synthetic hormones released by the BCP can significantly affect the gastrointestinal system by altering the gut flora, thereby increasing intestinal permeability.
By altering the bacterial balance of the microbiome, the pill can create an environment that allows for the overgrowth of potentially pathogenic bacteria, yeast and other microbes. This causes intestinal imbalances, resulting in indigestion, bloating, constipation, gas and diarrhea.
As our body’s largest organ of excretion and secretion, our skin displays the majority of inflammation and imbalance that we experience internally- which is why many GI issues are accompanied by acne, eczema and rashes. It is also well-known that our microbiome impacts brain functioning, which is why the GI is sometimes referred to as the “second brain” due to the Gut-Brain-Axis feedback loop. When the microbiome is disrupted, anxiety, mood imbalances and even depression can develop, and in other cases, exacerbate.
An increase in the permeability of the intestinal wall directly correlates to an increase in systemic inflammation. A compromised intestinal (“gut”) lining is referred to as “leaky gut,” which is a temporary and completely reversible condition which allows for undigested food particles and other toxicants to "leak” through the intestinal tight junctions and out into the peripheral bloodstream which then mounts an immune response.
In order to manage the effects that BCP has on gut bacteria or intestinal permeability, it is essential to eat and live in a way that allows the gut to heal. One way to better understand the effects of birth control pills is to run a comprehensive stool analysis, which examines the bacterial balance, inflammatory levels, enzymatic production, and the presence of yeast, potential pathogens or parasites present within the gut. Another great option is to run a food sensitivity kit, which determines which foods can cause a reaction, how you react, and to what degree of severity your body mounts a response.
From these results your provider can determine if you are experiencing leaky gut, candida overgrowth, any overt sensitivities to specific foods and even aversions particular food groups. Food sensitivities are responsible for digestive distresses such as gas, bloating, distention, constipation, diarrhea, as well as certain skin issues like acne and eczema. By following a proper elimination diet, while simultaneously introducing other nutrient-rich foods, pre-/probiotics and other GI-specific herbs and supplements, you can start to heal your gut while also balancing your hormones.
This of course will look different case by case, but a good starting point is to prioritize your water intake and to avoid the top inflammatory foods:
Gluten
Dairy
Eggs
Corn
Soy
Fried + Fast Foods
Refined sugars and carbohydrates, many of which are made with “white,” nutrient-void ingredients: white rice, white bread, white sugar, white flour products, added sugars.
There are also a number of dietary interventions which may help support your body moving back to more balance. These include:
Ensuring adequate hydration. We recommend aiming for half your body weight in ounces of water per day.
Eat a diverse and varied diet: think veggies, fruits, and spices which are rich in fiber, vitamins, minerals and phytonutrients that support the function and regulation of certain hormones as well as lowers inflammation.
Don’t skimp on the fiber. Both soluble and insoluble fiber helps us have healthy bowel movements which is one of the primary ways we detox/remove hormones from the body.
Ensure adequate protein intake from a variety of sources such as pasture-raised and grass-fed meats, seafood, lentils, and beans.
Ensure adequate intake of healthy fats and omega-3 rich foods which are critical precursors for hormones and are important components of cell membranes.
Sources of omega 3s: wild-caught fish, nuts, seeds, olives, olive oil, avocados.
Consume plenty of foods that support liver detoxification (another way we process hormones) such as: onions, garlic, leeks, green tea, broccoli, cabbage, cauliflower, brussel sprouts, kale, arugula, and dandelion greens.
Reduce and or avoid alcohol which can further perpetuate hormonal imbalances and inflammation.
As you can see the process of coming off of BC is a complex and multifaceted process.
Managing Stress While Getting Off of Birth Control
Another helpful tip is to work on stress management in order to help reduce overall inflammation and to respond well to changes in the gut that may be affecting mental well-being.
Meditation: Apps for this include Deliciously Ella, Insight Timer, Headspace.
Yoga: Find Yoga with Adrienne on YouTube, use the Deliciously Ella app, Nike Training App, Peloton App, or find a local class!
Breath work: Box breathing (inhale for four counts, hold for four counts, exhale for four counts) is a great place to start with breath work. We also recommend belly breathing and finding your Ujjayi breath (easy to find guidance for these on YouTube!).
Sufficient sleep: Most people thrive on seven to nine hours per night! Find your sweet spot in terms of hours and stick to a consistent schedule of going to bed and waking up.
A good support system and social interaction
Focusing on anti-inflammatory nutrition, ample hydration, and managing stress as best you can will not only help with PBCPS, but can help with a myriad of other aspects of health, from your complexion to improved sleep, regulated bowel movements and even improved athletic performance. That is the beauty of holistic healing – you get a domino effect when you look at an issue from its root cause and work toward healing from more than one angle.
Coping with Hormonal Imbalances
The release of synthetic hormones into the bloodstream is undoubtedly going to alter your hormone levels and can affect a wide array of other circulating hormones including cortisol, estrogen, progesterone, testosterone, DHEA, insulin, and even various thyroid hormones.
Many times, the mood swings, headaches/migraines, mood-related symptoms, weight gain, digestive distress, hair loss, and acne that BCP users and those coming off the BCP experience is due to the hormonal imbalances the BCP has created and/or masked for years.
Having blood drawn a minimum of three months after coming off of the pill is the best way to determine where your hormone levels are at, as you work towards restoring balance. The DUTCH (dried urinary test for comprehensive hormones) kit is a functional endocrinology tool that is useful to analyze hormonal levels at specific days and phases throughout the menstrual cycle.
There are various ways to help restore hormonal balance depending on what has been impacted. This may look like including or eliminating certain foods, working on stress management, modifying your exercise routine, prioritizing sleep, and of course supplementation when necessary.
What is the Best Supplementation When Coming Off of Birth Control
The DLW staff always recommends getting vitamins and minerals from food first, but it can be difficult to ensure that you are getting what need and in the form that is best-absorbed. In that case, we turn to supplementation. The following can be helpful to the restoration of nutrients once your levels have been evaluated by a health professional:
Methyl Folate
Our natural detoxification processes require ample amounts of B-vitamins; therefore they are one of the top nutrient priorities for anyone coming off of the BCP. Folate, or B9, is especially important if you have come off of the pill with the desire to become pregnant, as folate is absolutely essential to fetal development, specifically brain and neural tube formation. Many foods are now fortified with folic acid, the more stable form of B9, in acknowledgement of the dangerous impacts of folate deficiency.
Methylated B-Complex
B-vitamins are an incredibly important component to energy production, metabolic functioning and the nervous system. Methylated B-vitamins are more bioavailable than non-methylated vitamins, meaning they are more readily able to be absorbed and used by the body, namely the liver in this instance, at a faster rate than vitamins that are not in that form and would require that additional step once by the liver once ingested.
Zinc Picolinate
Zinc is essential to a wide range of bodily processes, including immune function, synthesis of DNA and transcription of RNA, cell division, and the prevention of cell death. Deficiency due to depletion can be incredibly detrimental, especially to immune function.
Magnesium Glycinate
Magnesium is a mineral that is incredibly important to heart health, nervous system and musculoskeletal system regulation, body temperature, and protein synthesis. It is used in over 300 different biochemical reactions in our body, and is a necessary cofactor in the liver’s detoxification pathways, which is what is necessary for proper elimination of excess hormones and toxicants within the body.
Selenium
We only require a trace amount of Selenium each day through our nutrient intake or else through supplementation, but that does not men that it is not essential for a room transition during this hormonal rebalancing phase. Selenium helps with the normal functioning of our metabolism, is crucial to our thyroid function and is an antioxidant, meaning that is fights the buildup of harmful, pro-aging free radicals and other toxicants within our bodies
Liver Support
There are various nutrients and herbs that help assist the liver in functioning optimally, and depending upon the patients exact needs and presenting condition, there are a variety of products that can be used to aid in the detoxification process and promote the health of liver cells, or hepatocyte functioning.
The following can assist in healing the gut:
Glutamine
Glutamine is an amino acid that acts as food/fuel for the intestinal cells, also referred to as the colonocytes. It also helps to fight inflammation within the gut which is often linked as a side-effect of prolonged birth control usage.
Probiotic
Lactobacillus and Bifidobacterium are the most common and beneficial bacterial strains in your intestinal tract, as well as in your vaginal tract. In the spirit of “two birds one stone” you want to find a probiotic that contains ample amounts of both with no less than 25billion CFUs per capsule.
The following can help restore hormonal balance:
Saw Palmetto, Pygeum, and Nettles
All can help prevent excessive buildup of androgens by targeting androgenic metabolism.
Red Raspberry
Fabulous source of gynecologically-specific antioxidants which can help with inflammation throughout the body. Also may help with blood flow to the uterus, helping alleviate cramps, soothe uterine contractions, decrease cystic formation and fibroid size and support healthy pregnancy.
Chaste Tree Berry / Vitex
Can help normalize and regulate ovulation, thereby bringing mensuration into “normal” 28-30 day timeframe.
HOW CAN TEAM DLW HELP ME COME OFF OF THE PILL AND OTHER HORMONAL BIRTH:
Here at DLW, we have a Naturopathic Doctor, a Nutritionist, and Licensed Acupuncturists who can help you recover from the effects of being on or coming off of an oral contraceptive.