The ONE Thing You Should Have in Place When Coming Off the Birth Control Pill

So you want to come off the pill and you’ve read or been told that there’s supplements or foods that can help your body make the transition easier.

Maybe you’re wondering if there’s a best way to discontinue your birth control pill, or if it even matters how you discontinue it. Maybe you wonder how going off the pill is going to change how you feel.

 

I got you.

 

There’s a lot of information on the internet and it can be incredibly overwhelming and downright confusing to attempt to navigate on your own.

 

I’m going to walk you through what you need to know about the pill (how it works), what to keep in mind and the ONE thing you need to have in place when you’re coming off it. But first, let’s revisit what we use the pill for.

 

The Birth Control Pill – What We Use it for

The oral contraceptive pill (also known as the birth control pill) has been around since 1950 (1) and has been transforming lives ever since (hello body autonomy!). Since its creation, it has both benefits and drawbacks, like any medical intervention.

The main use of the oral contraception pill is in its name: contraception, though it’s often used for additional concerns such as: heavy periods, painful periods, PMS, acne, irregular periods, and migraines (1, 2).

 

While the pill can be very helpful for certain reproductive concerns, it’s not for everyone, and it may not be fixing the underlying issue either.

 

There are many different types of birth control pills on the market. The most common ones used contain a mix of estrogen & progesterone (2). To understand how the pill works, let’s quickly revisit some biology.

Your Menstrual Cycle (A Super Quick Review)

There are 4 parts of your menstrual cycle. For the example below, we’re going to assume a 28 day cycle with no issues with ovulation, though this may not look exactly like your cycle and that is ok!

 

Part 1: Your Period (Days 1~6)

This is when you are actively shedding the uterine lining your body built up over the past weeks.

 

Part 2: Follicular Phase (Days 6-13).

This is egg growing & maturing time (in the ovary). Estrogen is your dominant hormone. It is a building hormone; it builds the lining of the uterus to house an embryo (if one is made).

 

Part 3: Ovulation (Day 14).

This is when the mature egg is released from the ovary and can be fertilized to make an embryo.

 

Part 4: Luteal Phase (Day 15-28)

During this phase, your hormones shift to the progesterone dominant part of your cycle. After you ovulate, one of two things happen: the embryo implants into the uterine wall OR the embryo leaves the body and your body prepares to get rid of the unneeded thick uterine lining that was built. The removal of the uterine lining is your period and happens with a corresponding drop in progesterone.

 

How the Pill Works

The pill gives you a constant steady dose of hormone (whether that is a combination pill or a single hormone) each day you take them. This amount keeps your body in an even state of hormones. The placebo pills contain no hormones and trigger what is called a “withdrawal” bleed. A withdrawal bleed is not physiologically the same as having your period (3).

 

The pill impacts your menstrual cycle in a few ways when used correctly (2,3):

• It impacts the body’s ability to grow/mature an egg in the ovary.
• Impacts the body’s ability to ovulate. No maturation of the egg in the ovary means no ovulation. No ovulation means there is nothing to be fertilized to create an embryo.
• Impacts cervical mucous by making it less friendly to sperm. It’s like an additional safety net (quite literally) to protect against conception.
• The uterine lining is impacted and does not support implantation of an embryo.

 

Many reproductive symptoms are due to the shifts in the hormones over the course of the menstrual cycle. The pill works by eliminating the fluctuations in your hormones, thereby improving symptoms (3).

 

What You Need to Know About Coming Off the Pill

There is no one best way to discontinue your birth control pill (6, 7), though this is something to discuss one on one with your healthcare provider.

 

There are two things to keep in mind when coming off the pill.

 

First and foremost, if you went on the pill for contraception, you will need another form of birth control if you are not wanting to become pregnant.

 

The next thing is that if you went on the pill for a reason other than contraception, your symptoms may come back once you discontinue it. Yes, your acne, irregular periods, PMS/PMDD, cramps/pain, heavy periods, mood swings, headaches can come back.

 

Often people can interpret the return of symptoms to signal a need to “detox” from the pill. This is not needed. The hormones in the pill significantly drop in the body within 24 hours. For this reason, it needs to be taken daily to continue working (that’s why the risk of pregnancy increases if you miss a dose!).  The hormones in the pill are completely out of the system within a few days when discontinued (4, 5). This elimination happens naturally in the body quite easily, so unless there is something impacting the body’s ability to eliminate these hormones, there’s no need to take additional supplements or eat particular foods to help with this process.

 

It is also important to note that the research tells us most cycles regulate within 2 months (for 94.7% of ovulators), though it can take up to 12 months after discontinuation of the pill (3).

 

Now, even though it may take a couple months (or more) for your body to regulate your cycle, this doesn’t mean you have to wait for months and cross your fingers and your toes that things get better on their own, especially if your symptoms return with a vengeance and are really wreaking havoc on your life. No one wants that!

 

It can be incredibly helpful to have a plan in place to help you navigate the return of the symptoms that caused you to go on the pill in the first place. In fact, this can make a huge difference and make things a lot easier for you!

 

Three Questions to Ask Yourself

There are 3 important questions to ask yourself (& discuss with your healthcare practitioner) when you are coming off the pill.

 

Question 1: why did I go on the pill to begin with?

Was it contraception? Acne? Irregular periods? Bad cramps? Something else?

 

Question 2: did my symptoms get better when I went on the pill?

Note: this is SUPER important for your healthcare provider to know as it can give good information regarding what is going on for you.

 

Question 3: what is my current plan to help deal with why I went on the pill?

 

Attempting to figure out what you need to do, especially with all the conflicting information on the internet can be overwhelming and downright confusing! This is where individualized support can be super helpful. You don’t need to go it alone.

 

You need a plan that:

• Addresses why you went on the pill in the first place
• Is in alignment with your concerns & health goals
• Is manageable for you based on where you are at right now

 

That is precisely the type of strategic plan that I build with patients.

 

So, how would we work at managing your symptoms now that you’re off the pill?

 

Step 1: We investigate what is happening and why, which often includes:

• Lab testing (to check various hormone levels to ensure they are optimal). The testing is specific to your concerns & health goals

 

Step 2: Provide recommendations to address why you went on the pill that work for your unique circumstances. This can look like:

• Lifestyle recommendations, nutrition recommendations, supplements, etc

 

Step 3: Monitor treatment/progress

• Monitoring progress is important to know that we are on the right track! This can include tracking period based symptoms, acne, headaches, etc or repeating lab work to keep an eye on how things are going.

 

At the end of the day, coming off the pill can be nerve-wracking for some people. It’s important you feel supported with your choice + have a plan in place that will work FOR you as you make this transition.

 

Want some help? Let’s make YOUR plan.

 

References

• Liao PV, Dollin J. Half a century of the oral contraceptive pill. Canadian Family Physician. 2012;58(12):e757-e760. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520685/#:~:text=Introduced%20in%20May%201950%2C%20the
• Cooper DB, Mahdy H. Oral Contraceptive Pills. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK430882/
• ​​Wright KP, Johnson JV. Evaluation of extended and continuous use oral contraceptives. Therapeutics and clinical risk management. 2008;4(5):905-911. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621397/
• ALESSE ® 28 Tablets (Levonorgestrel and Ethinyl Estradiol Tablets). https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020683s004s006s007lbl.pdf
• HIGHLIGHTS of PRESCRIBING INFORMATION. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021098s019lbl.pdf
• How do you stop taking birth control pills? www.plannedparenthood.org. Accessed March 31, 2022. https://www.plannedparenthood.org/learn/ask-experts/how-do-you-stop-taking-birth-control-pills
• What You Need to Know When Going Off the Pill | Walnut Hill OBGYN. walnuthillobgyn.com. Published December 30, 2013. Accessed March 31, 2022. https://walnuthillobgyn.com/blog/what-you-need-to-know-when-going-off-the-pill/