You’re ready. You suspect that hormonal birth control is no longer right for your body (and you have a sinking feeling it never was). You’re ready to come off, but you have a few questions. What symptoms or side effects might arise? What can you do to prevent them?
Those are the questions I get all the time from my readers and patients. How I wish there was a simple answer! If there was, I would have blogged about it before, and I would not have had to write an entire book about it.
I can’t offer you a one-size-fits-all list of recommendations, but I can tell you what I would do if you were my patient. I would not take you off hormonal birth control until I had first learned what your periods were like before. I’m not talking about your current pill-bleeds because they are not periods. I’m talking about your real periods — the ones you had maybe ten years ago.
What were your real periods like? Were they regular? Were they heavy or painful? Did you suffer acne? Those problems have not gone away. They have merely been masked by the pill, and they are probably going to re-emerge.
So your plan for coming off hormonal birth control is to address those period problems that you had before. Let’s look at four different plans.
Plan A: You had normal periods before
Is this you? You had regular periods before you took birth control, and they returned the last time you had a break from birth control.
The plan: This is the simple plan. Just stop the pill (or ring or implant or injection), and see what happens. Chances are, you’re going to be fine. You might experience some mild acne or anxiety as you withdraw from synthetic estrogen but it shouldn’t be too bad, and it shouldn’t last longer than three months.
Your goal is to ovulate and make your own (much nicer) estrogen. If you don’t ovulate after three months, then consider an ovulation-stimulating herb such as Vitex (a medicine prepared from the berries of a large Mediterranean tree). You might also want to talk to your doctor about blood tests for hormones such as FSH, LH, prolactin, and androgens. (For details about testing, please see Chapter 7 of Period Repair Manual).
⇒Tip: When it comes to period health, it’s all about ovulation, because ovulation is how you make your beneficial hormones estrogen and progesterone.
Plan B: You had irregular periods before
Is this you? You had irregular periods (or no periods) either before you took birth control, or the last time you tried to stop.
The plan: Before you stop birth control, try to figure out why you didn’t have periods before. Was it the insulin resistance of classic PCOS? Or was it something completely different such as nutrient deficiency or a problem with your thyroid? If you’re not sure, then ask your doctor: What was the problem with my periods before?
Your doctor might say PCOS, but that’s not a complete diagnosis. Look deeper to find the real underlying cause. (See 4 Types of PCOS.)
Ask to see your old blood tests because they may reveal some clues. Ask for new blood tests. You can’t test female hormones while you’re still on the pill, but you can test for other things such as insulin, thyroid, vitamin D, and gluten sensitivity.
Identify a possible underlying problem, and start treatment a month or two before you stop birth control. You’re removing obstacles to ovulation. You’re doing it now, before you actually try to ovulate. For example, if you are insulin resistant, then quit sugar and take magnesium. If you have a thyroid problem, then remove gluten from your diet. If there’s any chance that you have been too restrictive with your diet, then eat more fat, protein, and starch. It’s hard to have a period without those foods.
Once you’ve made those changes, then you are ready to stop hormonal birth control. You might be pleasantly surprised at how quickly your period comes this time. That’s because your body is different now than it was before. Give yourself at least three months off hormonal birth control before you try an ovulation-stimulating herb such as Vitex or peony. If no period after six months, then see your doctor.
Plan C: You had acne before
Is this you? Acne is why you went on the pill, and it’s why you’ve retreated back to it. Synthetic estrogen does clear skin, but it’s not a solution because your skin simply compensates by making more oil. That makes it harder and harder to stop synthetic estrogen. It will just keep getting worse the longer you stay on the pill.
The plan: Start natural acne treatment at least one month before you stop hormonal birth control. That way, the treatments have a chance to work before the peak of your post-pill acne (about three months after stopping synthetic estrogen).
Best acne treatments are: 1) Sugar-free, dairy-free diet, 2) zinc, and 3) the herbal medicine berberine. (Please see my acne post.) You can also consider diindolylmethane or DIM (a phytonutrient from broccoli extract). DIM works for acne — not because it detoxifies estrogen (it also does that) — but because it blocks androgen receptors.
Plan D: You had heavy bleeding and/or period pain
Is this you? Your period was frightening when you weren’t on hormonal birth control. It was heavy and/or painful and you are understandably a little reluctant to come off.
You’re right to be worried. If you had difficult periods before the pill, then you will probably have them again when you stop. (Remember, pill bleeds are not periods, so you can’t count those.) The exception are the heavy periods of your teenage years, which you have probably outgrown.
The Plan: If you haven’t already, please first see your doctor to look for any underlying condition such as fibroids or endometriosis (keep in mind that endometriosis is not easy to diagnosis).
If you do have an underlying gynecological condition, you may still be able to come off the pill, but it will be a little more complicated. Please see Chapter 9 in Period Repair Manual.
If you don’t have an underlying gynecological condition, then your pain and bleeding is from either inflammation, or from too much estrogen (or both). You need to reduce inflammation and promote healthy estrogen detoxification for at least one or two months before you stop hormonal contraception.
Promote healthy estrogen detoxification by avoiding alcohol, maintaining healthy intestinal bacteria, and by taking supplements such as DIM, calcium d-glucarate, and iodine.
Heavy periods need the additional treatment of iron. Please see my heavy period post.
Irregular periods, acne, heavy periods. Those are just a few of the symptoms that can arise when you stop hormonal birth control. Of course there are others, such as PMS and hair loss. Your best plan is to ovulate, ovulate, ovulate! Because that’s how you make the wonderful hormone progesterone to relieve those conditions. Please see my book, Period Repair Manual, and the following posts:
I recommend Fertility Awareness Method, copper IUD, or barrier methods such as condoms or cervical cap. I survey all the different contraceptive methods in Chapter 3 of my book.
Yours in Health,
Natural health evangelist, hormone expert, and author of Period Repair Manual, Lara Briden first worked as an evolutionary biologist at the University of Calgary. She went on to graduate as a naturopathic doctor from the Canadian College of Naturopathic Medicine (CCNM) in Toronto. Her love of science and the natural world has informed the way she practices medicine. During her nearly twenty years of practice, thousands of patients have entrusted her with their hormone stories. She shares what she’s learned at larabriden.com.