What is PBCS?
Post-birth control syndrome is a term used to describe a collection of symptoms that typically arises four to six months following the discontinuation of hormonal birth control such as birth control pills, patches, or hormonal intrauterine devices (IUDs). Many of the symptoms that occur are acne, absence of menstrual periods, hair loss, and anxiety. In many cases, the PBCS symptoms that occur are the ones the individual was originally trying to resolve when starting the birth control pill in the first place; these symptoms tend to reappear once the person has stopped taking the pill. This is because they were actually present the entire time, but suppressed by the medication.
While post-birth control syndrome is not an actual medical diagnosis in western medicine, it is very well known to the holistic community because of the devotion to finding root causes of unwanted symptoms, illnesses, and disease.
Dr. Aviva Romm's definition of PBCS is: "irregular periods and other symptoms that some people get in the months after they stop using hormonal contraceptives." and, Dr. Jolene Brighten states: "Post-birth control syndrome is a term that refers to the collection of signs and symptoms that arise when you stop taking the pill. These can be symptoms you were suppressing with the pill, or they can be added side effects the pill created that your body is waking up to."
Basic birth control information and common misconceptions
Hormonal birth control is commonly used to reduce period symptoms and unwanted pregnancy.
Birth control was primarily designed to prevent pregnancy by prohibiting ovulation, thereby preventing the release of an egg from the ovary. Additionally, it thickens cervical mucous, making it more difficult for the sperm to reach the egg, and thins the uterine lining, making it less receptive to implantation. Birth control is also commonly prescribed by doctors to suppress symptoms of acne, PCOS, endometriosis, irregular periods, heavy bleeding, and mood swings, among many others.
The pill contains synthetic hormones such as progestin, progesterone, and estrogen.
While hormonal birth control has been deemed as generally safe for most people, there are potential risks associated with synthetic hormone intake. These risks include an increased likelihood of blood clots, particularly in individuals with certain pre-existing conditions such as history of clotting disorder or smoking. Use of hormonal birth control may also affect fertility after discontinuation, and some individuals may experience symptoms like headaches, nausea, changes in mood or libido, weight gain, and breast tenderness.
In terms of gut health, some studies state that the use of the birth control alters the state of the gut microbiota, the beneficial bacteria in the digestive system, which affects digestion, nutrient absorption, and overall gut function. Additionally, the hormonal changes induced by the intake of synthetic hormones can contribute to symptoms like gas, bloating, and changes in bowel movements.
When you're taking hormonal birth control, your body stops making its own hormones.
The flood of synthetic hormones when taking on the pill, the patch, or an IUD dysregulates the body's natural hormone production and, over time, its ability to produce hormones naturally. Since your body is obtaining hormones from a different source, it eventually decides to stop producing hormones of its own (this is why a lot of people experience hormonal dysregulation and infertility when coming off hormonal birth control).
A healthy body creates hormones that allow your body to communicate all-over. Glands such as the pituitary, thyroid, adrenal, and reproductive organs produce such hormones and release them into the bloodstream where these hormones can travel throughout the body and bind to specific receptors on target cells or organs. Once bound, they initiate a cascade of signaling events within the cell, which can affect various processes like metabolism, growth, reproduction, and mood. Feedback loops regulate hormone levels, ensuring balance within the body's systems. Overall, this intricate network of communication allows hormones to coordinate and regulate numerous physiological functions essential for maintaining health and homeostasis (balance).
Hormonal birth control does not regulate your period.
True menstrual regulation involves restoring the body's natural hormonal balance, which hormonal birth control does not address. Instead, it provides synthetic hormones to suppress ovulation and induce a withdrawal bleed, giving the appearance of a regular menstrual cycle. However, this process does not address underlying hormonal imbalances but rather masks them. When someone stops taking hormonal birth control, their body must readjust to its natural hormone production, often resulting in a return of irregular periods as the body's own regulatory mechanisms reassert themselves. Holistic approaches focus on addressing these underlying imbalances through lifestyle changes, dietary adjustments, stress management, and natural therapies to support long-term menstrual health and hormonal balance.
You don't experience a period when you're taking hormonal birth control.
When you take hormonal birth control, the synthetic hormones it contains suppress ovulation and maintain a consistent hormonal environment. During the week of the inactive or "sugar" pills in the pack, the sudden drop in synthetic hormones triggers a withdrawal bleed, mimicking a menstrual period. This bleeding is not a true period, as it's not indicative of ovulation or the shedding of the uterine lining. Instead, it's a response to the absence of hormones and serves to reassure individuals that they are not pregnant while taking the pill.
More on post-birth control syndrome
Symptoms may show up 4-6 months after getting off hormonal birth control
PBCS symptoms may occur months after getting off the pill due to your body trying to adjust to different types of hormones as well as different levels of hormones. Your body needs to learn how to synthesize its own hormones again, which results in various symptoms showing up in various degrees. Symptoms of post-birth control syndrome can vary widely among individuals and may include:
Irregular menstrual cycles: Some individuals may experience irregular periods or a lack of periods altogether for several months after discontinuing birth control.
Hormonal fluctuations: Withdrawal from synthetic hormones in birth control can lead to hormonal imbalances, resulting in symptoms such as acne, mood swings, or changes in libido.
Menstrual-related symptoms: Women may experience symptoms like cramping, bloating, breast tenderness, or changes in menstrual flow as their bodies readjust to natural hormone levels.
Digestive issues: Some individuals may experience gastrointestinal symptoms like bloating, gas, or changes in bowel habits as a result of hormonal fluctuations affecting gut health.
Other symptoms: PBCS can also manifest as fatigue, headaches, or changes in weight, although these can be influenced by various factors beyond hormone withdrawal.
It's important for individuals experiencing persistent or severe symptoms after stopping birth control to consult with a healthcare provider for proper evaluation and management.
Symptoms may be worse than before/during hormonal birth control.
If the reason you started taking the birth control pill was to help address certain symptoms, it's important to be aware that these symptoms may reappear post-birth control and may even be worse than before taking it. This is because those symptoms were actually being suppressed rather than addressed- the synthetic hormones were covering up the symptoms.
New symptoms may arise.
You may experience new symptoms, again due to your body relearning how to balance and make hormones. To put it simply, your body is adjusting and learning how to return to its natural self.
It may take up to about 9 months to normalize your cycle, however, your body cannot do this task on its own. Supporting your body through whole foods, movement, stress management, and possibly through supplementation or herbal medicine will be needed.
You may develop pill-induced PCOS.
Post-pill PCOS is a common diagnosis whereas the individual experiences acne, excessive hair growth, and irregular periods or amenorrhea (no periods). These are some of the same symptoms as PCOS, hence why a medical doctor may diagnose the individual with PCOS. With proper support through nutrition and healthy lifestyle habits, in most cases, these symptoms can be reversed.
You may experience inflammation and immune imbalances
When coming off hormonal birth control, your body requires time to re-establish its natural hormone balance. This adjustment period can lead to fluctuations of estrogen, progesterone, and other hormones, which may influence inflammation and immune responses.
Hormonal fluctuations during the transition off birth control can influence inflammatory pathways in the body. Estrogen, for example, has been shown to have anti-inflammatory effects, and its decline after discontinuing birth control may lead to increased inflammation in some individuals. Inflammation is the body's response to injury or infection, but chronic inflammation can contribute to various health issues.
Hormones play a role in modulating the immune system, and changes in hormone levels can affect immune function. Coming off birth control may disrupt the delicate balance of immune cells and signaling molecules, potentially leading to alterations in immune responses. This can manifest as heightened immune activity or immune imbalances, which may contribute to symptoms such as fatigue, malaise, or susceptibility to infections.
Individuals with underlying health conditions such as autoimmune disorders or chronic inflammatory conditions may be particularly susceptible to inflammation and immune disturbances when coming off birth control. Hormonal fluctuations can exacerbate existing immune-related symptoms or trigger flare-ups of underlying conditions.
My personal PBCS experience
I feel passionate when it comes to this topic because this is something I have struggled with myself. I started taking the birth control pill because I had such painful and irregular periods as well as experienced extreme mood swings, cramping, headaches, and bloating. The irregularities of my cycles were especially a concern- one period would be heavy and last a week then, the next would be almost non-existent. When I started taking the BCP, I felt so much relief because my symptoms became very minimal. The only downside was that I gained some weight and experienced some minor acne.
Fast forward a few years: after three years of being on the birth control pill, I decided to stop taking it because I learned of all the nutrient deficiencies that it causes. Looking back, I wish I would have consulted a naturopath for some guidance and support but, I was determined to get my health back on track on my own.
Once I had been off the pill for about one or two months, I noticed some of my periods were once again absent and I was back to experiencing excruciating cramping and mood swings. These symptoms because worst with time. I also started experiencing even more symptoms such as anxiety, panic attacks, bloating, headaches, extreme fatigue, and brain fog.
Now that I am well-rounded on this topic, the mistake I made when coming off the birth control pill, which is a mistake many individuals make too, is that I did not support my body in the ways it needed support. I did not focus on nutrient-dense and balanced meals, replenishing depleted minerals and vitamins, nor the other numerous ways to support your body in times of overall imbalance.
The symptoms I have listed above are extremely common in the majority of the population currently taking some type of hormonal birth control, as well as are common in those coming off birth control. It is extremely important to note and understand that, while these symptoms are common, they are not normal. What I experienced is not normal and it requires a lot of nutritional support. Whether or not you decide to continue taking hormonal birth control, there are several ways for you to support your body (continue reading).
Upcoming blog: Ways to support your body post-hormonal birth control
But in the meantime, here are some things you can do:
Keep a journal of all your symptoms (both healthy symptoms and not-so-good symptoms), along with your food and beverage intake. This habit may help you pinpoint potential disturbances and symptoms caused by certain foods. Plus, if you start working with a natural health practitioner, they will love you even more for this information.
Ensure you are consuming protein with your breakfast each day. This is beneficial for many reasons, especially to help avoid mood swings, cravings, and energy crashes.
Practice mindfulness. Whether this is reading, going for a walk on the beach, or making a nice homemade meal, it is important to sit with yourself. I have found this to be one of the most difficult things to do because of the overwhelming and busy lifestyle modern day has become. Taking some time every day to be with yourself will help you understand your body and what it wants to tell you.
Eat real food. Yes, real food. Refined carbohydrates are sugars- your inflammation and painful cramps could easily be due to your diet, along with many other common symptoms. Try substituting artificial or refined sugars with maple syrup, honey, or coconut sugar instead. Avoid the processed or packaged foods as much as possible and aim for fresh and organic foods.
Castor oil packs for cramping and a cup of hot tea always feels nice. Try a ginger tea for anti-inflammatory properties or kava as a sleep aid.
Peppermint essential oil on your neck and temples does wonders for easing headaches.
Diffused lavender essential oil is wonderful for calming an anxious mind.
In articles to come, I will provide information on how to support your body while taking hormonal birth control as well supporting your body when coming off hormone birth control. Stay tuned.
It's important to note that not all women will experience PBCS, and for many, any symptoms are usually temporary and resolve as the body is supported and adjusts to its natural hormone balance. However, for some individuals, symptoms may persist, and they may require medical evaluation and management to address any underlying hormonal imbalances or other contributing factors. If someone is experiencing persistent or severe symptoms after stopping birth control, it's advisable to consult with a healthcare practitioner for proper evaluation and guidance.
References
The post-birth control pill hormone reset by Aviva Romm, MD
Fix hormonal imbalance & reverse birth control side effects - Beyond the Pill by Dr. Jolene Brighten
Post-birth control syndrome + how to heal now - by Dr. Jolene Brighten
Nutrition and Health: The Fundamentals by Sidney Shindle