Coming Off the Pill to Conceive (Episode 409)

Full Transcript: Episode 409

Lisa Hendrickson-Jack:

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 teach women’s health professionals how to utilize the menstrual cycle as a vital sign in their practices, and 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’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 me today.

Today I’m sharing another episode in my Conception Series. And today I thought I would cover coming off the pill. It’s a question I get a lot in my direct messages, and it’s a question that comes up a ton in all of my classes. And it does pertain to the whole conversation around conception, and it certainly applies to fertility awareness as well. I would say that there’s a pretty significant percentage of women who discover fertility awareness as part of their conception journey, potentially shortly after they’ve come off the pill or other hormonal contraceptives. So today we’re just going to dive right in. We’re going to talk about basically the strategy for coming off the pill as it pertains to conception and also in general, we’ll touch on some of the general aspects as well. So with that said, let’s go ahead and jump into today’s episode.

So I would say to start this conversation, the very first question I want to address or the very first point or topic is when you should come off of the pill when you’re trying to conceive. Now, the word should can get a little bit preachy. So what I always tell my clients is that it’s really up to you when to come off contraception. And in many ways, there isn’t one right answer that’s going to work for everybody. I think that we all know that there are some women who come off birth control and conceive right away, some even unfortunately conceive while on contraception. But there are other women who come off of contraception and don’t conceive right away. And it can take quite some time in some cases. And so the question then is, well, how do you strategize? What is a good compromise? What is a good plan?

And I’ve spoken to many women over the years who potentially they’re planning to get married or they have a specific plan to start trying to conceive, let’s say, within a year or so. And to the point that they go to their medical doctors and seek advice — you know, I’ve been on the pill for X number of years, should I come off of it a little bit ahead of time? We’re planning to start trying to conceive next year in the fall. What do you think? And what I found is that many of these women are basically told, “Oh, you don’t need to come off early. You’ll probably conceive right away.” And so I’ve spoken to a number of women who actually did this. And I mean, if you think about that, you have this kind of intuitive sense that drives you to pick up the phone, make an appointment, and then put on your clothes and go and see the doctor because you’re concerned that maybe there could be some sort of effect on fertility. So I would say that that in and of itself is significant — the fact that many women do have these questions of should I be doing something? I’ve been on this thing for a long time. I don’t really know what my normal cycles are like.

And I would say that the advice to just wait until basically the month that you’re ready to try is flawed. And I would say it’s flawed because of what the science tells us about coming off the pill. And so it’s interesting when you take a look through the research around conception. And of course, this is something that I talk about in detail in chapters seven and eight of The Fifth Vital Sign. If you’re wanting to delve into it a little bit deeper with all the citations, you can delve into the research as well — I would certainly suggest that as a place to start.

But what’s interesting about the research is that when you take a look at it, there’s no evidence to suggest that the pill causes any kind of permanent negative effect on fertility. And I think that’s good news, right? That’s good. So I feel like in that way, we can all kind of breathe a sigh of relief. But what can be a little bit challenging is interpreting the data kind of down to the letter. So there’s a lot of studies that will look at the kind of one-year conception rate after coming off contraception. And they’ll often report on essentially the conception rate at that twelve-month mark. And so generally speaking, anywhere from 70 to 80 percent of women who are wanting to conceive, conceive, let’s say, after the end of that twelve-month period.

And there are a couple important things to pay attention to just with that approach in the research. One is that they are not telling you month to month about any kind of delay in conception. So within that twelve-month period, there are going to be some women who do conceive you know the first month after they come off or the second. But many aren’t conceiving until the fourth, fifth, sixth, seventh, eighth, ninth, tenth month. And if you think about how that plays out in real life — after a lifetime of being told that we’re fertile every day, we can conceive all the time — it can get really stressful, especially if you’re trying for several months and it hasn’t started happening yet, especially when you’re hitting that month six, month seven, month eight.

And so that’s something to pay attention to. And it’s often not necessarily easy to find, but one of the things that I look for when I’m looking at the research is to see the studies that actually provide the breakdown of how long it does take and if there’s any difference. And so I would say that’s the first issue. So one of the studies that I cite in The Fifth Vital Sign clearly showed that women who had come off hormonal contraceptives — so the combined synthetic estrogen progestin contraceptive options — on average took about twice as long for conception to happen. So there were couples who stopped using condoms, and the average duration of time to conception was about four cycles, four months. And for the women who were coming off of combined contraceptive pills, it was more like eight months. So that in and of itself is important information, and it can help to inform your decision of when to come off.

So the second piece of this research — critically analyzing the research — is that when you look at these studies, they do purposely exclude any women who did have pre-existing conditions that interfered with their normal ability to cycle. So for example, women who they know have PCOS or women who they know had issues with hypothalamic amenorrhea or generally just didn’t have normal regular cycles. So women who did not normally cycle prior to taking the pill are excluded from these studies. And I think those are two really important points to consider when looking at this topic because this also helps to inform that question of when should you come off the pill when you’re trying to conceive.

So for general purposes, I think that a period of at least six to twelve months is in order. I tend to recommend on the longer end to kind of encapsulate for all the different types of contraceptives. And you know, maybe eighteen months to two years out, but I’ll kind of just deepen into that a little bit. So I think that it’s really important when you’re thinking about this — when would be a good time for me to come off? For me specifically — is that the first question asked is: before you started taking the pill, did you have normal regular cycles? Had you basically completed the process of puberty? So the first few years after menarche, after your first period, it does take a little while before the cycle fully normalizes and regulates and things like that. So there are some women who just never really got to that point. Maybe they started menstruating and then they were put on the pill before they had even reached a full year of cycling. And then there are other women who were put on the pill because they had cycle irregularities — women who didn’t know when their next period was coming or tended to have these long, irregular cycles.

So if you fall into that category where you were actually put on the pill because you had cycle issues, that puts you at a greater risk of having a delay in the return of fertility or having some cycle issues when you come off. And the basic reason for that is because the pill doesn’t fix cycle issues. The pill works by suppressing ovulation and giving you a withdrawal bleed if you’re taking a pill that has a sugar pill week. And so ultimately if you did have issues before, you can’t expect that the pill fixed them for you. So that does put you in that category. And if you think back to the research I mentioned, women who fall into that category are generally excluded from those studies because it’s not that the pill is causing these problems — the pill is masking the problem. So if you fell into that category, then it’s a better idea to consider more of that eighteen-month to two-year time frame.

So then the other category would be women who were cycling normally, who did go through that stage of puberty. Their cycles were pretty normal. They don’t really remember any big issues or anything like that. And so if you fall into that category, then it’s more likely that when you come off the pill, your cycles will resume in a kind of normal fashion. And it doesn’t guarantee that there couldn’t be a delay, but you’re certainly at a lower risk for that. So I would say those are a couple important points to consider in terms of when should you come off, especially when you’re coming off for the specific purpose of planning for a baby.

And so that is kind of step one. And I would certainly say that generally speaking, if you do have the ability to come off of the pill a bit before you want to start trying, it is a good idea. It’s a good idea to give your body a little bit of time to normalize. It is a good idea to give yourself time to kind of see what your cycles are like and allow them to normalize. And the other thing that’s really important to consider is the post-pill transition phase. So what the research tells us is that there is a temporary period of subfertility post-pill. And this is related to the fact that the pill and other hormonal contraception tend to suppress ovulation either fully or to some degree. And so your ovaries are essentially at rest, or you could say that they’re fully suppressed for a period of time. And so what the research tells us is that it takes about six to seven months or so before your ovaries are kind of back up to full capacity, specifically with regards to producing your ovarian hormones estrogen and progesterone, and also for your ovarian reserve parameters to normalize.

And so many of you may be familiar with the kind of tests that are involved with ovarian reserve, especially if you’ve been dealing with some fertility challenges. So that has to do with ovarian volume, follicle count, and AMH — anti-Müllerian hormone. And there’s enough evidence for us to know and enough research to show that when you’re on contraceptives that are suppressing ovulation, there is this reduction in those parameters. And so if you were to do those tests while you’re on the pill, the results are going to show kind of a reduced state of fertility. And it does take about six to seven months post-pill for those parameters to normalize.

So just from all of those basic standpoints, there is this transition phase. It doesn’t mean that conception isn’t possible. Conception is possible in any cycle with ovulation. So if you do plan to take this route and have a buffer period built into your conception journey, then you will want to consider a form of non-hormonal birth control so that you have a way to prevent pregnancy during that transition phase, until you’re ready to start trying to conceive.

And so I’m definitely suggesting, not mincing words, that when you’re coming off the pill to try to conceive, whenever possible I would suggest to take a minimum period of six to twelve months to just allow your cycles to normalize, see what it’s like. And the worst thing that happens is you come off the pill and your cycles regulate pretty quickly — I mean, that’s kind of the best-case scenario. This is kind of like buying insurance. The worst-case scenario in a way is if you come off of it and it takes many months for your cycle to return. And it’s much different going through that process when you’re not actively trying. When you did give yourself a period of time before you’re ready to start trying, while your cycles are normalizing, if you have to wait a couple of cycles or a couple of months before your first cycle returns post-pill, and if it takes a little bit of time for those cycles to normalize, then it’s different when you’re going through that and not actively trying to conceive versus when you are going through that and there’s this pressure to have a baby right away.

So all of that was point one. And just to add a little bit of context — there’s a study by a researcher named Noth who looked at two separate groups of women, one group of women who had taken contraceptives for two years or more, and another group of women who had never used contraceptives before. And basically the women who were on contraceptives — they had them come off, and then they just measured the cycle parameters cycle after cycle. And what they found was that compared to the women who had never taken contraceptives, it took the women about nine to twelve cycles off birth control before all of those parameters normalized. And so we’re talking overall cycle length, luteal phase length — so that’s the length of time between ovulation and your next period, which is supposed to be about twelve to fourteen days in a healthy cycle but the first several cycles post-pill they’re often shorter — cervical fluid production, all the different parts of the cycle.

And so that’s something to keep in mind as well. The important point as I kind of wrap up the first part is that regardless of all of the wonderful things that you do during this time to encourage your body to normalize and to restore normal cycling and hormone production, the transition phase is still something you have to go through. So we can do as much as we can to ease our journey through that phase, but you can’t skip it. You could take all the vitamins and do all the stuff, but you’re still going to have this period of time post-pill where the cycle parameters are not necessarily going to line up, because it just takes some time for all these things to normalize.

So that was point one — essentially addressing that question of when to come off. So the second point that I wanted to talk about and address is more specific to the timing of when to come off, because again, this is one of the questions I get a lot as well. And so the question that I often get is: when do I stop taking it? Do I have to wait until I get to the end of my pill pack? Can I stop now? Those kinds of questions. And I think the answer to this question starts with an understanding of what hormonal contraceptives do in the body, how they work. Because it’s really interesting. I think we’re really stuck on that idea that it’s like a cycle and so you have to finish that pill pack and wait until you get to the end of those pills to stop taking your birth control. And ironically, my answer to that is that you can stop taking it whenever you want. You don’t have to wait until the end of the pill pack. There are no rules here.

One way to look at it is when the inventors of the pill created the very first pill — and it was Enovid in the 60s — they actually started with a formulation that was continuous. So the first formulation of the pill didn’t have the little break in between. And they just gave these women in the test runs in the late 50s this continuous version of it. And so what happened — if you think about the 50s, there was no pill up until that time — women had the expectation that they would have their period unless they were pregnant or unless they were really ill or breastfeeding or something. But outside of those natural circumstances, women would just bleed when it was time. And so these women went on this continuous pill and they just stopped getting their periods. And so many of them actually thought they were pregnant. And the doctors tried to convince them that they weren’t pregnant — like, okay, no, no, it’s because of this pill. But really, they didn’t really get it. And so it was quite devastating for some of these women to discover, oh wait, no, you’re not actually pregnant — this is the pill that’s causing you to lose your periods.

So this is why to this day, we have those sugar pills. And we have those pill-free weeks, so that we can simulate this withdrawal bleed to mimic a woman’s natural cycle. And it has nothing to do with health. It’s more of an arbitrary decision to have it this way, so that women of that time would have been more accepting to it. So now, sixty years into this pill thing, many women are comfortable with not having their period. And so now there are a lot of different birth control options that allow you to stop cycling if that’s what you want or to have far fewer periods.

So with that in mind, knowing that when they created the pill, it was this arbitrary decision to create these 28-day pill packs — they could have chose 36 days, they could have chose 45 days, they could have chose 24 days, but really they chose that 28-day model to mimic a woman’s normal cycle so that she would be more willing to take the birth control. So with all of that in mind, when it comes to coming off of the pill and deciding when to stop taking it in that particular kind of pill cycle, just know that there are no rules. If you are a week into that pill pack and you’re wanting to stop, you can just stop. And yeah, you might have that withdrawal bleed a little closer to the other one. But there’s no solid hard-and-fast rule around this. And if you do that, it’s not going to cause any damage, because again, it’s not a real cycle — it’s a synthetic hormone cycle. And it is quite arbitrary in that respect. So you could just stop taking it today if you wanted to.

All right, so that was the second point. Now I want to get into some of the planning — what do I do? One of the main issues with the birth control pill is that it is well known to deplete certain nutrients. So in particular, the pill is known to deplete B vitamins, including folate, vitamin B12, and vitamin B6. And these depletions are linked to certain side effects and different issues that can happen. So in addition to the B vitamins, the pill is also known to deplete zinc and selenium and a variety of other nutrients. It increases our requirements for vitamin A and vitamin C, and kind of disrupts that copper-zinc balance.

And so with that in mind, one of the things to consider when you’re coming off of the birth control pill — or if you’ve recently come off the birth control pill — is to really take some time and put in some effort to replenish some of these nutrients. So that could be as simple as taking a B complex and/or a multivitamin and just making a point of doing that for a period of time. You can take it a step further if you want to work with a functional practitioner, get some testing done, and see where everything falls. But I wouldn’t be shocked if you do like a hair and mineral analysis and it shows that your zinc is low and your copper is kind of high, because that’s one of the things that happens off contraceptives.

So whether or not you want to jump in and do a nutrient panel or something like that to look deeper into it, whether you do that or not, it’s still a good idea to kind of focus on some of those things. And I would say in particular if you’re trying to conceive — all of my clients know very well that I talk about liver all the time as a way to replenish nutrients. Liver is an incredible multivitamin. I would say liver is actually nature’s multivitamin, meaning that before multivitamins were created, this is one of the ways that people would get their nutrients. And if you look at traditional cultures, eating those organ meats are a part of most of these cultures. So liver is rich in vitamin B12, iron, vitamin A, zinc, all the B vitamins, and a number of other supportive nutrients including selenium.

So for example, incorporating liver somehow into your diet is a great way to replenish some of those nutrients post-pill. And then in addition to that, just incorporating foods that are rich in choline — eating some eggs, having fish for the omega-3s. There are a lot of different things that you can incorporate into your diet — adding in oysters or mussels, some of those shellfish alternatives, if you’re able to consume them, as a rich source of zinc. And then red meat is actually a really good source of zinc. It’s one of the most common ways that we get our zinc. Of course, that’s not the only way to do it, but just throwing it out there. And so that’s something to consider post-pill as a way to replenish those nutrients.

And you know, sometimes even if you eat a great diet, depending on how long you’ve been on the pill and what some of those symptoms that you’re experiencing are, or how deep those deficiencies go for you, you may still need to complement that with supplementation, just depending on the situation. But certainly food for thought, if you’ll pardon the pun.

Kind of to build on that point — all of those suggestions apply if you’re planning to conceive in the future. But I would say that if you are purposely coming off birth control and then giving yourself that period of six to twelve months, and/or eighteen months or two years, then it is a really good idea during that time to take it really to heart and make a point of incorporating some of those — I would call them ancestral fertility foods — but really looking at some of those dietary complements as a way to not only restore the nutrients that were depleted on the pill, but to build up your stores as you move towards your plan of conceiving in the near future.

And some of the nutrients that women are commonly deficient in that pertain specifically to pregnancy — I could go on, the list is long — but certainly iron, and again taking us back to liver, it’s a great way to stock up on those things. It would be not a bad idea if you want to do a nutrient panel — see where you’re sitting with these things, make sure that you start optimizing your vitamin D levels, incorporating fish as I mentioned into the diet is really helpful and important to build up your omega-3 fatty acids. And of course if you are partnered and you and your partner are planning for pregnancy, these dietary changes also benefit him as a way to improve his sperm quality.

And then in terms of planning for pregnancy, if you’ve come off the pill and you have a period of time where you’re still avoiding — because I do recommend when possible to come off before you’re ready to start trying — so that would mean that you’re avoiding potentially, and there would be a period of time there. And so taking the opportunity to learn fertility awareness, to start charting your cycle, to start understanding the different phases of your cycle, to develop some body literacy so that you’re able to identify which phases of the cycle are fertile and which are not, how to identify when the best time is when you’re ready to start conceiving. And also to learn a little bit more about the cycle parameters so that you can work towards having that healthy cycle length, good strong ovulation, good strong estrogen progesterone production, a strong luteal phase, all of those kinds of things.

If you’re able to identify those different aspects of the cycle, then as you go through this post-pill transition phase, having that knowledge will allow you to support your body a little bit better during that time, and also to be able to see that progress and to give you that confidence when you’re ready to start trying to conceive. You know, if you give yourself six to twelve months post-pill and you kind of see some of those concerning things at the very beginning — shorter luteal phase, some hormone imbalances, things like that, maybe some scant mucus production — but over the course of that six to twelve month period, as you’re replenishing nutrients, working on balancing your hormone health, getting in some good fats to support your estrogen and progesterone production, et cetera, then as you get towards that period of time when you’re ready to start trying to conceive, you’ll have seen that transition from some of those concerning parameters at the beginning of the stage — which is actually to be expected, it’s part of the transition phase — but you’ll see that phase and how your cycles start to normalize ideally afterwards.

The other part of it is that if your cycles don’t start to normalize, if you don’t see a return of your period within four to six months, I often get the question of like at what point should you worry? Well, I don’t know if worrying is going to solve anything, but certainly once you’ve come off contraception, if you haven’t started to cycle within a period of four to six months, then you would want to consider seeking support just to make sure that there’s nothing wrong. And then if you do identify that there’s something going on — whether it’s post-pill amenorrhea, or if it’s exercise-induced, or related to under-eating, or if you do have a condition like PCOS or something like that — then that buffer period that you gave yourself post-pill will allow you to identify if there were any issues.

And I suppose just to kind of bring it back to one of the points that we spoke about a little bit earlier — if you did have a history of cycle disruptions or issues, if you had a history of disordered eating and/or exercise-induced amenorrhea or something like that, then those are things to be aware of. And again, once you get to that four to six month mark if your cycle hasn’t returned, that’s why you give yourself the buffer. That’s why I recommend a period of eighteen months to two years if you did have one of those risk factors. Just in case. Because the worst thing that could happen is that your cycle doesn’t come back. But if you gave yourself a year and a half to two years, then that actually gives you the time that you need to sort it out and to do what you need to do to bring back your cycles, because it is possible to do that. It gives you enough time to not only bring them back but to help to normalize them. It gives you time if you need to seek support to help you achieve that. But if you come off right away and want to start conceiving tomorrow but you have this issue, you end up going through that issue and still kind of sorting all of those things out, but it’s so much more stressful because you’re trying to conceive at the same time.

And then on the flip side, if you come off the pill and you start cycling right away, that’s not necessarily a bad thing either. But it does mean that you will have to make a plan for alternative contraception methods that are non-hormonal.

So there are a couple last things I want to talk about, and this is related to some of those post-pill issues and also some of the specific issues that could prevent you from even wanting to come off of birth control. So I think the first thing I’ll just mention is the birth control issue. If you come off of birth control, you do need to have a backup method. And if you’re wanting to jump into fertility awareness and learn it — I always have a specific recommendation for that. If you are coming off birth control and you’re planning to learn fertility awareness as your primary birth control method, you can’t actually jump into fertility awareness right away. There is a learning curve for fertility awareness charting. You need to have a backup method — something like condoms, diaphragm, something like that — during that period of time when you come off.

And so if you’re wanting to learn fertility awareness and you’re learning it on your own without the help of a certified instructor, then my recommendation is a minimum of three to six months — or I could phrase that as a minimum of three to six cycles. And that might end up being more than three to six months, because often the first couple cycles post-pill can be a little bit longer. And the reason for that is because you need to actually go through the cycle — period, ovulation, period — three to six times so that you can first of all see what’s happening with your cycles. Not everybody can rely on cervical fluid. And so you need to really assess those first couple cycles to see what’s going on. And that is something that you need to go through as part of the learning process as well, to be able to identify ovulation, understand how to interpret your temperatures, really be able to tell if you’re ovulating or not.

I always use kind of like a driving analogy — you could read a book about driving, but if you’ve never actually gotten into a car and driven anywhere, the book doesn’t help you to drive. You have to learn how to drive as a separate thing to reading about driving. And similar to fertility awareness — you can read about it in the book, but when you start to chart, life like a real human adult female is not just this perfect textbook thing. And so especially if you’ve just come off of contraceptives, you can expect there to be some abnormal mucus patterns — whether that’s not seeing a lot, or seeing it all the time, or having a difficult time interpreting your observations. It just takes time to learn how to do that. And then there are all the temperature questions around when to take the temperature and how to interpret it if there are ups and downs — that takes a little bit of time. And then confirming ovulation. And what happens if you look like you’re approaching ovulation but then you don’t right away, and you see mucus a couple of times? These are kind of real-life scenarios that you have to go through as part of the learning process before you can feel confident using the method.

And so if you’re not learning with an instructor, I recommend a minimum of three to six full cycles. It’ll depend on your comfort before you start using fertility awareness as your birth control method. If you do work with an instructor, that period of time is often truncated — so instead of three to six months, you might be able to start your process of using fertility awareness as birth control as early as month two or three. It just depends again on your comfort, your cycles, and the overall picture of what’s happening for you.

So to get into some of the specific issues — for you know, what if you had period pain? What if the reason you were put on the pill is because you had really bad period pain? I know that was the case for me. And so when I was thinking about coming off the pill, I did have to have a strategy of how to deal with that. And when I was around seventeen or eighteen — it’s hard for me to remember the exact date at this point, it’s been a long time — but when I was coming off of the pill, when I made that decision to come off of the pill kind of for good, I did have to have the, like, what am I going to do?

So the good news is that there are some things, especially pertaining to period pain, that you can do while you’re still on the pill, especially if your situation was really dire and your pain was really severe. So there are some things that you can do while you’re still on the pill, to some extent, to try to lessen the severity. And so for example, if your period pain was moderate to severe or very, very severe, it would be worthwhile to consider working with a health professional — naturopathic doctor, a functional medicine doctor — and/or educating yourself about some of the causes of period pain or some of the things that make the pain worse, some of the inflammatory factors. And so for example, you could take a period of time — two to three months, let’s say, while you’re still on birth control — to really ramp up your efforts to reduce inflammation in your body. So that can be things like magnesium and zinc, turmeric, it can be looking at your dietary sources of inflammation, whether that’s regular commercial milk products.

I’m not anti-milk products, but I do think that women who experience severe period pain should know that conventional dairy — particularly dairy with the A1 protein, A1 beta-casein — it’s linked to significant inflammation. And there are many women who find that they experience a reduction in their period pain if they switch to goat’s or sheep’s milk, or if they specifically look for A2 dairy. There are certain things of course that you would want to look at. High sugar in the diet can contribute inflammation, industrial seed oil consumption. So it would make sense, especially if you had really severe pain and you’re really really concerned about coming off of it, to take some time actually while you’re still taking the pill — like I said, two to three months while you’re still on it before you come off — and just get yourself into an anti-inflammatory protocol. Get additional support if you need it from a functional provider, and take that time to really work on reducing inflammation in your body. It doesn’t mean that you wouldn’t have any pain — I mean, it’s possible — but at least you’re setting yourself up for success in this way.

Another concern that I hear about a lot is a concern about having imbalanced hormones — kind of like that post birth control syndrome. I mean I typically don’t use that buzzword to describe what happens during the transition phase post-pill. But for what it’s worth, many women do find that coming off the pill, they have a number of different symptoms. And many women have described their experience on the pill as — especially if you had, say, hormonal issues before you took the pill, let’s say you had a kind of a rocky ride with PMS symptoms or something like that — as kind of a way to stabilize your moods, right? Because then you’re not having the ups and downs of the hormones, you’re just having the steady dose of the synthetic hormones. And so many women are concerned that when they stop taking the pill, they’re kind of going to be thrown into this hormonal roller coaster.

So one thing we can be sure of is that it will be different when you come off birth control. And once your ovaries start making those hormones again, then it certainly is possible that you could have some of those symptoms return. I think that’s something that’s a valid concern, of course, especially if you experienced it in a really negative way. With that in mind, at the end of the day, when you come off the pill, there is a post-pill transition phase. We’re not going to be able to skip that completely. But what we can do is work on as much as we can ways to ease that transition. And so I go back to some of the previous things that I suggested with regards to restoring nutrient balance, taking time to learn about the specific nutrients that are depleted while you’re on contraceptives, making a concerted effort to replenish some of those nutrients post-pill.

I would say going back to some of the foundational factors that I talk about with my clients all the time — there are certain basic things that we all need to do to optimize our hormone health. For example, getting a good night’s sleep, ensuring that we’re eating enough throughout the day — three square meals a day, each meal containing sufficient protein, fat, and carbohydrates. Protein is essential in order for us to function as human beings, but also to make sufficient hormones to support a healthy menstrual cycle. It’s really important, especially if you’re active, to make sure that you are getting sufficient protein at every meal. In addition to that, we need fat to make hormones, and the combination of protein and fat and carbohydrates together in each meal or snack helps us to balance our blood sugar.

So when you’re coming off the pill, it’s equally important to make sure that you are getting at least the basic macronutrients and micronutrients that you need to support healthy hormones. If you’re not eating enough, if you’re not getting good quality sleep, then it’s going to be a lot harder for you — if not impossible — to actually make optimal hormones.

And then if you know that you had a history of significant PMS symptoms, or you have concerns about hormonal imbalances, then we can do a number of things to support progesterone production. Some of the basic things we want to do — magnesium is really supportive of progesterone production, particularly in the luteal phase, and B vitamins, vitamin B6 in particular. Those things will be less effective if you’re not doing the basic foundational stuff. But either way, there are strategies that you can employ to support that hormone production.

The other thing I’ll mention is that in addition to suppressing ovulation and normal ovarian function, the pill is associated with a number of other potential issues. When you come off the pill, you may have a short period of time where you have transient hypothyroid symptoms. For example, some women that I’ve seen will come off the pill, notice the temperatures are super low, and might actually be showing some symptoms of a thyroid issue or something like that. So it’s always a good idea to get things checked out. But if you’ve literally just come off the pill, what you could be experiencing is that transition phase. So you want to pay attention to these things and pay attention to any persistent issues. If it’s something that’s transient and related to the pill, then you would expect that it would resolve within that three to six month period depending on the situation. But if this problem persists beyond that, then you certainly want to start seeking support.

It’s also helpful to know that the pill has been known to disrupt the microflora in your gut to some degree. Some women find when they’re on the pill or when they first go on the pill that they start getting yeast infections and they end up doing this back and forth between yeast infections, getting something from their doctor to take care of that, and then going into bacterial vaginosis and kind of going back and forth. And so some women find that when they come off the pill, they may actually have some gut dysbiosis issues, some gut-type issues that may flare up a little bit more. So just monitor those things, and if it is an issue, obviously look into some support to resolve some of those issues.

So just to kind of bring us to a close — I’m going to briefly just go through the main points that we talked about. So the first point was essentially answering that question of when should you come off. And so I shared my argument for why a minimum of six to twelve months is something we should be looking at if you can take that much time, especially if you’re trying to conceive in the near future, and then the situations where we might need more time — that would be looking at eighteen months to two years if you fall into one of those risk categories. And so within that point, we went through the post-pill transition phase, what that looks like, to basically give you that background information of why it can be helpful to take that time before you’re ready to start trying to conceive.

So if your doctor is telling you, “Ah, you don’t need any time” — well, you might not, but you might. And so this is kind of like your insurance policy.

The second point that I covered was more specifically in terms of do I stop in the middle of my pill pack, do I have to wait until the end? And again, my advice on that was there are no rules. So you can really stop taking that pill whenever you want, and there’s no evidence to suggest that stopping in the middle of the pill pack is going to do any harm.

The third point was around replenishing nutrients — just being aware of what types of nutrients the pill depletes, and during that post-pill transition phase working towards restoring those nutrients. And then in addition to that point was some specific elaboration on that for preparing for pregnancy. And again, that post-pill transition phase recommendation — coming off of the pill ahead of time — goes hand in hand with taking a preconception period so that you can build up nutrient stores when you’re planning to conceive. And that applies to both you and your partner.

And the last few points I discussed were some of the things to do to prepare for coming off the pill especially if you had some issues — some of the strategies for coming off if you had experienced period pain, and also if you are concerned about some of those post-birth-control syndrome issues, particularly pertaining to hormonal imbalances. And I also mentioned a couple of honorary mentions — thyroid issues and gut health.

I feel like actually now that I’ve wrapped all of that, just to kind of throw it into the mix — one of the issues of great concern to many women coming off of the pill is post-pill acne. And so again, that can be related to nutrient deficiencies. There is a potential link there between having a deficiency in zinc after you’ve come off the pill, as well as potential gut issues. So some women find a resolution by making sure to replenish the zinc and incorporating some of those things intentionally. And others find maybe that the acne doesn’t necessarily start right away, but maybe closer to that four to six month mark once the hormones are kicking back in. But ultimately all of the strategies that we’ve spoken about to balance hormonal health and all of those things play into that as well.

I hope that this episode has been helpful and that it has provided you with some specific strategies. And I think most importantly, maybe built your confidence a little bit about coming off the pill. I know this is a big topic and I get a lot of questions about it. I think we have a lot of anxieties around coming off the pill, and also having a strategy for birth control post-pill — a non-hormonal method — is really important, especially if you’ve never really had to rely on a non-hormonal method before.

If you know of somebody who could benefit from hearing today’s episode, you can share the episode. The link to today’s show is fertilityfriday.com/409. And with that, I hope you have a wonderful weekend whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.