Deciding to come off the Oral Contraceptive Pill (OCP) can feel overwhelming and difficult to navigate although having a plan, realistic expectations and support from your Women’s Health care provider can make the transition to support your body with your own hormones for a monthly menstrual cycle much smoother and can be a positive life decision.
So, what does having a plan look like?
Living with the seasons of your cycle with a natural cyclical fluctuation of hormones supports you to learn and connect to your body and is a wonderful gift you can give yourself. Coming off the pill can be compared with seeing the world in brighter colours or feeling like yourself again as your body becomes familiar with an increase in its own hormones including Follicular Stimulating hormone, Luteinizing hormone, Oestrogen and Progesterone.
However, due to the Pill being a medication, it can be expected to experience withdrawal symptoms depending on the individual and their menstrual health history prior to beginning the OCP. By preparing for coming off the Pill can make the transition easier to know what to expect when waiting for your period to return.
3 tips for building a plan for coming off the Pill:
1. Consider the timing of coming off the Pill
I always recommend considering the timing with your current life commitments when considering coming off the Pill. A busy period of time with social activities, a new role at work, during exam time or travelling is not the ideal time to come off the Pill.
I recommend planning a three-month window of time that you predict is going to be slower such as university holidays, or the winter season if this is generally a slower pace for you or where you can predict less external pressures and stress to give you the space to adjust to working with your hormones as we support Ovulation to begin and a regular menstrual bleed.
2. Build your healthcare team around you prior to coming off the Pill
This has to be the most important tip of the three. By building a healthcare team around you that is trained in Women’s Health will be a great support for you by helping you to prepare for coming off the Pill, knowing what to expect for you as an individual by investigating your menstrual history and having an informed choice about appropriate contraception options or, establishing a conception plan.
Considering your menstrual history prior to coming off the OCP, your healthcare team will be able to guide and educate you each step of the way and provide ways on how to prepare for coming off the Pill. This is particularly important for women who experienced painful periods and/or Endometriosis or irregular periods as unfortunately these symptoms have not disappeared, rather a ‘bandaid’ temporary solution has been provided for the period of time the Pill has been taken and further investigation and establishing an alternative management plan may be required.
I recommend discussing with your healthcare provider, that you want to prepare for coming off the Pill and request having a blood test within 6 months prior to coming off the Pill. Long-term pill use can have a significant impact on nutritional status and the absorption of key nutrients and we can check a large number of these through a blood test to check for micronutrient deficiencies such as Iron and Vitamin D. By supporting these levels prior to coming off the Pill will prepare and support your hormonal health as your body begins to adjust to relying on her own hormones again.
Supplementation should also be discussed and individually tailored for the individual based on their health history, blood test results and duration of taking the OCP. Supporting the body prior to coming off the Pill can help give the body a headstart by re-establishing levels that have been affected through long-term use including Magnesium and Zinc to reduce the severity of hormonal imbalances, minimising the intensity and frequency of some of the expected side effects of coming off the Pill and supporting efficient Ovulation for a regular period to return
I would highly recommend that all supplementation is prescribed to you rather than self-prescribing again with the focus that treatment needs to be individually tailored and each woman’s hormonal imbalance can be completely different.
3. Reconnect with your body by downloading an app
During the time of taking the OCP, it is likely to become hormonally disconnected from your body due to experiencing a predictable, synthetic bleed each month which is different to a hormonal, menstrual bleed.
By beginning to track your current symptoms such as the amount, colour and length of the bleed as well as any symptoms such as bloating, headaches, premenstrual tension and skin breakouts whilst on the OCP gives you a headstart to learning to reconnect with the body once coming off the OCP.
This also gives your healthcare provider helpful data to support you as you come off the OCP and allows insight into the nature of how your periods return.
I recommend using an app where you know your data will be protected such as the Clue app
What are realistic expectations for coming off the pill? Will my period arrive in 28 days?
Realistic expectations for coming off the Pill can look different for each individual. Factors that can affect how the body responds to coming off the OCP include the length of time the pill, lifestyle factors such as diet, smoking and alcohol intake as well as menstrual health history.
Once coming off the Pill, it is expected to feel better overall. From increased energy, improvement in mood (particularly around Ovulation!) and increased sexual desire by working with your hormones.
It is possible to finish taking the Pill and to begin a regular cycle the next month although I recommend for patients to expect 3-6 months until you can expect to feel these improvements in the body as well as the hormonal changes before the period becomes regular again.
Patience can help throughout this time by understanding what the body is required to go through to regulate the return of the menstrual cycle. This significant requirement of energy involves the body turning its own hormones back ‘on’ like a light switch by activating the hypothalamic-ovarian axis. Whilst on the Pill, that has been turned off and needs to be reconnected. This can take time for the body to adjust to the increased demand on hormonal production to support Ovulation and can take up to a year to begin ovulating again.
Rather than the menstrual bleed, Ovulation is the main event of the cycle. The focus for regular menstrual bleeding returning is in fact Ovulation which is ideally between D10 – D21. A regular menstrual bleed will begin roughly 14 days post Ovulation. You can learn more about Menstrual Cycle education here – What Happens in your Menstrual Cycle?
Realistic expectation also comes with symptoms that are not as welcome such as post-pill acne, Premenstrual Syndrome or amenorrhea which is defined as no menstrual bleed for over three months. These symptoms can be temporary as your body adjusts and can peak as far as 6 months after coming off the Pill. These are not symptoms that you need to deal with alone and there is support available to reduce these symptoms as your body transitions to coming off the Pill.
Remember, if you were experiencing symptoms prior to beginning the Pill then it is likely that they will return. There are other options on ways to manage these symptoms to improve your quality of life and this is why having a healthcare team who are trained in Women’s Health is vital.
How can Traditional Chinese Medicine and Acupuncture support a smooth transition of the pill?
In Traditional Chinese Medicine, the Pill is viewed as turning off the flow of Qi and Blood to the Bao Mai Channel and making the Ovaries go to ‘sleep’. Traditional Chinese Medicine and Acupuncture support creating a smoother transition when coming off the Pill by supporting efficient Ovulation and a healthy, regular menstrual cycle between 28- 35 days. The treatment focus is on regulating the Hypothalamic Ovarian Axis, opening the Bao Mai Channel and building Qi and Blood flow to support efficient Ovulation, blood flow to the Uterus, calming the central nervous system and encouraging a healthy, regular menstrual flow.
When coming off the Pill, treatment including Acupuncture, Chinese Herbal Medicine, Supplementation to support micronutrient deficiencies from blood tests and Chinese Dietary therapy involves waking up the Ovaries again to support the Hypothalamic Ovarian Axis to support Ovulation, a regular cycle and to reduce post-pill symptoms.
My treatment approach differs depending on the patient although we begin all the way when the patient experiences menarche (first bleed) prior to beginning the Oral Contraceptive Pill. Consultation involves investigating the reasons why the prescription of the OCP began and how the patient has looked after their emotional and physical body over the period of time also.
Planning the timing and dose of Acupuncture once coming off the OCP is imperative to treatment outcomes and I recommend beginning treatment a minimum of one month prior to coming off the Pill to prepare the body and mind, investigate the patient’s menstrual health prior to coming off the OCP and we, together can managing the transition period. Once coming off the OCP, I recommend treatment weekly for four weeks and then reduce treatment to fortnightly to support Ovulation and the cycle. Acupuncture treatment will differ depending on which phase the patient is currently in of their menstrual cycle and what associated symptoms they are experiencing.
What is the timeline of treatment?
I recommend patients give themselves 6 months to one year to expect their hormones and menstrual cycle to return regularly and to give themselves this time to get to know their hormones and how they respond to each stage of their cycle. Through education, we discuss living with the seasons of the cycle and scheduling life around their cycle to optimise their quality of life over the month. For patients who are coming off the OCP with the intention of being open to conceiving, I also recommend giving themselves a minimum of 3 months, but ideally a year of time after coming off the Pill to support their body for preconception care.
Coming off the Pill is a unique experience for each individual and can be an unknown and overwhelming time. With the right healthcare team around you and education, this experience in fact, can be truly one of the most empowering choices in life by reconnecting with your body and using your hormones to support you in each stage of the cycle.
Recommended education resources:
Podcasts:
You can learn more here about living with the seasons of the cycle – Integrating Chinese Medicine Podcast, Understanding the Seasons of the Menstrual Cycle
Where did my period go? All about Amenorrhea Part One & Two
Books:
The Period Repair Manual by Lara Briden
The Essential Art of Preparing for Pregnancy by Heng Ou
Video:
New York Times: ‘How birth control made me four different people’
