Getting Your Period Back After Birth Control (Episode 358)

Full Transcript: Episode 358

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.

Lisa: Today, I’m sharing a brand new episode in my Fertility Awareness Reality series. And in today’s episode, I’m sharing my interview with my client Liz, who was a member of my recent Fertility Awareness Mastery Live group program. And in her case, she came off of the pill several months before she joined the program. She was cycling, but her cycles have been inconsistent and irregular. And so in today’s episode, we talk about that and we talk about the post pill transition phase. And so without further ado, let’s go ahead and jump into today’s episode with Liz.

Lisa: And I’m excited to be here today with Liz. Liz is a member of my current fertility awareness mastery program, and we’re about just about midway through, I would say, so a great time to have a private public conversation on air. So welcome to the show, Liz.

Liz: Hello.

Lisa: Well, thank you for being here and coming on the show. I’d love just to start by giving you a chance to share a little bit about your background, more specifically, when you got your first period and what that was like. And if you’ve ever used birth control, so I guess the birth control history and what led you to opt for fertility awareness at this stage?

Liz: Yeah, so I got my first period, I want to say it was sixth grade, so what is that, 11, 12 in that range. But then I don’t think I had it again until like six months down the line, eight months down the line. So you get your first one and you’re like, oh my gosh, what is this, and then you’re spared a few months and then it finally actually really starts. I don’t remember much of my period pre-high school, but in high school I do remember it being ever so heavy. I have been cursed with that. So that was one of the main reasons I did go on birth control in high school. I remember sitting in class and bleeding through a tampon and through a pad and being terrified to stand up, and class periods are like 45 minutes in length, so they were very heavy in high school. So I did go to the gynecologist and was put on birth control, and that was the end of the discussion. It was like, oh, we’ll fix it, we’ll put you on birth control, no problem, and that was it, like no questions for me. I mean, I was 18 at this point, so I made it mostly through high school, it was senior year, but there was no explanation to what it does or how it works, it was just birth control. So I was on it for 16 years. I went on it at 18, so it was a long time, and in that stretch there was maybe only a six-month time when I wasn’t on it, and it took that long for my period to actually come back, and when it did it came back even heavier than I remembered it from high school. So it’s been a journey. I remember switching many different types of birth control. The first one I was on was the one where you’re only supposed to have a period once every three months, so you take the active hormones for three months and then you have a period, but it didn’t work out that way, I remember just having a period for months at a time. So we switched off of that one, just constant switching for the first few years, and then finally landed on something that I felt worked. It made my periods predictable, they weren’t much lighter, but I think they were manageable, and having gone through it for so long, manageable is still probably quite heavy for some people. So anyway, cut to 2019, right around Thanksgiving, and I remember this because it’s the day after Thanksgiving, it’s Black Friday, everybody’s out shopping and I just had cabin fever, so I went wandering around, ended up in a Barnes & Noble just looking for books, and I came across the book This Is Your Brain on Birth Control. And I started flipping through it because of course it caught my eye, and just panic came over my face, like oh my gosh, what am I taking, what have I been taking for the past 16 years? So I kind of panic-read that in the Barnes & Noble, went home, started looking at all these different books on my Kindle that I could download and read, and just kind of deep-dived into this world of what the birth control is doing to your body and your brain and things like that. I think I downloaded like three or four books, including yours, and just went into this deep dive of, I really have never questioned what it is that the birth control is doing, and if I’m being quite honest I’m not sure I really knew exactly how it worked, because you have these discussions with your friends and by the time you get to college all of your friends, or at least most of them, are on birth control, it’s just how it is, and we never question it, we never really talk about it, it’s just a thing you do. And I’m thankful for it, I avoided pregnancy, I managed my period as best that I knew how. But then reading everything, it’s like, wow, maybe this really isn’t the best option for me at this time. And I slowly started questioning it, actually, with my gynecologist, because I am 35, so last year when I went to my appointment I was 34, and in every ad you hear it’s birth control and blood clots and age 35, and it’s like, okay, is this the time when I should be considering coming off of it? As you get older your body starts doing different things, and the gynecologist wasn’t concerned, he was like, oh, because you’re not a smoker you’re fine, it’s not a big deal, but it was always in the back of my mind. So then when I came across these books it was like, oh no, maybe we really should have come off of this many years ago. So thankfully I found the books that turned the light on for me, and I immediately booked an appointment with a naturopath, because in all of your books, and in everyone’s books, you are doubted by the gynecologist. And I was coming up on an appointment and I brought it up with him, and he was like, oh, so what are you going to use for birth control, and I said fertility awareness, and he said, oh, okay, and he just sounded very doubtful. But I started working with a naturopath and we did a lot of blood tests, and I was concerned mainly about coming off of it, about the rebound of the hormones and the potential hair loss and potential acne and things like that. So I worked with her and just wanted to avoid any kind of post-pill rebound, so we did all the blood tests to see where everything was, and she gave me some supplements, and we’ve been monitoring that. So long story short, I came off of birth control in March 2020, and it is now almost a year later, and I’m still on this journey of getting my period back to being normal, at least normal for me, and feeling confident in the fertility awareness method. It’s definitely a learning curve, but so far it’s been a fun journey, and I feel more in control of my body and how it’s working, and knowing that it’s actually working and not just through a synthetic hormone.

Lisa: Well, thank you for taking us through that. It’s always fascinating to hear essentially decades of your life, at least one aspect of your life, in a short period of time, and I think there’s so much of your story that so many of us can relate to. One of the things that stood out to me, of course, was your sentiments around the pill, like you’re minding your own business in a bookstore and you see Sarah Hill’s book. I have an interview with Sarah Hill about her book, This Is Your Brain On Birth Control, and it’s a fabulous book full of research about how the pill affects your brain, your hormones, and your emotions. I actually had a message earlier today from someone on social media who had the same thing, like, I just found your podcast and I’m freaking out, because it’s like, what did I do? So I feel like it’s a good thing to acknowledge that although there is a lot of information about birth control, and certainly a ton of research around the effects it can have, the message I want to drive home is that even though it can feel really overwhelming, we all do what we can based on what we know at the time, and there’s no use in beating yourself up. I think the good news is that when you look at the research, there are effects, there are definitely effects, but the research itself doesn’t show that these effects are necessarily permanent, they’re reversible, the body does rebound back, and there’s a lot of ways to manage any potential ill effects that happen. So if we can ground ourselves in that, then although it feels like there’s a need to freak out and worry and wonder, I think that on the flip side, and this is a horrible thing, but I think many medical professionals are trained not to talk about the side effects because they think that women will freak out. So there’s this interesting line, but it’s like, if I’m taking this medication I do have the right to know what it could be doing to me, even if it means I freak out. But at the same time, I think that the other thing I wanted to say was that in your case, you had a legitimate and quite serious concern around your bleeding, and so again, we do the best we can with what we know at the time. So you were making a decision to help yourself manage this, and it’s a legitimate concern, obviously it’s never good to lose too much blood. So I just wanted to say that, and I think you and all the listeners can appreciate that this is never about shaming ourselves, oh, I did something wrong. It’s literally, in my opinion, about sharing information so that when we do learn other ways to cope, we can make the choices that are appropriate at that point. And I think, given the information at the time, which was nothing, you’re meant to trust your doctors, and I mean, I was a senior in high school, my mom was in the room with me, and we just, she wasn’t informed, I wasn’t informed, and I don’t pin that on anyone, but it is just that twinge of anger looking back of, how can no one tell you?

Liz: And again, information wasn’t as readily available, I’m making myself sound like I’m 50 million years old.

Lisa: But a lot has changed.

Liz: Yeah, I can relate because I’m not 80 years old, but when I was 18 it was a different world, there were no smartphones, legitimately none, there was no social media, the internet was kind of newly a thing. I got my first computer when I was 17, when I went off to university, and that was the first time I ever had my own computer in my house. And I didn’t get my first cell phone until at some point in senior year, and it was a flip phone and I loved it. So I wasn’t able to research as easily, like, oh, maybe I shouldn’t be eating as much dairy, maybe that’s contributing, or all the information that I have now in this deep dive of this past year that my poor friends are probably so sick of hearing about. It’s just a different time, and thankfully now we’re at the information superhighway kind of thing where you can find all this info to help any kind of situation.

Lisa: Well, back then you would have literally had to go to the actual library, and based on the books that were physically present at the library you would have had to sift through whatever was there. So very, very different time. So one question I have for you, now that you came off birth control, and we’ll get into the charting, but how did you find your bleeding since you’ve come off birth control? You’ve been off for about a year now, you’ve had several bleeds, we talked about that in our hot seat, not all were ovulatory, but how was the bleeding?

Liz: So it took, I came off in March, and I think my first period was in May, like end of May, so it took a cycle for it to be like, oh right, we’re going to do this, and it’s going to be a real period. And the first one back was very heavy, so that was alarming. I emailed my naturopath, like, this isn’t working, and she said she wasn’t concerned, that my body was just restarting itself, and it was going to be this way, to just give it a beat. So my panic subsided, and it’s been manageable, and it’s been much like it was on birth control, if not even a little bit shorter. I can still go in and be like, okay, I need to change my tampon on day two every so many hours to avoid any leaking. So it’s very predictable, the end of it is where it’s like, oh, I have some blood this day, but then nothing the next day, and then just a smidge the day after. In terms of heaviness it’s maybe even a smidge lighter, but I’m also factoring in my diet and the supplements I’m currently on, because when we did the initial testing my iron was super low. So I think the whole process has been positive in terms of where my bleeding is right now. Is it still heavier than I would want in an ideal world? Yes, but it’s totally manageable.

Lisa: Well, let’s quantify it a little bit, because this is something we didn’t get into a ton in your previous hot seat. So how many days does your period last, and on the heavy or moderate days, first of all, how do you collect your menstruation?

Liz: During the day, when I’m at the office, I use tampons, but I’m in the process of trying to migrate more toward the menstrual cup. At night I do sleep with a menstrual cup because having a tampon in that long freaks me out, so I sleep with a cup and have never had any issues, I love it at night. It’s the changing of it during the day that’s the challenge, I think I just need to buy a second one and swap them out rather than trying to clean the dirty one in a stall.

Lisa: So then when you’re using your tampons, how frequently are you changing?

Liz: On my heaviest day I will go through a super plus in three hours, and that’s the entire day, so I’m changing every two to three hours, it’s almost three hours on the dot, and that’s the nice predictability of it, I can look at the clock and know it’s time. There will be a rare occasion where it barely starts to leak at three hours, or it won’t be completely full, but the next one usually will be. So for the most part it’s very predictable.

Lisa: And is there just one day like that, or two days like that?

Liz: It’s mostly one day, the day after will be more like I could go four, four and a half hours on a super plus tampon, and then it really tapers off after that. This last period my day two was my heavy one, day three was kind of the medium day where I could go four to four and a half hours in one tampon, and then my next day was just light, which to me is maybe filling a regular every three hours, so maybe only one or two tampons that day, and then I won’t fill a regular one for the rest of the day.

Lisa: Okay, but your period is over, we’ll pull up your charts here. I know listeners won’t be able to see your charts, but you list your period as five days, so it doesn’t go on and on forever, it does end.

Liz: Yes, it does end, and it’s been about five days for the past three or four cycles at least. Part of me remembers having like a full seven-day period on birth control, and now that’s so far gone I don’t even remember, and of course when you’re on birth control you’re not paying as close attention to your period as one should be. So since I’ve been charting, it feels like five days is pretty standard, which is a nice change.

Lisa: Well, certainly that is heavy, it’s obviously heavy, and this is actually what we’re going to be talking about today in our class, the normal parameters of the menstrual cycle, but the top end, when I was looking through the research of what is considered normal bleeding, there were some researchers who said the top end of normal should be about 60 milliliters, but generally speaking 80 milliliters is kind of the top, which is something like four to five ounces. What that would mean is that 80 milliliters would fill one menstrual cup about five times over the whole cycle, since a cup is usually about an ounce depending on the size.

Liz: What?

Lisa: Yeah, so we’ll be going through that, and we’ll be doing a little demo because that makes it a bit more real. So it’s interesting timing, it hasn’t been released at the time we’re recording this, but I recently recorded an episode specifically about bleeding disorders, and something the individuals I interviewed were talking about is that it’s not so common, but it’s also not so rare, and it’s also something that’s not well known by a lot of physicians. So although you’ve probably been screened for things like fibroids and polyps with an ultrasound, that’s not necessarily something that’s automatically looked at as a possibility. Certainly I wouldn’t be the one to say whether or not you fit that criteria, but just having the knowledge that there could potentially be something there, particularly because you were on the pill and mentioned that it didn’t really lower the bleeding a whole lot, it lowered it a little bit, but it was basically still the same volume. So we can talk more about that in our upcoming classes, but that’s something I wanted to mention because it’s on my mind, since I just did the interview you’ll hear on the podcast eventually. Isn’t it interesting that there’s a percentage of women who have bleeding disorders that would cause heavy bleeding, but they would really have to push for it and have that background knowledge to ask for the right referral and testing, because it’s not something that would be automatically screened for.

Liz: Yeah, potentially aggravating for sure, feeling silenced when you know your body, and it’s like, no, this isn’t right, this shouldn’t be this way, I know my body, so please help me.

Lisa: Well, one of the things they pointed out in that interview was that, like anything else we’ve talked about on the podcast, whether that’s irregular cycles or pain that you’re being put on the pill to quote-unquote regulate or minimize, those scenarios obviously help manage symptoms, which is very helpful especially when we’re teenagers just trying to live. It’s really helpful to have symptom management, but of course the problem becomes, when you actually want to start a family, if there’s an underlying problem you’ve kind of put it off and still have to address it. But then also, if there’s an actual health condition underlying it, one of the things they said is that if a woman has a bleeding disorder but was put on the pill to manage it, it can cause a problem when she’s having a baby and it gets identified when she starts hemorrhaging. So I’m just sharing this for information, but it makes sense that it would be good to rule something like that out just in case.

Liz: Right, exactly, and thinking back, I’m sure the birth control helped a little bit with the bleeding, and again high school was so long ago it’s hard to picture what it actually was. I do just remember sitting in class bleeding through whatever size tampon I had in and panicking, thinking this can’t be life. But knowing that I am definitely on the heavy side, there’s always been that sense of, this can’t be normal, there’s so much happening during my period that my friends aren’t dealing with, and that’s how we quantify everything, by our friends. So it’s all very fascinating, and I’m like a sponge taking it all in now, and thinking, okay, next time I go to my gynecologist maybe I really should bring this up, because I don’t know if we’ve ever really talked about it, since I was on birth control and it was all fine and dandy. But now that I’m a grown adult and know what I’m doing with my body, let’s address this and see what he has to say.

Lisa: Yeah, because when it comes to period issues, it’s the whole concept of using the menstrual cycle as a vital sign. One of the things I’m always telling my clients is that if we’re seeing these signs and we know what they could mean, it makes sense to get to the doctor and check things off the list. Of course with your symptoms it’s been consistent this whole time, but in a different example, if a woman’s cycles were always one way and all of a sudden she starts flooding, then you’ve got to screen for things to make sure it’s nothing serious, like uterine cancer, because it’s a different thing if it suddenly shifts. But anyway, I wanted to say that, and I think this is again why it’s so important to track the cycle and understand what’s normal and what’s not, and when you have that sense that something could be wrong, to keep pushing until you get some answers. So let’s jump into the charting part of today’s on-air session. Last time we went through the charts you’ve had for the past year, we looked through and analyzed those, so let me know what was on the top of your mind today that you wanted to make sure we talked about.

Liz: I like the idea of checking your cervix as a third sign, because I think my need for structure doesn’t allow me not to have another thing to look at. But I think, and we’ve talked about this in class, that it’s a process, so checking that is still questionable. Earlier in the week I felt like, oh, I think that’s it, I think that’s what I’m looking for, and then yesterday and today I felt like I couldn’t find it again. I guess that’s a question too, is it possible for it to be harder to find some days than others even when you’re not at that stage in your cycle yet?

Lisa: Yes, definitely. So one of the things I often joke about is, at the basics, like we talked about before, when you’re approaching ovulation, under the influence of estrogen the cervix changes position as well as texture, moving into a higher position in the vagina, and for some women when they’re checking their cervix the sign that they’re approaching fertility is that the cervix goes so high they have a hard time reaching it. One thing you can try, and you may have already tried this, is squatting when you’re checking, it’s possible that it might be a bit easier to find it that way. But certainly, yesterday you could find it and today you can’t, and I think about all these things because this is what I do all day, but we all have different size feet, so it makes sense that our anatomy differs too, and our fingers aren’t even the same size, so it makes perfect sense that for some women it might be harder to find. But yes, that in itself would be a sign, I would try the squatting. I do see in your notes that there was a difference toward the beginning of the cycle and toward the end of your previous cycle, you were noting the cervix as essentially low.

Liz: Right, and I think at this point this is still me guessing, until I actually feel comfortable, so by no means am I taking my cervix charting into full consideration, it’s more of a trial and error. The website you sent is also helpful because it gives me a visual, like, is that what I’m feeling? So that’s really helpful, but at this point it still feels like a guessing game because I’m not 100% sure what I’m looking for is actually what it is.

Lisa: Yes, that is totally normal. The website you’re referring to is the Beautiful Cervix Project, so you can search that, and it’ll be in the show notes too. It’s literally pictures of women who’ve done this, actual pictures of the cervix throughout the menstrual cycle. It’s a website I’ve been referring clients to for a long time, and it helps because the cervix is an internal organ that most of us have never actually seen, unless you’ve had a really cool doctor who’s offered to show you with a mirror. It’s helpful sometimes to see what it looks like, it kind of looks like the end of your nose, sort of, but once you see it, it clicks. So this is your first full cycle of checking the cervix, my recommendation when you’re wanting to check it, since it’s an optional sign, is to check it once a day every day for a full cycle. You’re in the middle of it and you’re also in the stage before you’ve ovulated, so you haven’t yet felt the shift. The biggest shift is between the pre-ovulatory cervix and the post-ovulatory cervix, that’s the biggest shift in position, texture, firmness, and openness. You never feel confident the first cycle, but what I can tell you, since I’m looking at your notations, is that even though you’re not confident, there’s one day where it feels one way and one day where it feels another. That much I can tell, so we’re not quite there yet because you haven’t ovulated just yet. The goal is literally just to figure out how your cervix feels in the fertile window and how that’s different from how it feels once you’ve ovulated.

Liz: Yeah, because I feel like I’m searching for this big, prominent, nose-like feeling, and I’m like, what am I even feeling for.

Lisa: Yeah, and again, it’s internal, so you’re going in blind and just kind of feeling around and wondering.

Liz: I felt like I felt a little nub on Saturday or Sunday, and then it’s gone, and I do squat, TMI everyone, I do squat to find it, and sometimes I just feel like there’s nothing that I’m feeling for.

Lisa: Well, that’s something I would note, because you might find that at quote-unquote peak fertility your cervix is higher and it’s harder to reach, and you might find that correlates with that stage of your cycle. So that’s just something to keep in mind, but my advice is always to keep going, I know you want to curse me a little, but it will definitely make more sense if you force yourself to check once a day for the full cycle. The only thing at the end of the vagina is the cervix, it’s the base of the uterus, the part that opens and dilates when you have a baby, so there’s nothing else up there.

Liz: And that’s the thing too, it’s like, am I up farther, am I positioned wrong, am I feeling back instead of, it’s all a whole question mark. But also I question it because it’s day 15 and I haven’t been ovulating until like day 32, so I can’t possibly not find it yet, because heaven forbid I ovulate when I’m supposed to.

Lisa: Well, and one thing we’ve seen a bit of is that currently in your cycles you haven’t necessarily seen a ton of cervical fluid, so even though you very well could be approaching ovulation right now, you’re not getting the mucus sign as of yet, and that’s something that does happen to a certain percentage of women coming off birth control, especially long-term birth control. It’s certainly something we’ll work on together, but that in and of itself makes it a bit more challenging. Currently in this cycle, have we seen any mucus?

Liz: No, right now in this cycle I haven’t seen any, and on the cycles that I have ovulated, I see it the day I ovulate, and that is it, and it’s smooth and lubricative.

Lisa: Okay, that likely means you’re ovulating right now, so we’ll keep watching that. And I did mention I was going to go all TMI on you, so if you want I could share a few tips about changing a menstrual cup in public, since I’ve used a cup for about 20 years myself.

Liz: Yeah, no, that makes sense, and I’ve actually found, and again this might not even be a thing, but at least since I’ve been off birth control I’ve been playing with the menstrual cups more, and initially I wasn’t a fan of them during the day because I feel like they sit funny against your bladder. But somehow, now that I’m off birth control, again this might not even be a thing, it feels like it sits differently, so I don’t know if my cervix has moved or something’s moved in there, but it doesn’t feel like it pushes as much against my bladder now, so it’s not as hard to sit in for a long period of time throughout the day. I think you just have to get used to them, and I’m trying different versions, one’s more like a disc and the one I sleep in is more like an actual cup that suctions, so it’s finding the version that feels right and fits and stays in place. For some reason it feels better during the day now than it did a year ago, but it’s been 2020, so we’ve all been comfortable in our own homes.

Lisa: It’s probably been a really good year for menstrual cups, I would imagine, for all the menstrual cup manufacturers, since a lot of people aren’t going out to work. So I think it’s helpful to talk about this because I think it’s one of the biggest things people worry about, what happens if I have to change and I’m not at home, and it really isn’t the end of the world, but it is something you’d have to get comfortable with and figure out what’s going to work for you. In terms of the pushing on the bladder, I would say that’s a real thing, and I’m sure that when you’re on the pill, since it is a hormone, it could have an effect on where your cervix is situated, so that’s not out of the realm of possibility. Sometimes it’s easier to fully empty your bladder at a normal rate when you remove the cup, even though you can urinate with the cup in, depending on how everything’s organized down there it can be easier to remove the cup first. And of course there are different sizes and firmnesses of cups. So hopefully this is helpful to go over some of these options so it doesn’t feel as daunting, and if it doesn’t work out you can always go back to tampons.

Liz: Right, and I think part of me is so used to tracking my flow based on what I fill in a tampon, that’s the comfortable part for me, whereas at night I take out the cup and try to look at it and think, is that full, or is that half full, so it’s a bit of a guessing game, and then I have to adjust my calculations of my period based on how many hours it was in versus how many tampons that would equate to.

Lisa: Well, one other thing, your alternative of getting a second cup, many women would be more comfortable with that option too, you’d just need a plastic bag to put the used one in until you can wash it. I don’t necessarily think it’s essential to buy two cups, but it’s a lot different now than when I started using cups, there are so many companies making all kinds of cups and sizes now, and many women do have multiple cups, so if that’s more comfortable for you and makes it easier, that would be just as suitable an option, you’d just have to remember to bring your little baggie. Cool, well, menstrual cups for the win today. Before we wrap up our call, were there any other topics you wanted to talk about?

Liz: I don’t think so, I know we’ve talked about it in class, hoping my mucus finally comes back even though it’s been a year, there were some hiccups early on with my cycles, so I’m just hoping mucus becomes more of a telling factor as we move forward, because I know you mentioned it can take like nine months to a year for cycles to actually normalize.

Lisa: So there’s a research study that showed that when they measured all the different cycle parameters, including overall cycle length, mucus patterns, luteal phase length, which is the period of time between ovulation and your period, and follicular phase length, on average it took about 9 to 12 cycles for the group of women who had just come off of birth control to have basically the same parameters as the control group of women who had never been on birth control. And nine to 12 cycles can mean 12 to 18 months or more. What I would say is it’s not so typical that I see women have absolutely no mucus for multiple cycles, though certainly I do have a certain percentage of clients who come off birth control and even though they’re ovulating, the first three, four, or five cycles there’s very limited or no mucus, but the good news is it usually does improve. We also spoke about some of the ways we can support mucus production and support the cervix and replenish some of those nutrients, and that doesn’t happen instantly, it usually takes two to three cycles for instance if you start supplementing, replenishing some B vitamins and things like that. It’s obviously not instant, but as your body starts to replenish, I’ve seen that improve on the chart, and that’s something we can keep working on.

Liz: Okay, great, and then at some point, as I mentioned, I’m working with the naturopath on multiple supplements, so at this point it’s like once we get comfortable with where I am and get blood work done again, I’m just looking to see what supplements I can come off of and what’s going to be more of a mainstay, which I’m fine with, because I know my testosterone is high, so maybe that’s one I have to stay on to help regulate my period, but also so I don’t grow a beard. So things like that, I’m just looking at what’s in a good range versus what’s more of a long-term thing in terms of blood levels.

Lisa: Yeah, this is the tricky part, there’s a book called something like The Messy Middle, this is the tricky part because you’re in the midst of this transitional phase, and although it’s been a year, which can feel like, oh my gosh, it’s been a whole year, I don’t remember off the top of my head exactly how many true menstrual periods you’ve had, but I believe it’s like three or four.

Liz: Yeah, I want to say this current cycle is cycle four.

Lisa: And that’s four cycles where you ovulated and actually had a bleed as a result of ovulation. So this is the tricky part of when I share things like this study showed nine to twelve cycles, because for many women in that first year they may only have three or four cycles. It depends, I wouldn’t say that’s so common, but it’s possible if it takes you two to three months to have your first ovulation, and your cycles don’t fall into normal parameters right away, meaning they’re longer, it’s taking your body longer to ovulate, which isn’t uncommon. For some women, sure, they ovulate within a month and their cycles regulate in the sense that they’re ovulating within 30-day stretches, but that’s one of the tricky parts about it.

Liz: Yeah, it’s definitely been a learning curve, and really tracking it has been so eye-opening, and really knowing, like, okay, my cycle this month is 43 days long, but I didn’t ovulate until day 32, seeing it all written out on the chart has been amazing, it’s really eye-opening, and it’s been quite the journey.

Lisa: Well, and what I would say is probably the hardest part, is that you are still in the post-pill transition phase fully, you are not out of the transition, and you can be in that transition for 18 months to two years, and I’m not saying this to be discouraging, I’m saying it because when you look at what actually happens when you’re charting, even the women who start ovulating within a month and have cycles that fall within a 30-day window, their parameters are still not necessarily all normal. I’ve had numerous clients who ovulated shortly after coming off the pill, and their cycles are within the date range we’d consider normal, but in terms of their mucus patterns and luteal phase length and all the different signs, I’ve never had a client who came off birth control and had every single cycle parameter normal right away, that’s not a thing, it doesn’t happen. So in your case it can feel like, oh my gosh, there’s something wrong with my cycles, because it’s this long and I’m not seeing any mucus, and the temptation is to freak out, like what did I do to my body. But the hard part is to think of the longer range, it’s not always going to be this way, you are working on it, and the other thing is that you can take all the supplements, eat healthy, get good sleep, eat enough food and good food, and all of that is very important to support your body to restore normal cycling, but it doesn’t mean you don’t go through the transition, there’s no supplement that’s going to make it so you don’t have to go through the transition.

Liz: Right, exactly, and knowing that for sure, being like, okay, the supplements are just going to assist, it’s not going to magically fix it. I started the supplements in December, in advance before I came off in March, to give it that time you mentioned, because it doesn’t happen overnight, you’ve got to give it three months or so to at least get them working, so that way when you do come off it’s not as much like running into a brick wall. But yes, it’s a process.

Lisa: Yes, well, I’m looking forward to it, since we’re only halfway through the program, I’m looking forward to our future hot seat sessions and additional sessions so we can keep tracking your progress and keep working on it together. As we bring our interview to a close today, what would you want to say to the woman who’s listening, maybe the woman who’s just come into all this stuff and had her mind blown like you did when you were in the Barnes & Noble and read Sarah Hill’s book, what would you want her to know about birth control and the fertility awareness method?

Liz: I think my biggest takeaway is, don’t get frustrated with the learning process, and really deep-dive into all of the information in order to learn more and figure out if it’s the right move for you. For me it just was, I wanted to learn more and more, and then actually doing it was a bit of a step, but don’t be daunted by it, there’s a sort of strength in being able to be comfortable doing this on your own and not relying on a drug, but learn as much as you can. Your friends are going to think you’re crazy, and your friends are probably going to get very annoyed with you dropping knowledge bombs on them, as my poor friends have had to learn, but it’s a great way to take control of your body and be strong. So if it’s the right move for you, I recommend just deep-diving into it and taking the plunge.

Lisa: Well, and for someone who is thinking about switching from birth control, and they’re not trying to get pregnant, they’re actively trying not to get pregnant, what would you want them to know?

Liz: Yeah, again, this is a process, and I’m one of those people not trying to get pregnant at all, and you do such a great job of helping us understand when it’s completely safe and that you won’t get pregnant, and just the reiteration that you can only get pregnant in a certain window, it’s not the entire month, and being taught things we should have been taught as teenagers, but I’m sure health class glossed over that, really learning the ins and outs of the fertility awareness method is eye-opening in and of itself, realizing, oh, okay, I can still have sex and not have babies, and it is effective, so it’s great, do it.

Lisa: Wonderful words to end on. Well, Liz, thank you so much for being with us today and sharing your story and your experience, I know this episode is going to be so helpful to the women who listen, so thanks again for joining me.

Liz: Of course, thank you.

Lisa: Thank you for listening. I hope that you enjoyed today’s episode with Liz, and at the time that I’m releasing this episode it’s actually been a couple of months since we had that conversation, so I thought it would be helpful to take a couple of minutes and talk a little bit more about that post-pill transition phase we were discussing. This is something if you’ve been tuning into the podcast, or if you’ve read The Fifth Vital Sign, I talk about a lot because it’s really important to understand what the pill does and what it doesn’t do. So I always try to be really clear, when you look at the research there’s no evidence to suggest that the pill has a permanent negative effect on fertility, but what we do see is a transition period. When you come off the pill we see a period that lasts anywhere from about 12 to 18 months, so about 9 to 12 menstrual cycles, where all of the parameters aren’t exactly normal, especially if you’ve been on the pill long-term, and in the research studies long-term is typically defined as two years or more. In cases like that, what we’re seeing is not that it takes 12 months for your cycles to return or for you to start ovulating and having your period, but we’re talking about the nitty-gritty aspects of the cycle, the overall cycle length, when ovulation is happening, cervical fluid patterns, whether you have mucus and for how many days, and also the length of the luteal phase, the period of time between ovulation and your period. So when I share that it often takes even a year for cycles to normalize, I’m talking about all of those aspects pulled together into those normal cycle parameters, and that’s what I see, that it does take some time and several cycles before everything really starts to normalize. But I think the one thing that’s really important is that there is always a point at which we can no longer blame the pill. We can blame the pill during that initial post-pill transition phase, but once we get past that first 9 to 12 cycles, that first 12 to 18 months depending on what happened in your cycles and how long it took to get your first period, if we’re still continuing to see irregularities, if after let’s say nine cycles you’re not seeing a movement toward a normal, regular cycle within that 24 to 35 day range, at that point we really have to start looking at whether there are any other underlying factors that could be contributing. So just for the record, although the pill is associated with this temporary period of cycle irregularity that can last for a year or even a little more depending on the situation, we do have to at some point look at other factors, especially if the cycles don’t seem to be normalizing. But if it’s been like four cycles and things haven’t normalized, we can’t jump to conclusions, because it could very well still be related to the pill. I wanted to add that in because I think it’s important to make that distinction, and ultimately if you’re in this situation, having come off birth control and seeing some wonky patterns, hopefully this gives you a bit of a guideline for how to interpret it, because it’s helpful not to jump immediately to conclusions, and to really understand the difference between that temporary post-pill phase and an underlying problem that will persist. That’s basically the difference, after you’ve gone through that transition, if the cycles are still wonky at that point, that shows an increased likelihood of an underlying issue. With that said, I want to thank you for tuning in to today’s episode, and if you’re hearing this episode and can think of a few friends who would really benefit from listening to it, please share it. And with that said, I hope you have a wonderful week or weekend, whenever you’re tuning in, and of course, as always, until next time, be well and happy charting.