Coming Off Birth Control: A Real Story (Episode 359)

Full Transcript: Episode 359

Lisa: Welcome to the Fertility Friday Podcast, your source for information about the Fertility Awareness Method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys. I know, I know, I’m a busy girl, but I managed to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health. And I’m so excited that you’re here with us today.

Today, I’m sharing a brand new episode of my Fertility Awareness Reality series. In today’s episode, I’m sharing my conversation with my client Allison, who is a member of my most recent Fertility Awareness Mastery Live group coaching program. She is sharing her experience coming off birth control. She recently came off birth control and is just jumping into fertility awareness cycle charting as her primary method of birth control. For those of you who are kind of in the same boat, or considering coming off birth control, or have recently come off birth control, I think this is a good episode to listen to just to really get a sense of what it’s like. So without further ado, let’s jump into today’s episode with Allison.

I’m really excited to be here today with Allison. Allison is a member of my current Fertility Awareness Mastery program, and I think we’re almost halfway through, or about halfway through, at the time that we’re recording this. So I welcome you, and thank you.

Allison: Thank you.

Lisa: I’d love to start just by giving the audience a bit of background. Maybe you can let us know when you had your first period and what that was like, if you’ve used hormonal contraceptives before, and what led you to choose fertility awareness now.

Allison: All right, so I got my first period when I was 11 or 12, and I freaked out whenever I got it. I didn’t tell my mom for a few months because I was like, I don’t want to. And so she found out one day, and she was like, what are you doing? I was like, I don’t know. I had my period, and they were pretty fairly normal. I didn’t ever really pay attention to it. It was just something that came, and I was like, here it is, like another time.

I started birth control when I was 18, when I got into college. I was living that college life, so I got on birth control, and I was on it for only about a year, and then I went off of it. Then I got back on when I was 21, and then I got back off of it again. And then when I was 23, I went to study abroad, and I was like, I want to know when my period’s coming, because I never tracked my period, I never tracked the days or the months, it never occurred to me to do that. So I was like, I want to be on a schedule so I know when I can prepare for it. So I got back on it when I was 23, and I’ve been on it since then, and now I’m 28, and I got off of it about a little over a month ago now.

I discovered fertility awareness two years ago, actually, because I had been thinking about coming off birth control and reading some stuff about side effects, and I was like, oh, this is pretty sketchy stuff. But then I started reading other articles about fertility awareness online that said it doesn’t really work, and I was like, oh wait, maybe I don’t want to do this. It scared me off of it. And I didn’t do the research I should have — I was in my master’s program at the time, so I didn’t have a lot of free time to dig into it. But it always stayed in the back of my mind. I knew once I got married I wanted to go off birth control, because I didn’t want to be on it after that, and I was afraid of getting pregnant before I got married. So I just didn’t do it.

Then I found your podcast this year, actually — I found it back in, I want to say, February. I started listening to it, and I was like, oh, she knows what’s up, she gets it. It really encouraged me to make a plan of when I wanted to go off birth control and actually do it. The reason I didn’t do it immediately is I wanted to read all the books about it, I wanted to be prepared so I knew what was going on. So I read Taking Charge of Your Fertility, which I liked, but it was kind of confusing to me. Then I read your book, and I was like, this makes a whole lot more sense. Then I decided to join your Mastery class, because I figured if I was going to do this, it would really help. I had emailed you about it because I wasn’t sure if I should wait a few cycles or just do it, and you said just do it. So I did, and I’ve been off of it for a month, and it’s been pretty good. I’m so glad I’m in your class, because I think if I had decided to do it on my own, I don’t know where I would be right now.

Lisa: Well, thank you for taking us through that. I love how we can get a sense of essentially a decade or more of your life in just a few minutes. It really speaks to the fact that not only is there not one birth control option that’s going to work for everybody, but at different times of our lives we need different things. There are certain times when we don’t necessarily have the energy to really focus on something like this, because it does take a bit of time — an initial investment, though not a time commitment forever — but there is a period where you have to commit the time to learn it and manage the fear of the unplanned pregnancy question.

Allison: Yeah, and it’s very frustrating knowing more where to look for information rather than just Google, because Google isn’t really ever that helpful. I didn’t know where to look for resources until I found your podcast, and then I looked into the Cervical Mucus Project and the Cervix Project, and found a lot of people on Instagram who are more fertility-awareness based. I wish I would have known about this two years ago when I first found out about it.

Lisa: It’s interesting, because Google has changed. There was a time when Google was more organically driven, where the things people were searching for were the things that actually came to the top. That was years ago — I remember being in my 20s, over 10 years ago. There are a lot of accounts now that are shadow-banned, meaning a lot of people in the natural health space no longer get traffic from Google for generic search terms the way they used to. It’s more challenging to organically find this information now. With certain accounts, you actually have to search their name along with the topic, or you’d never find them organically.

Allison: Yeah, I found other search engines — I think DuckDuckGo is one — but there’s still a challenge, because most other search engines still pull from Google. I know this isn’t totally related, but it’s something I see as problematic, because it’s really not the same as it used to be.

Lisa: Exactly. But back to your story — I think what a lot of the women listening can relate to is all of those decisions we have to make. Whether you’re studying abroad, going to university, doing your master’s — all of these things happening in your life while you’re juggling relationships and uncertainty. Switching to fertility awareness in the middle of that can be a bit of a challenge. It sounded like your periods weren’t the reason you went on the pill — did you have any real concerns, or was it more that you didn’t have a lot of negative side effects?

Allison: No, I’ll say the only side effect I had was when I was 21 and got put on a low-estrogen pill — I was so angry for about six months of my life, and I didn’t know why. It didn’t correlate in my head that it was a side effect, but I would be irrationally angry at people for no reason. It was so frustrating, because in my mind I’d think, why am I so angry today, calm it down — but I couldn’t calm myself down. Then when I got off of it, I also gained a little bit of weight while on it, which I’d never had an issue with before, and when I got off of it I dropped the weight and felt happy again. It was wild. I looked into the side effects, and a lot of women had commented that it made them really moody and angry. That was it for me. But I never had any period-related problems. The only time I remember having a really heavy period was in middle school, and it was miserable, but after that it’s been pretty easy — barely any cramps. I do think I have longer cycles, so I didn’t get my period every month, more like every other month, and I didn’t understand why. That’s part of why I wanted to get on the pill in the first place, to be more regular, since I travel and wanted to know when to expect it. No one had ever told me that tracking your cycle was even a thing, until I started listening to your podcast.

Lisa: Of course you can look back and wonder why you didn’t know, but that’s an unfair assessment, because this is how our world is designed — until there’s a concerted effort to publicly educate women about basic menstrual cycle biology, most women just don’t know. It’s interesting that something prompted you to want to come off of it — that experience, mild as it was, of being on something that changes your mood, and realizing it’s a bit strange that you’d be angry while taking a drug and not angry when you’re not.

One of the things I’ve noticed, and it’s also shown in the research, is that women who go on the pill without intense underlying cycle irregularities — meaning their cycles were already fairly regular and ovulatory — are more likely to come off and start ovulating and menstruating again within a reasonable amount of time. It’s women with underlying cycle issues who are more likely to have a delay in the return of their cycles, because the pill was masking whatever was going on, not causing it. In your case, you came off the pill and started ovulating, and you’ve already had your first cycle.

Allison: Yeah, which I was so stressed about, because I sent you the Read Your Body app — I don’t know if you got that in the email. I did ovulate and had my period, but I was so stressed wondering if it was going to happen or not. I think that’s probably been the hardest part of coming off the pill and starting fertility awareness — wondering if I’m going to be somewhat normal, or if I’m going to wait three months and not have a period. I wasn’t necessarily surprised, but I guess I was surprised that it came, that I ovulated and got my period so quickly.

Lisa: This is the double-edged sword of hormonal contraceptives. For a woman trying to conceive, it can go either way depending on her history. This is why I always say pregnancy is possible in any cycle with ovulation. If you’re coming off the pill, you need to be aware that even though there’s typically a temporary delay in the return of normal fertility, some women ovulate within about 14 days of stopping. Not everybody, there’s a range, but it is possible to come off the pill, ovulate, and get pregnant pretty quickly. So when you’re coming off with the intention of using fertility awareness for birth control, you have to be vigilant from the beginning and have a backup method until you’ve learned enough to rely on your own observations. For most women that’s condoms or another barrier method. Some women simply won’t have sex for the first month or two while they figure things out. However you do it, it’s important to have a backup method and give yourself a few cycles to actually learn before you start relying on charting alone.

Let’s jump into the session part of our time together — I’ve pulled up your charts here. What’s at the top of your mind that you want to make sure we cover today?

Allison: The first one is whether my baseline is correct. I understand baselines, but I’m not sure I put it in the right spot. My second question is that since coming off the pill, my temperatures have still been a little higher than what I was having before — still in the 97 range, but I had a 97.9 this morning, which felt kind of high. I don’t know if that’s stress or normal after coming off the pill.

Lisa: Let’s start with the baseline question. The baseline is the line you draw between your pre-ovulatory lower temperatures and your post-ovulatory higher temperatures. It looks to me like you drew it correctly, because to confirm the thermal shift we’re looking for three temperatures in a row that are higher than the previous six — and that’s exactly what you did on days 19, 20, and 21. You drew the line a little bit above 97.8, and that’s where I would draw it too. Your temperatures look good overall. We talked about this in class, because a couple of women had temperatures on the lower end — ideally we want temperatures to sit above about 97.4, since basal body temperature is a measure of metabolism.

As for the higher temperatures — one interesting thing about charting is that temperatures during the period itself are often erratic, higher or lower, because everything is normalizing at that point. In the second half of the cycle, progesterone is high and then starts to drop, while you still have fairly significant estrogen in the post-ovulatory phase, so it’s pretty normal for period temperatures to look a bit erratic. Most of my clients continue charting through the period so they don’t fall out of the habit, but you also have the option to skip it and start again once your period ends.

Allison: Okay. I also had a question about my cervical position — I’ve only checked it three times, so I’m still very much learning. One question I had was that the day before my period started, it felt hard but also really high, and I thought it was supposed to be low right before your period starts. My period still came, so maybe I just have a high cervix?

Lisa: Generally speaking, as you approach ovulation, you’d expect the cervix to be softer, a little more open — like a dimple, not open enough to insert a finger — and higher, meaning you have to reach a bit deeper to feel it. But when you check every single day of your cycle, some women find it doesn’t necessarily feel higher around ovulation, or it feels higher at other times too. I teach cervical position using four main signs: firmness, openness, height, and tilt, since the cervix can also shift to face different directions at different points in the cycle. When you check daily over a full cycle, you start to notice which of those signs are the most reliable indicators for you — usually there’s a couple that stand out more than the others. Even though your cervix felt higher, you mentioned it also felt firm, so in the fertile window you’d likely still notice it becoming a lot softer.

Also worth mentioning — the cervix isn’t fixed in place. It’s the base of the uterus, and it moves. If you check after a workout or after sex, it can feel higher or lower than it would otherwise, since arousal causes the vagina to lengthen and the cervix to shift out of the way. That’s part of why I don’t recommend checking multiple times a day — you might be picking up on movement rather than a true cyclical pattern.

Allison: Okay, that makes sense. I checked it the day before my period and thought it felt high, so I started freaking out that my period wasn’t coming, but it came anyway.

Lisa: Once you check the cervix every day, you may be able to identify some of those shifts by paying attention to it consistently, but I’d say one of the most reliable signs that your period is coming is actually the temperature drop. It’s not universal, but in the vast majority of charts I see, the temperature rises after ovulation, stays high through the mid-luteal phase — not a perfect arc, since we’re human and not robots — and then trends gradually downward, often dropping the day of or the day before your period. That tends to be a more reliable signal.

The good news is that you’ve started checking your cervix, so I’d encourage you to check every day, even though missing a day here and there isn’t a big deal. Once you complete a full cycle it starts to make a lot more sense.

Allison: Yeah, I have to mentally build myself up to do it — I never did it before, and it’s a little strange learning about myself this way. It’s an optional sign, though, right? Plenty of women chart without checking their cervix, but I’m interested in learning it.

Lisa: Exactly — it’s optional, and you don’t have to check it forever. If you’re interested in learning to interpret it, checking daily for one or two full cycles is usually enough to get a feel for the difference, so that if you ever have a cycle where the mucus is harder to read, you have that extra sign to rely on.

Allison: I had my annual exam last week, and I actually thought about asking my doctor to show me what my cervix looks like with a hand mirror, but I didn’t end up doing it.

Lisa: I give you permission to ask that question next time — it’s okay if it feels awkward. There’s a website called the Beautiful Cervix Project with photos of women’s cervixes throughout their cycle, and it can be a fun way to bring it up with your doctor.

Something you said at the very beginning made me want to ask a follow-up — you mentioned you didn’t want to tell your mom when you got your first period, and you waited a few weeks. Can you tell us why?

Allison: Oh my gosh — my mom made such a big deal about it, saying it was something we were going to celebrate because it’s a good thing, and that made me so embarrassed. I didn’t want to celebrate it, I didn’t want anyone to know, and I just got uncomfortable and decided not to tell her. I didn’t tell her for about three months. She eventually found out because I didn’t have period products and was using toilet paper, and our dog got into my underwear. When she found out, I just felt weird about the whole thing — she offered to take me to dinner and I said no, I just wanted to be alone. Looking back, I regret it, but I was just being a preteen and being awkward about it.

Lisa: I’m sure you’re not the only one who felt that way — it’s ironic that as adults we look back and wish someone had told us how wonderful our periods could be, but as teenagers, we all have different personalities and reactions. Some girls are thrilled and excited, and others feel exactly the way you did. I think it’s a nice reminder for those of us with teenage daughters, nieces, or young people in our lives that we can’t force that excitement onto someone who isn’t ready for it — we can offer resources and stay open to the conversation without pushing.

Allison: Yeah, if I ever have a daughter, I want to give her your book and make sure she has an instructor available, so she has all the information and can make her own choice about it.

We were talking a little bit about the cervix and the temperature, and how sketchy period temperatures can be. Looking at my chart, it seems like I’m doing okay with my dampness observations — it’s not a lot of dampness, but when I got closer to my period I noticed more of a shiny observation. I also got back on a higher dose of folate, because I have the MTHFR gene mutation. I think being on birth control definitely depleted a lot of nutrients — I started seeing a naturopath back in July, who recommended supplements, and I started taking those in August. I didn’t see much improvement until about two weeks ago, and I’ve been feeling a lot more energy and just better about my life overall.

Lisa: That makes sense, because we’re recording this at the beginning of November — you came off birth control in September, so it tracks that you started feeling better in October. In my interview with Ross Pelton, a pharmacist who researched the interactions between drugs and nutrient absorption, there’s an acknowledgment that there’s enough research to confidently say the pill disrupts nutrient metabolism — particularly B vitamins, magnesium, selenium, and CoQ10, among others. There’s an argument to be made for supplementing those key nutrients while taking hormonal contraceptives, which raises the question of why women aren’t routinely advised to take something like a B-complex while on it. But even with supplementation during use, nutrient metabolism doesn’t fully normalize until you actually come off.

For anyone who isn’t familiar — a certain percentage of the women I see, particularly those who’ve come off birth control, notice an interesting pattern in their cervical mucus observations. I teach clients to wipe externally when checking for mucus, and sometimes you’ll notice a damp spot on the toilet paper that isn’t urine, since you’re checking before you pee. When that shows up consistently throughout the cycle, it can be a sign of an issue with cervical health, particularly cervical dysplasia — abnormal cervical cells. We can support the cervix through a number of things, including folate, and over the course of a few cycles that pattern often gradually improves and eventually resolves, along with an overall improvement in cervical mucus production. That matters, because if cervical dysplasia isn’t addressed, it can increase the risk of needing a cervical procedure down the line.

Allison: I was actually diagnosed with HPV in 2018, and we’ve kept an eye on it since. My six-month checkup in February came back fine, and I’m still waiting to hear back from my most recent one.

Lisa: One other thing worth mentioning — when I was researching for The Fifth Vital Sign, I found a lot of research showing a connection between long-term pill use and folate deficiency. It’s an interesting area, because there are also a number of short-term studies — over a three-month period, for example — that allow participants to take folate supplements and then conclude there’s no relationship. But most women don’t take the pill for just three months; most are on hormonal contraceptives for one to twenty years. When you look at the long-term studies, there’s a clear connection, and there’s also a clear connection in the literature between depleted folate and increased risk related to HPV persistence. To be clear, this isn’t about folate causing or curing HPV — it’s a virus — but when you’re not depleted in folate, your immune system is better equipped to clear it, similar to how it handles a common cold.

Allison: That makes sense, especially with the MTHFR piece — you can’t process folic acid efficiently, so taking a vitamin with folic acid in it can actually make things worse rather than help. My doctor had actually recommended a prenatal with folic acid in it, alongside prescribing me a separate folate supplement, so I think those two things may have canceled each other out, especially since I was still eating a lot of foods fortified with folic acid without knowing to watch for it.

Lisa: It’s unfortunate, because there’s so much research on MTHFR at this point. Folic acid doesn’t occur in nature — it’s a synthetic, inexpensive form that supplement companies use because of the cost, but a large percentage of the population can’t process it efficiently due to this gene variant, whether they inherited it from one parent or both. That’s an argument for removing folic acid from fortification and supplements altogether in favor of methylated folate, but it can take decades for research like this to make its way into standard medical practice.

Allison: It’s frustrating, but I’m really grateful for people like you doing this work.

Lisa: I think there’s some empowerment in that message too — it’s harder, but we have to be the ones advocating for ourselves and finding the answers. Menstrual cycle charting is really the gateway into trusting your body and your own intuition over what anyone else says, because your actual experience trumps any theory.

Allison: I definitely agree with that. Since coming off birth control, I’ve had some pre-period symptoms I hadn’t experienced in five or six years, and now that I’m paying so much more attention, I can usually guess my period is coming based on how I’m feeling. It’s wild how much everything gets masked by the pill without us even realizing it — my doctor always just said it was fine.

Lisa: That’s tied to one of the biggest myths about the pill — that it regulates the menstrual cycle and makes everything normal. In reality, it shuts the whole system down and gives you a scheduled bleed, which leads many women to think they’re getting a period when they’re actually not.

Allison: It’s sad to think about, because I’m 28 and would think I’d know more, but I genuinely didn’t realize that wasn’t a real period until I started listening to your podcast.

Lisa: As we wrap up, what would you say to a woman who’s in a similar position — done with the pill, but scared of making the transition?

Allison: Just do it. The fear is valid, but it shouldn’t hold you back, especially if you have a good instructor helping you along the way. Having an instructor has been key for me in learning to read my signs and my temperature. I wish I hadn’t waited as long as I did — my number one piece of advice is just to jump in and not let the fear keep you from playing the game.

Lisa: I love it. Thank you so much — this has been fantastic. I love doing these Reality series episodes because they’re real conversations, and this is what it actually looks like when you’re doing this in the weeds. Stepping outside of the standard medical system can be really helpful with the right support in place, especially at the beginning — it doesn’t mean it’s harder forever, it just means there’s a learning curve, the same way there is with learning to drive.

Allison: I could have figured it out on my own eventually, but I think I’ve learned to do it faster with support, even though there’s still a learning curve.

Lisa: For sure. Well, thank you so much, I’m so glad we did this, and I’ll see you next week.

Allison: Thank you so much, Lisa.

Lisa: Thank you for listening. If you enjoyed today’s show, please share it with a friend. I hope you enjoyed today’s episode with Allison — my Reality series episodes are among my favorites to record, because of the different places the conversation can take us.

One thing I found particularly interesting was Allison’s experience with her first period, and not wanting to tell her mom about it even though her mom wanted to make it a positive, celebratory experience. I often get asked about my thoughts on teenagers and fertility awareness — my stance is that condoms are my recommended method for teenagers, since they also protect against STIs. That said, I think all teenage girls can benefit from learning fertility awareness, even just to understand ovulation, the phases of the menstrual cycle, and how cervical fluid relates to predicting a period.

Most of the women I speak with, myself included, didn’t learn any of this as teenagers, and once we do learn it, we tend to want to shout it from the rooftops. But it was a good reminder from Allison’s story that not every teenager wants that same enthusiasm directed at them. I think the best approach is simply to stay open, provide resources like Taking Charge of Your Fertility or The Fifth Vital Sign, and let a young woman come to the conversation in her own time rather than pushing it.

I hope you enjoyed this episode, especially if you’re contemplating coming off birth control yourself or researching whether fertility awareness will work for you. The good news is that it doesn’t typically take long to go from beginner to feeling confident with cycle charting, especially when working with an instructor within the first two to three cycles. With that, I hope you have a wonderful week, and as always, until next time — be well and happy charting.