Transitioning Off Hormonal Birth Control

Question 1

Can the HBC pill (also patch and Nuvaring) be stopped cold turkey?

Answer 1

Yes, there’s no reason to finish the pack.

Once they stop the pill, they will likely experience a withdrawal bleed and then after that their body will start to prepare for ovulation and resume their menstrual cycle yet again.

Question 2

Can the IUD/implant be stopped cold turkey?

Answer 2

Yes, however, to have them removed they will need to make an appointment with their OB/GYN.

Question 3

How long does the Depo-Provera shot last?

Answer 3

Roughly 3 months, so the progestin will still be active until the shot expires. They should take note of when their last shot was taken and avoid getting any other shots in the future.

They may wish to use a barrier method as a backup until they have confirmed that their cycles have returned to normal

Question 4

If someone went on HBC to manage cyclical symptoms such as intense pain, PMS, PDD, etc. will those symptoms come back?

Answer 4

Yes, they may and sometimes with a vengeance.

Question 5

Can supporting the body beforehand help decrease the overall burden of coming off the synthetic hormones, making the detoxification process easier on the liver to handle

Answer 5

Yes, it can. It also provides the chance to introduce plenty of quality nutrients & targeted support, which may decrease chances of any withdrawal effects

Question 6

What should they do to decrease their overall toxic burden?

Answer 6

Make sure they are avoiding any exposure to endocrine-disrupting chemicals and are using non-toxic menstrual care products such as 100% organic pads and tampons, or reusable options like menstrual cups, washable pads, or period panties

This will decrease the overall burden on their liver, allowing it enough energy and resources to prioritize detoxificatio

Question 7

Supporting BLANK stabilization through optimizing nutrition will be an important step to ensure they are modulating inflammation and taking the extra burden off of their liver.

Answer 7

Blood sugar

Question 8

What can increase the risk for post-pill induced PCOS?

Answer 8

Coming off of birth control cold turkey, specifically with progestin-only options, while also experiencing blood sugar imbalance

Question 9

Supporting the BLANK directly can help to improve its function and prioritize hormone detoxification when the times comes to quit the pill.

Answer 9

Liver; one of the best ways to support the liver is by supporting digestive function

Question 10

Why is it important to support a client’s digestive health before they go off the pill?

Answer 10

The pill can harm intestinal integrity, and gut microbiota diversity.

Due to these impacts, it can be common for women to experience digestive disturbances after discontinuing the pill

Question 11

How can you optimize a client’s digestive health before they go off the pill?

Answer 11

Through supporting the north-to-south process, and ensuring they are getting in some high-quality probiotics daily

Question 12

Addressing stress management is important for not only optimizing their adrenal health, which can get taxed from being on HBC, but also important for BLANK and BLANK.

Answer 12

Stabilize their blood sugar and support their ovulatory function.

Heightened stress during this time, alongside discontinuing hormonal birth control, may impact follicle maturation and corpus luteum quality. This in turn can have an impact on how much progesterone they are able to produce, which as we know, is important for keeping estrogen in check and promoting a healthy luteal phase experience.

Question 13

Should a client transition off of HBC during a time of heightened stress like planning a wedding or studying for college finals.

Answer 13

It’s not optimal, as stress can lead to more post-pill symptoms

Question 14

Hormonal birth control is known to deplete certain nutrients such as…

Answer 14

Vitamin E, Vitamin C, B Vitamins, Magnesium, Selenium & Zinc

Depending on how long a person has been on hormonal birth control, they may experience deficiency-related complications once discontinuing, if they aren’t already.

Question 15

A client should consider taking direct supplementation before and after transitioning to replenish BLANK.

Answer 15

Potential lost nturients

Question 16

B vitamin complex can help

Answer 16

specifically B5 and B6 can help to support follicle and corpus luteum quality

Question 17

Vitamin D deficiency can lead to BLANK disorders such as BLANK and BLANK.

Answer 17

Ovulatory disorders such as PCOS and infertility.

Question 18

Vitamin C nourishes the BLANK and may also support healthy BLANK levels

Answer 18

adrenals; progesterone

Question 19

Omega 3 fatty acids from a quality fish oil are important for modulating BLANK and BLANK levels, which may be elevated both during and post hormonal birth control usage

Answer 19

inflammation; prostaglandin

Question 20

The most common minerals that are depleted by hormonal birth control are

Answer 20

magnesium, zinc, and selenium, which are critical for many physiological and enzymatic processes within the body.

Question 21

The copper IUD can interfere with zinc concentrations because

Answer 21

Copper and zinc are antagonistic to one another

This can be problematic as zinc is a necessary mineral for facilitating oocyte growth and antral follicle development as well as progesterone production

The thyroid gland is also very sensitive to copper, thus excess copper may also have a negative impact on its function

Question 22

If you are unsure of your client’s mineral status and ratios, you may suggest they order what test?

Answer 22

Hair, Tissue, Mineral Analysis (HTMA) test

Question 23

If someone is looking to come off the pill to conceive, it may be best for them to take how many months before hey start trying in order to improve their nutrient status post-pill and optimize their egg quality and ovulatory function?

Answer 23

3-6 months

Question 24

Should a woman try to get pregnant right after coming off the pill?

Answer 24

No, although they may easily get pregnant right after coming off the pill, there is some evidence showing that conceiving right after discontinuing oral contraceptives may be linked to preterm delivery and low birth weight

Question 25

Does HBC manage hormone related issues?

Answer 25

Hormonal birth control may appear to manage hormone related issues, as it can deter one’s symptoms, but what it’s really doing is suppressing natural hormones, including any imbalances that are present, this is why it is very common for symptoms to return once discontinuing hormonal contraceptives

Question 26

What is Post-Birth Control Syndrome, or PBCS?

Answer 26

Certain progestins, such as Levonorgestrel, which is found in the mini-pill, implant, and Mirena IUD, have a “high androgen index” meaning they can stimulate androgen receptors, including DHT.

These forms of progestin contraceptives are usually associated with side effects such as acne and hair loss.

Other forms of progestin-only contraceptives, such as Drosperinone found in combined contraceptives, have a “low androgen index” meaning they suppress androgen levels.

Although this may seem beneficial in some regards, the body can’t recognize this mechanism as natural, thus, it typically compensates by stimulating more androgen production, especially once the contraceptive has been discontinued.

This can result in symptoms of PCOS, such as cystic acne, facial or nipple hair growth, hair thinning, and irregular cycles after discontinuing hormonal contraceptives

Question 27

Is Post-Birth Control Syndrome, or PBCS usually temporary?

Answer 27

Yes, lasting anywhere between 1- 2 years

Question 28

Having Post-Birth Control Syndrome, or PBCS can cause women to get diagnosed with BLANK, which can lead to BLANK?

Answer 28

True PCOS; This can lead to improper treatment plans, as the PCOS symptoms have likely been induced temporarily from discontinuing the pill, rather than being an actual metabolic dysfunction.

Question 29

Can true PCOS develop post-pill?

Answer 29

Yes, but this is typically due to insulin resistance brought on by being on hormonal contraceptives, which is a different mechanism of action than post-pill PCOS.

Question 30

What is a way to differentiate between true PCOS and post-pill PCOS?

Answer 30

Take note of if or not they experienced any PCOS tendencies before going on the pill.

In most cases of post-pill PCOS, prior to hormonal contraceptives their cycles were regular, and they did not experience symptoms of high androgens. Whereas with true PCOS, they may have experienced certain symptoms such as irregular cycles, acne, or facial hair.

Question 31

What should you observe to determine if a client has post-pill PCOS or true PCOS?

Answer 31

Look at LH/FSH ratios

It is common in PCOS to have LH levels higher than FSH, typically at a ratio up to 3:1, alongside other criteria for PCOS11. However, in post-pill PCOS, a high LH/FSH ratio seems to be the only distinguishing criteria and typically goes back to normal levels after 1-2 years

Question 32

The pill can impair feel-good neurotransmitters such as Serotonin and GABA, which lead to

Answer 32

Depression, anxiety, and mood swings

Question 33

Hormonal contraceptives can interfere with the ability to properly metabolize the amino acid, Tryptophan, while also depleting levels of B6, both of which are necessary for BLANK production. Thus, leading to BLANK deficiency and the development of BLANK.

Answer 33

Serotonin; serotonin; depression

Question 34

Can GABA production be impacted while on hormonal contraceptives?

Answer 34

Yes

Question 35

Why is GAB production impacted from being on HBC?

Answer 35

Progesterone metabolism is important for the production of GABA, which is an inhibitory neurotransmitter that helps to modulate excitatory signals that can induce anxiety. While on hormonal contraceptives, natural progesterone isn’t produce.

Question 36

When coming off HBC, it can be common to experience a temporary increase in BLANK until the body begins to cycle and produce BLANK naturally

Answer 36

anxiety; progesterone

Question 37

Headaches, migraines, and other PMS-type symptoms as well as heavy and painful periods may be common simply due to BLANK and BLANK.

Answer 37

Low progesterone and estrogen dominance

Birth control can increase inflammation as well as prostaglandin levels, leading to an increased prevalence of post-pill dysmenorrhea

Question 38

Why is a common symptom with coming off the pill low libido?

Answer 38

Although progestin-only contraceptives are associated with androgen elevation post-discontinuation, combined oral contraceptives are associated with lowered androgen levels, specifically low testosterone. This can be problematic as Testosterone plays a major role in stimulating a healthy libido.

The increase in SHBG post-pill may very well lead to hormone imbalances such as low testosterone, or even low estrogen, both of which can contribute to a decreased sex drive.

Question 39

T or F: coming off HBC can lead to the potential for are the potential for Hypothalamic-Pituitary axis dysfunction, which may contribute to the onset of hypothyroidism and adrenal insufficiency.

Answer 39

True

Question 40

T or F: Taking a hormone panel immediately after coming off hormonal contraceptives may be irrelevant, as the body is still processing the synthetic hormones

Answer 40

True; therefore, they may receive inaccurate results that could potentially cause unnecessary worry and concern

Question 41

How long should you wait after going off of HBC to do any hormone testing?

Answer 41

3-4 full cycles

to give time for the body to rid of any synthetic hormones and begin cycling naturally.

For many, post-pill symptoms tend to clear up around this time, especially if they are diligent in supporting their hormone health.

Question 42

Because hormonal birth control suppresses the communication between the brain and the ovaries, stabilizing BLANK, including BLANK may be important, especially if one is experiencing a delay in their ovulation and menstruation or symptoms of low testosterone and estrogen.

Answer 42

HP axes, including the HPA, HPT, and HPG axes

Question 43

What are adaptogens?

Answer 43

Acategory of herbs that help to nourish the adrenals and support a healthy stress response.

Some adaptogens can be phytoestrogenic, whereas others can promote androgen production, so it’s important to know what herbal allies may support your client’s situation, and which may not.

Question 44

What is Maca?

Answer 44

An adaptogenic root that helps to support the health and function of nearly every endocrine gland

It does have mild phytoestrogenic properties that can help promote estrogen balance, but its properties are not limited to estrogen alone. Some research shows that Maca may have certain alkaloids that are nourishing to all H-P axes, helping to stabilize endocrine communication as a whole

Question 45

What is the dosage and contraindications for Maca?

Answer 45

In general, Maca is considered safe at higher doses, but it may be best to start with lower quantities.

Maca is not recommended for those with Hashimoto’s or iodine sensitivity as Maca contains high amounts of iodine.

However, because of the high iodine concentration, Maca may be supportive for those with a hypo-functioning thyroid.

Question 46

What is Ashwagandha?

Answer 46

Another adaptogenic herb that nourishes HP axis function, specifically with the adrenals and thyroid.

Ashwagandha has been shown to promote testosterone production, so although this herb may not be beneficial for those with symptoms of post-pill PCOS, it may be helpful for those experiencing symptoms of low steroid hormones or female sexual dysfunction such as a decreased sex drive or vaginal drynes

Question 47

What is the dosage and contraindications for Ashwagandha?

Answer 47

Roughly 250-500 mg taken in ivided doses can be a good starting point. Per usual, start slow and work up to determine how the body reacts.

With adaptogens, I do suggest switching on/off each month to avoid too much adrenal/thyroid stimulation.

However, I would recommend your client consults with a trained herbalist to determine if a higher or lower dose is necessary for their specific situation. This herb is not recommended for pregnant or lactating women, nor for those with thyroid disease.

Question 48

If your client hasn’t started cycling again within 3 months of discontinuing hormonal contraceptives, what is a helpful herb?

Answer 48

Vitex (Chastetree Berry)

a helpful herb for promoting HPG communication and ovulatory function, as well as progesterone production, which may support a healthy luteal phase experience

Question 49

Why can Vitex help with hypothalamic pituitary stablization post HBC?

Answer 49

Elevated levels of prolactin, which may be common after long-term use of hormonal contraceptives, can interfere with GnRH pulsation and inhibit ovulation. This can result in post-pill amenorrhea and is characterized by a low LH to FSH ratio and Vitex can promote HPG communication and ovulatory function

Question 50

What is the recommended dosage and contraindications for Vitex?

Answer 50

Vitex is best taken in liquid tincture form at a dose of around 500 - 1000 mg daily, upon rising, for 3-6 months to promote healthy HP axis function.

However, it is not recommended for those with high LH levels, such as with post-pill PCOS, as Vitex can increase LH levels further and may exacerbate cyclical delays.

Question 51

For those experiencing symptoms of post-pill PCOS, a combination of which herbs may help promote normalization of LH & FSH and aromatization of testosterone to estrogen, helping to modulate overall androgen levels.

Answer 51

White Peony & Licorice Root Extract

recommend consulting with an herbalist for more details

shouldn’t be taken longer than 6 months and is not recommended for those with high blood pressure

Question 52

For liver and detoxification support, taking which herbs for 2-3 months post HBC can support phase 2 detoxification?

Answer 52

NAC or Liposomal Glutathione

NAC is a precursor to the production of glutathione, the body’s most powerful antioxidant. 600mg twice daily is recommended. Most common forms of glutathione are found in their reduced form, which tends to break down faster than the benefits can be received, therefore I do not recommend reduced glutathione

Question 53

Support for general liver health are nutrients are herbs such as

Answer 53

Dandelion, Milk Thistle, and Artichoke

Question 54

What herb may help support egg quality if your client is trying to get pregnant soon after discontinuing hormonal contraceptives?

Answer 54

CoQ10, specifically in the form of Ubiquinol, which is an important nutrient for mitochondrial health and function, as well as their chromosomal activity, which can help to support fertility and improve IVF outcomes.

Question 55

What is the recommended dosage of Ubiquinol?

Answer 55

The recommended dosage is 100 mg, twice daily for 2-3 months before trying to conceive

Question 56

True or False: female egg contains more mitochondria than any other cell in the human body

Answer 56

True!

Because of this, mitochondrial health is imperative for optimal egg quality

Question 57

To support overall detoxification, insulin sensitivity, and stress management, BLANK through frequent movement dry brushing, and hydrotherapy can help

Answer 57

stimulating lymphatic flow