The combined oral contraceptive pill (the Pill) is a combination of oestrogen and progestogen similar to our own ovarian hormones. They create an artificial cycle that looks like real 28-day menstrual cycle.

In this Pill-cycle though, the hormones we take and the dosages we take them at, work to suppress ovulation and thicken cervical mucus which prevents sperm traveling through the cervix. The ‘period’ we experience is when we take the non-active pills, giving us a hormonal break. Note this is not a true menstrual cycle or period, because no ovulation occurred - hence my terms ‘Pill-cycle’ and ‘period’.

What changes might you experience after coming off the Pill?

It seems obvious…of course women are going on the Pill for contraceptive purposes!

But…women might also choose the Pill, or have it recommended to them by their GP’s, to assist with managing polycystic ovarian syndrome (PCOS), irregular periods, heavy or unpredictable bleeding or spotting, hormonal migraines, period pain, endometriosis, acne, premenstrual syndrome. For these women the artificial Pill-cycle provides a welcome break from uncomfortable symptoms.

It stands to reason and is important to know, that once you stop the Pill those original underlying conditions or symptoms are still lying in wait and will very likely rear up again, and this is a change from Pill-cycles that many women experience. I commonly see in practice that in addition to women getting ready to conceive when they come off the Pill, they also need assistance with managing underlying hormonal imbalance.

Another change you’ll experience when coming off the Pill is getting to know your natural cycle and period again.

For a start, on the Pill, you know exactly when your period will begin. But when you come off the Pill and as your own hormones kick in again, there’ll be some uncertainty as to when to expect your period and how regular your menstrual cycle will be. You’ll get a ‘withdrawal’ bleed once you stop the Pill, and then you’ll be waiting for your own cycle to re-establish itself again, which may take some time (more on that later).

On the Pill, you’re taking a regular and measured dose of hormones every day. However the rhythm of a natural cycle is different, with changing amounts of oestrogen and progesterone being secreted on a daily basis as you move from menstruation through to ovulation, and then through to your next period again (or conception!). And our body responds to these changing hormone levels in ways that you can see and feel.

When you come off the Pill, you might notice that the period itself is different - it will usually be a bit heavier and last a bit longer than on the Pill.

You’ll also notice a change in your cervical mucus. As you approach ovulation, you’ll notice your cervical mucus become more profuse. You might also notice it changes from thick or dry mucus, to more thin, wet and stretchy mucus. This is a sign that your body is approaching ovulation. After ovulation you’ll probably notice your mucus dries up again.

And off the Pill, you might also notice an increase in some premenstrual symptoms like breast tenderness, fluid retention, mood changes and changes to appetite and food cravings (although these may be side effects of some Pills).

Is there anything you can do to reduce the severity of symptoms after coming off the Pill?

Specific symptoms will require specific and tailored treatment, but you can’t go wrong with going back to basics - eat well, play well, relax well.

Diet

A balanced and nutritious diet is a starting point for balanced hormones.

Eating protein regularly with any carbohydrates helps keep blood sugar levels stable and ovulation regular, which can be an issue particularly for women with PCOS - think lentils, legumes, nuts, seeds, eggs, dairy, meat, fish.

A good dietary intake of fibre helps create a diverse gut microbiome, assisting with oestrogen metabolism, and also improving oestrogen clearance from the bowel - choose a wholefood diet including lots of vegies, lentils, legumes, plus fruit and wholegrains.

The essential fatty acids in fish reduce inflammation (such as that with endometriosis), and reducing saturated and trans fats in favour of more healthful mono- and polyunsaturated fats (in extra virgin olive oil, nuts, seeds, avocado) can make a difference with period pain too.

Exercise

Regular exercise is a fantastic way to manage stress, build bone density, maintain a healthy body weight and reduce cardiovascular and diabetic risk. Regular exercise has also been shown to reduce the incidence of endometriosis and the severity of PMS.

But…be mindful that over exercising can suppress the hormonal axis that regulates ovulation, causing your periods to disappear. This is more commonly seen in athletes and very lean women with low body fat.

Stress management

Stress can contribute to irregular cycles, increased PMS or period pain and, just like over-exercising, can cause menstruation to cease.

Incorporating stress management techniques and activities into your day is just as important as what you eat and how much you exercise, and should be a priority for healthful self-care. You could try exercise, meditation, yoga, colouring-in, journaling...

Enjoy the adventure of getting to know your cycle again! Lean into it. Because stressing about what your cycle should and shouldn’t  be doing can interfere with your hormonal balance.

How can naturopathy help the process?

By asking all the right questions, a naturopath can create a tailored treatment strategy specific to your needs.

You’ll be asked questions…a lot of them! And this is good, because a naturopath aims to get to the root cause of any health issue, and there’s no such thing as a one-size-fits-all approach. You'll be asked all about your current symptoms, but also about your menstrual cycle and reproductive health prior to commencing the Pill. Your naturopath will also want to know about your diet and digestion, your stress levels and your sleep habits. So get ready for lots of questions about periods and poo (two of my favourite subjects!).

After taking a comprehensive case-history, your naturopath will create a treatment plan that will likely include appropriate dietary and lifestyle interventions, and potentially herbal medicine and nutritional supplementation. Herbal and nutritional medicines offer a treasure trove of safe and effective ways to restore and nourish hormonal balance.

How long does it take the body to re-regulate after coming off the pill? 

It’s a myth that your body ‘stores’ the hormones from the Pill, or that you’re ‘toxic’ from the Pill. Once you stop the hormones are rapidly cleared from the body (which is why if you miss a day its contraceptive effect is compromised).

Having said that, each woman will have a unique experience when coming off the Pill.

Some women will immediately fall back to their previous menstrual pattern and have a regular cycle re-establish itself right away. Other women will wait up to three months for their natural cycle to kick in again. And unfortunately, others again might not have their periods return for 12 months or more (1 in 100 women) - this is known as post-pill amenorrhoea, and is most commonly seen in practice in those women who started the Pill as teenagers before their hormonal axis was mature, or in women with an underlying condition like PCOS. If you haven’t had a period after three months of stopping the Pill, see your GP for further investigations and your naturopath for treatment options.

Expect the unexpected, and know that it’s ok and normal for your body to take time to recalibrate after the pill.

How much time should you give your body before trying to become pregnant?

While the hormones from the Pill start to clear immediately, you should still give yourself some time off the Pill before trying to conceive. This is due to the nutritional deficiencies the Pill causes.

Research has regularly shown the Pill reduces folate levels. Folate (Vitamin B9) plays an important role in the early life of an embryo, preventing neural tube defects, and for this reason women are advised to start folate supplementation three months before trying to conceive. Folate also plays a role in preventing anaemia and miscarriage. 

Folate levels will return to baseline within three months of stopping the Pill - this should be considered the minimum time to give your body before conception.

Other B vitamin levels are also compromised while on the Pill, including Vitamins B2, B6 and B12. 

A good quality and specific pre-natal multi vitamin is essential when coming off the Pill as you prepare to conceive.

The Pill also reduces Zinc levels. Zinc has over 200 uses in our body and is necessary to support a regular ovulatory pattern and for fertilisation to take place - in fact, a zinc 'spark’ occurs at the moment of fertilisation. Zinc assists with hormone production and balance. In pregnancy, its deficiency is associated with low birthweight babies and premature delivery.

When contemplating how much time to give your body between the Pill and conception, also keep in mind your overall health. Do you have other health concerns that would benefit from being addressed prior to conception? Low iron levels? Thyroid issues? Weight concerns? Previous hormonal imbalances? Are you taking any medications that should be reassessed with a view to pregnancy? Give yourself the time to address these, to ultimately improve your fertility.

What should you do if you don't become pregnant after coming off the pill?

We come off the Pill because we’re super keen and ready to have our baby! But sometimes it doesn’t happen quite as quickly as we’d expected.

One in six couples have difficulty conceiving. 

• 30% of fertility issues are related to female factors

• 30% of issues are related to male factors

• 30% of the time it’s a combination of female and male concerns

• 10% of the time there’s no known cause, frustratingly known as ‘unexplained infertility‘

Provided intercourse is timed appropriately at ovulation, most women under the age of 35 will conceive within 12 months. After this it would be worth visiting your GP to do some further investigations on you and your partner.

For women over 35, pop to your GP if you haven’t conceived within six months.

Getting some further and focused investigations will ensure nothing is being missed on your way to parenthood, and will get you there sooner!

You could also look at doing some preconception healthcare. Preconception healthcare takes advantage of the time it takes for your egg cell to mature, and the time it takes for a sperm cell to be made and mature, to get you and those cells in optimal health to improve your chances of conceiving. It involves a healthy diet and lifestyle, and targeted herbs or supplements to support your fertility.

Added bonus - healthy habits during this preconception window have been shown to positively influence baby’s health (and even, believe it or not, your future grandchildren’s health!).

So, don’t panic if you aren’t conceiving as quickly as you’d expected to (remember what I was saying about stress...).

But do reach out for help. There are plenty of practitioners out there ready to be on your team - your GP, fertility specialists, acupuncturist, naturopath, nutritionist, counsellor. Look for someone with experience and, most importantly, who listens to you.

If you have any questions about coming off the Pill to conceive, or you’d like to nourish your hormones, health and fertility, please book an appointment with me to discuss.

While you’re here, you might also be interested in:

• my 90-day first. fertile. program to support your fertility

• my article Why you should consider detoxing before pregnancy

• my free meal planner to keep you on track with your healthy eating goals

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