Written by Dr. Jordan Robertson, ND
The oral contraceptive pill can play a major role in managing both contraception and preventing pregnancy and to support the symptoms of many common women’s health conditions. As women move past the need for the pill in their life, or desire to return to regular hormone function, the question often arises:
“What should I expect when I come off the pill?”
These three considerations and questions to ask can help you understand what your post-pill experience will entail and can give you clarity on the months that follow discontinuing the pill, which are often riddled with new or returning symptoms.
Why did you go on the pill in the first place?
The pill has a larger role in health than just contraception and it is often added to a woman’s health plan to help with her menstrual cramps, irregular cycles or acne.1,2 If the pill was added into your health plan to manage a symptom, it’s possible that these symptoms will return when you discontinue it. Very few hormonal symptoms, with the exception of adolescent acne, are ‘grown out of’ and the although the pill is excellent at masking the symptoms in your day-to-day life, the underlying condition causing your symptoms is probably still there. If you have ever been diagnosed with PCOS, endometriosis or had irregular cycles for other reasons before you went on the pill, your acne, irregular cycles, menstrual cramps or unwanted hair growth may return when you stop.2,3 When your past symptoms return, it’s an excellent time to consider having lab tests to understand your hormones, or to consider natural treatment options to support your symptoms. Nutrients such as inositol4, zinc5,6 and vitamin D7,8 play a role in supporting the hormone symptoms that are often masked by the pill. Learn more here.
Remember that ovulation doesn’t happen when you’re on the pill, and neither does PMS
Cycles can take a few months to resume full hormone function and sometimes as ovarian function resumes, new symptoms related to hormones present themselves.9,10 PMS symptoms are often absent when on the pill and can rear their head in the months following the discontinuation of the pill as ovulatory function turns back on.11 Symptoms such as breast tenderness, bloating and irritability may start to arrive, even before you’ve had your first period.12 PMS symptoms are triggered by the release of progesterone as an egg is ovulated, which proceeds the menstrual cycle by approximately 2 weeks.12 These new symptoms are a sign that ovulation is returning. PMS symptoms may become worse with age and these symptoms may feel new to patients who have been on the pill for some time.13 The symptoms of PMS can be alleviated by herbs such as vitex14–16, which have been shown to lessen the physical and emotional symptoms triggered by ovulation.
It can take a full 6 months to get back to normal
Depending on your reasons for going on the pill in the first place, it’s possible that your body may take 6 months or more to resume regular cycles after discontinuing it. Studies have examined how long it takes for ovulation to resume (and subsequent pregnancy in patients who desire to become pregnant) and within the first year after discontinuing the pill pregnancy rates (and ovulation rates) are similar to patients who are not on the pill 9,10. If your cycle does not regulate, or if your past experience of irregular bleeding, painful periods or other symptoms return, it is worth a conversation with your practitioner about testing for conditions such as PCOS, endometriosis or even perimenopause. Patients who take the oral contraceptive for 10 years or more technically don’t have a change in their ability to ovulate because of the pill, but their underlying hormonal health and ovarian aging that has occurred in the 10 years while being on the pill can have a significant impact on cycle regularity17.
Whether you are ready to discontinue the pill because of side effects, the desire to return to natural cycles or because you no longer need contraception, the first 6 months after stopping the pill can bring a return of old symptoms or a new hormone experience that may need support. Symptoms such as PMS, a return of adult acne or irregular cycles are all indications that your health needs attention. These symptoms are a clue to your underlying hormonal health and can guide you towards understanding supporting your body better.
- Archer, J. S. & Chang, R. J. Hirsutism and acne in polycystic ovary syndrome. Best Pract. Res. Clin. Obstet. Gynaecol. 18, 737–754 (2004).
- Cooper, D. B. & Mahdy, H. Oral Contraceptive Pills. in StatPearls (StatPearls Publishing, 2021).
- Weisberg, E. & Fraser, I. S. Contraception and endometriosis: challenges, efficacy, and therapeutic importance. Open Access J. Contracept. 6, 105–115 (2015).
- Kamenov, Z. & Gateva, A. Inositols in PCOS. Molecules 25, (2020).
- Brandt, S. The clinical effects of zinc as a topical or oral agent on the clinical response and pathophysiologic mechanisms of acne: a systematic review of the literature. J. Drugs Dermatol. JDD 12, 542–545 (2013).
- Cervantes, J. et al. The role of zinc in the treatment of acne: A review of the literature. Dermatol. Ther. 31, (2018).
- Bahrami, A. et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecol. Endocrinol. Off. J. Int. Soc. Gynecol. Endocrinol. 34, 659–663 (2018).
- Giampaolino, P., Della Corte, L., Foreste, V. & Bifulco, G. Is there a Relationship Between Vitamin D and Endometriosis? An Overview of the Literature. Curr. Pharm. Des. 25, 2421–2427 (2019).
- Barnhart, K. T. & Schreiber, C. A. Return to fertility following discontinuation of oral contraceptives. Fertil. Steril. 91, 659–663 (2009).
- Girum, T. & Wasie, A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept. Reprod. Med. 3, (2018).
- Yonkers, K. A., O’Brien, P. M. S. & Eriksson, E. Premenstrual syndrome. Lancet 371, 1200–1210 (2008).
- Gudipally, P. R. & Sharma, G. K. Premenstrual Syndrome. in StatPearls (StatPearls Publishing, 2020).
- Schweizer-Schubert, S. et al. Steroid Hormone Sensitivity in Reproductive Mood Disorders: On the Role of the GABAA Receptor Complex and Stress During Hormonal Transitions. Front. Med. 7, 479646 (2021).
- Berger, D., Schaffner, W., Schrader, E., Meier, B. & Brattström, A. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS). Arch. Gynecol. Obstet. 264, 150–153 (2000).
- Cerqueira, R. O., Frey, B. N., Leclerc, E. & Brietzke, E. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch. Womens Ment. Health 20, 713–719 (2017).
- Huddleston, M. & Jackson, E. A. Is an extract of the fruit of agnus castus (chaste tree or chasteberry) effective for prevention of symptoms of premenstrual syndrome (PMS)? J. Fam. Pract. 50, 298 (2001).
- Peacock, K. & Ketvertis, K. M. Menopause. in StatPearls (StatPearls Publishing, 2021).
- Zimmerman, Y., Eijkemans, M. J. C., Coelingh Bennink, H. J. T., Blankenstein, M. A. & Fauser, B. C. J. M. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum. Reprod. Update 20, 76–105 (2014).