A Naturopath’s Guide To Coming Off The Pill

The oral contraceptive pill (OCP) is the most prevalent method of contraception in Australia! It is used by over 40% of contraception users, with 18% opting for condom use, and a growing trend towards LARCS (long-acting reversible contraception), which includes the IUD (Mirena, Kyleena & copper IUD) as well as the Implanon & contraceptive injections.

Essentially, the way the pill works is inducing a chemical menopause: via shutting off ovarian hormone production, ovulation & therefore progesterone production, ovulation being the main-event of the menstrual cycle. It reduces sebum levels in the skin to pre-puberty levels. The synthetic progestins in the OCP (such as levonorgestrel) aren’t the same as the progesterone our body makes, so the pill also takes away all the beautiful monthly benefits of progesterone: progesterone is anti-inflammatory, calming to the nervous system, stimulates neurogenesis in the hippocampus, supportive to skin & hair health, immune modulating, prevents autoimmune disease, increases deep sleep & more. The bleed experienced on the pill is not a period, but rather a withdrawal bleed from the drop in progestins when you take the “sugar pills”, which causes the endometrial lining to shed. Furthermore, progestins can cause symptoms such as hair loss, and the fake oestrogen in the OCP such as ethinylestradiol can cause insulin resistance. The pill also increases an enzyme called SHBG which can be protective for the skin against the actions of testosterone & oestrogen, and SHBG drops about 3-6 months post-pill, just as hormone production kicks back in!

Our goal together is to re-engage the body and provide it the necessary time & resources to get into the rhythm of ovulating naturally every month, and therefore producing progesterone, followed by a bleed about two weeks later (11-17 days) due to declining progesterone levels. Because the pill shuts off communication between the brain and the ovaries also known as the HPO axis (so natural sex hormones aren’t produced), your body will take some time to re-establish ‘talk’ between the brain and the ovaries. Synthetic hormones In the OCP have been binding to hormone receptors and exerting a weak effect, but now, the brain (specifically, the hypothalamus), will register that there aren’t any sex hormones floating around.

In response, our ovaries will kick into overdrive and our hormones will surge, and the action once oestrogen & testosterone binds to hormone receptors will be amplified. This surge typically peaks at about the 3–8-month post-pill mark, after which point post-pill acne and post-pill hair loss tends to to reduce (but not for everyone because underlying acne drivers including gut and liver detoxification, stress, thyroid function, inflammation, immune function & insulin resistance hasn’t been addressed).

It can take 12 years for the HPO (hypothalamus-pituitary-ovarian) axis to fully mature. This would mean that if you got your first period as a 13-year-old, it isn’t until age 25 that you are having robust monthly ovulations, so going on the pill in your teens can slow this maturation process.
But, don’t fret- we will get there! Your body WANTS to ovulate, we just need to remove the obstacles to regular ovulation + give the body time to do its thing.

Common complaints when coming off the pill include irregular or absent periods, mood swings, hormonal symptoms such as breast tenders, heavy & painful periods, spotting, post-pill hair loss, in some women I’ve seen weight loss and in others I’ve seen some hormonal bloat come on, and the dreaded: post-pill acne. However, I also speak with women who feel less anxious, experience less brain fog and just generally feel more like themselves during their post-pill journey! It is also important to ask yourself the question: what were me periods and skin like before going on the pill? If each of these factors were doing fine before you went on the pill, chances are your transition will be a lot smoother. If you had acne, PCOS, or issues with your menstrual cycle, those issues will return post-pill because the pill has simply put a mask on them.

Here’s what we can do to encourage ovulatory cycles & reduce post-pill symptoms, in a process that is ideally begun 3-6 months before stopping the pill:

Replete Deficient Vitamins & Minerals

PLEASE NOTE: DO NOT SELF PRESCRIBE! I TREAT MANY WOMEN DURING THEIR POST-PILL TRANSITION AND EVERY WOMAN REQUIRES A DIFFERENT PRESCRIPTION! SEEK HELP FROM A QUALIFIED PROFESSIONAL BEFORE YOU GUESS! The OCP depletes beneficial gut bugs or bacteria, vitamins B2, B6, B9, B12, vitamin C and E, and the minerals magnesium, CoQ10, selenium and zinc.

• Zinc will be particularly important for supporting skin health: it reduces the bacteria responsible for causing pimples, it reduces testosterone which is a male androgen that increases post-pill (the cause of post-pill PCOS), reduces hypersensitivity of androgen receptors in the skin, and it supports wound healing so will help pimples that do emerge to clear quicker.

• B6 is one of the most important nutrients for ovulation and supports progesterone production, so will be necessary in helping the body to re-establish an ovulatory cycle.

• Essential fatty acid status! This comes back to omega 3 and omega 6: every skin cell has a cellular membrane around it, if this membrane is more omega-6 rich, it means the cell can’t absorb as much water, which effects skin barrier function and leads to skin dehydration, and poor cell to cell communication. We get enough omega 6s in the diet naturally from nuts and seeds, meat, dairy and eggs. Omega-6 rich vegetable oils like canola and sunflower are hidden in most packaged food items, barista nut mylks and takeaway foods which quickly throws out our omega 3:6 ratio.

  We get omega 3s (EPA, DHA & ALA) through the diet from cold-water, oily fish like salmon, sardines, herring & mackerel, however we typically don’t consume great amounts of these. Supplementation with EPA & DHA (always under the guidance of a practitioner) is essential for clear skin. Make sure you take your fish oils with a meal, and with a fat source for proper absorption. Omega 3s change the viscosity of the oil in our skin so that is water-like and free-flowing, rather than a gluggy, cottage cheese consistency that causes a blockage in the hair follicle, immune activation, inflammation, and a pimple. Consistency is key with fish oil supplementation.

• Magnesium is imperative for nervous system function, female hormone balance and insulin receptor sensitivity.

• CoQ10 is needed for healthy mitochondria (the energy powerhouse of the cell) which is also present in every skin cell, and helps skin cells clear out free radicals that damage the skin.

Address Insulin & Blood Sugar Levels
Particularly essential if your periods weren’t regular prior to the pill or if you have a history of PCOS. However, stabilizing blood glucose levels and improving sensitivity is important for every woman because insulin resistance inhibits ovulation, and insulin resistance is a key driver of testosterone excess, which drives sebum production.
We need to focus on: a healthy balance of the macronutrients, with a focus on protein and swapping simple carbohydrates for complex carbohydrates.

We need to be really aware of significantly reducing sugar intake, and this isn’t just from the obvious sources (cakes, lollies, chocolate, ice cream & junk food), but it also means coconut sugar, rice malt syrup, brown rice syrup, honey, agave and coconut syrup as they still impact the blood sugar response. Whole fruit (not dried or juiced) is still good! Whole fruit has fibre which naturally slows down blood sugar spikes.
Exercise also supports insulin receptor sensitivity, so regular movement and building muscle mass through resistance training is important.
On the flipside, we don’t want blood sugar levels dropping too low either, and this can be avoided by eating every 4 hours and avoiding significant fasting, and ensuring a correct macronutrient balance.

Optimise Detox Pathways: The Liver

The liver is kind of like the body’s filter. Hormones enter the liver in phase 1 detoxification and get transformed into metabolites, and get bound to nutrients that we give the body through the diet, for safe clearance out of the liver in phase 2 detoxification. In total, the 3 liver processes we need to consider when it comes to liver hormonal clearance are sulfation, glucuronidation and methylation (there are other phase 2 detox stages, however these apply more to other substances rather than hormones). We need to support synthetic hormones leaving the body, and get the liver in a prime position to start properly metabolizing and detoxifying your natural hormones.
There are many nutritional & herbal ways we can support this process including:

The liver needs the right ingredients for hormonal clearance so we need to ensure adequate protein intake. Proteins get broken down into amino acids, and amino acids ‘switch on’ our sulfation, glucuronidation and methylation pathways.

Sulfation: deals with oestrogen, progesterone, DHEA & thyroid hormones. Support this stage via eating protein, specifically the Sulphur containing amino acids cysteine, methionine and taurine & the supplementation of NAC & glutathione (only under guidance of a practitioner). Sulfur rich foods like cruciferous veggies (broccoli, cauliflower, cabbage, Brussel sprouts, kale etc) and Allium vegetables (garlic, onion, shallots and chives) help. Epsom salt baths increase sulfation, and sunlight exposure stimulates production of cholesterol sulfate.

Glucuronidation: deals with oestrogens, testosterone, DHEA, and thyroid hormones. Supplements that induce UGT enzymes and support glucuronidation include resveratrol, curcumin, d-limonene and quercetin. Consume citrus foods including limonene from the peels of oranges, lemons, limes and grapefruit, cruciferous veggies, & dandelion, rooibos, Honeybush and rosemary tea. Note: high-levels of beta glucuronidase in the gut can undo glucuronidation and send oestrogen back into circulation.

Methylation: deals with oestrogens. Support methylation conjugation with nutrients that donate or support creation of methyl groups including SAMe, methionine, methyl B12, 5-MTHF (active folate), trimethylglcyine, B6 B2, Magnesium, zinc and choline (again, only under the guidance of a naturopath).

• Herbs like Schisandra, Turmeric, St Mary’s Thistle, & Dandelion Root can help, assuming the liver has the right ingredients from the diet.

• Cruciferous vegetables: aim for 2-3 cups per day of chopped/lightly cooked broccoli, kale, brussel sprouts, cauliflower, cabbage, etc.

• Supplementation with Diindolylmethane (DIM), which is a compound derived from cruciferous vegetables that helps to reduce post-pill acne and optimize oestrogen metabolism and reduce androgens (only from a practitioner).

• Broccoli sprout extract (only from a practitioner).

• Support liver production of BILE which binds to hormones and aids bowel clearance.

• Reducing chemical exposure and environmental toxins. This is a BIG topic! We want to give our liver the chance to focus on hormones, rather than a massive load of chemicals from deodorants, makeup, skincare, laundry liquids, perfumes, haircare, dishwashing liquids, etc.

• Reduce alcohol, especially at ovulation! Oestrogen peaks right before ovulation, and if you drink alcohol especially at this time, the liver will shift its focus to detoxing the alcohol, and not the oestrogen.

  Optimise Detox Pathways: The Bowel
  We need you to poo at least once per day. Ideally up to 3 times per day. Anything less than once per day and I would consider you constipated! To test your intestinal transit time, you may like to do ‘The Corn Test’. Eat corn kernels (they pass through your digestive tract relatively intact as they are indigestible), and look in the toilet to see at what point they appear in the stool. If it’s longer than 12-24 hours post-consumption, you are likely retaining waste and have slowed transit time.
  We also need to consider: water intake, fibre intake, and supporting digestive enzyme secretion and other aspects of your gut that could be slowing things down (e.g is it SIBO?).

  Target The Stress Response
  DHEA (a kind of androgen, or male-sex hormone) and our stress hormone cortisol are released from our adrenal glands in response to stress, whether it’s real or perceived stress. Both cortisol & DHEA are also produced IN the skin, and can stimulate sebum production too, which is like a double whammy of sebum production when it’s coming from both the stress hormones and our ovarian hormones. Stress could be triggered by thinking about a to-do list that bothers you, a tough conversation at work, or a blood sugar drop from say, not eating for a period of 4+ hours. We need to increase your body’s ability to handle and perceive stress (stress management techniques, deep-breathing) + utilise adaptogen and nervine herbs like Withania and Passionflower, as well as supplementing with the likes of Magnesium, Taurine & L-Theanine (again, only under a practitioner’s guidance!).

  Support the Immune System
  Signs your immune system needs some loving is slow-healing breakouts, recurring infections like tonsillitis and bronchitis, skin infections like boils, dermatitis and fungal overgrowths, breakouts under the jawline/along the neck/on the body/around the lymph nodes, and a history of recurring ENT infections as a child.
  When C. acnes bacteria proliferates, an immune response is launched, and we need this to be done effectively and efficiently to clear breakouts as soon as possible. The immune system and the lymphatic system are closely linked, the lymph system acting like a sort of ‘sewage system’ for the body to clear waste.
  Lymphatics rely upon movement/exercise because the lymphatic system doesn’t have its own set of pumps like the cardiovascular system does. The lymphatics also like high water intake, hot & cold exposure (say from infrared saunas and cold showers), and lymphatic cleansing herbs like Echinacea, Clivers, Calendula and Poke Root.

  Testing

  Before you come off the pill, we can investigate the following so that we can address any imbalances before we transition you off, to get your body in a better position to optimise post-pill outcomes.

• Nutrient status (B12/active B12, folate, iron studies, Vitamin D, zinc)

• Fasting insulin (an OGTT is even better!)

• Liver function

• Inflammation markers CRP, ESR, homocysteine

• Thyroid panel: TSH, T3, T4, reverse T3, thyroid antibodies TPO & TG

  Once you are at least 3-4 months post-pill, we will also investigate your reproductive hormones (now that production has been re-established) and can begin to work on specific hormone modulation for imbalances that may be present:

• FSH, LH, prolactin, oestradiol

• Testosterone, androstenedione, DHEAS, SHBG, FAI

  During your consultation we will discuss how to go about testing!

By Phoebe Ackland, (BHSc Naturopath)

Available for naturopathic consultations for women struggling with acne, perioral dermatitis, Rosacea, PCOS & other menstrual cycle-related conditions or digestive issues.