How to Transition off of Birth Control
My Hormone Health Journey - Part 2
In part 1 we established the side effects that are common with BCPs and the ones I experienced myself as well as what it looked like from a lab testing perspective. In this section I'm going to walk you through the steps that I took to help recover and balance my hormones. After months or years of BCP use we've got some repairing to do. The main components are to cultivate a balanced, nutrient-dense diet, support our gut health so we can absorb nutrients better and excrete toxins and accumulated synthetic hormones efficiently, replete any deficiencies, support liver detoxification and add in any cycle-regulating herbal support, if needed.
DISCLAIMER: I am not a medical doctor. This post is not intended to replace the advice from your physician. Though many women experience similar effects of hormonal contraceptives, there are also many women who never experience these things (you lucky ducks!).
Step 1: Nutrient Dense Diet
This has to be the starting place. You can add vitamin and mineral supplements and herbal support all you'd like, but if the foundational diet isn't strong you won't reap the same benefits. The best way to get into a nutrient dense diet is to focus on food quality: minimal ingredients and minimal processing. You should be able to identify where a food came from (i.e. an apple came from a tree vs. a 100-calorie pack of cookies comes from....who knows). A wide variety of colorful fruits and veggies ensures you get the full spectrum of vitamins, minerals and phytochemicals that plant foods have to offer. Aim to mix and match cooked and raw sources for best nutrient absorption. You should also focus on high quality protein which almost always means organic. After months or years of being exposed to synthetic hormones from BCPs, the last thing we want to do is eat meats chock full of hormones and antibiotics - organic (and preferably grass-fed) meats are free of these additives and boast a more favorable fatty acid balance than the conventional counterparts. Real, anti-inflammatory fats are nourishing and help our body create its own hormones again. In general aim for 1/3 of your plate from colorful veggies, 1/3 from high quality protein, 1/3 from real carbs like fruits/starchy veggies/gluten-free grains and utilize healthy fats to flavor or cook your food.
Step 2: Focus on Gut health
In addition to a nutrient dense, unrefined diet listed above there are several other things you can do to take care of your gut. Restoring beneficial gut bacteria is super important. You can accomplish this with a probiotic and adding in fermented foods like yogurt, kefir, kimchi, saurkraut and kombucha on a regular basis. Getting the right bacteria in the gut is part 1, the next part involves feeding those bugs so they can thrive! This is where fiber comes in: a wide variety of plant foods is a great way to provide prebiotics (or food for the bacteria). There is promising research on resistant starch (basically a starch that avoids digestion and thus makes it to your colon relatively intact) as a great way to promote optimal gut health, you can accomplish this with cooked and cooled potato or rice (easy to do if you meal prep!) or through slightly unripe bananas or a product like green banana flour. In addition to feeding the gut bugs, fiber also helps to bind with and excrete toxins like synthetic estrogens that have accumulated over time. A good goal to aim for is around 35-45g every day. Not sure where you're falling? Track a day or two in My Fitness Pal to take a look - you may be surprised how short you're falling in this category (I know I was) especially if you follow a relatively low-carb approach. If that's the case you can either gradually increase your carb intake to boost fiber or you can try adding in a fiber supplement (my favorite is FiberMend by Thorne).
Step 3: Replete Deficiencies
Even in the absence of testing, it is pretty safe to assume you are deficient in at least the B-complex, magnesium, zinc, vitamin C and E based on the research. This is where high quality supplementation can be very beneficial since repleting deficiencies from food alone would be a very slow, sometimes impossible process. In addition to the core foundation of a multi and a b-complex, I added in extra zinc, magnesium and vitamin C based on the results of my lab testing. Interestingly enough, vitamin C helps boost progesterone levels and zinc helps improve testosterone - two things I needed to work on anyways! I totally nerd out over things like this; connecting the dots between symptoms and hormonal imbalances with deficiencies of key vitamins and minerals used to build them is seriously so fun (I realize I'm probably alone in that. Further proof I'm in the right field!).
It is also important to ensure adequate essential fatty acid levels because we use them to build hormones and reduce inflammation in the body. Essential fatty acids are fatty acids that we don't make within our body and therefore it is essential to get them in the diet. You can absolutely focus on dietary sources but I've found the easiest way to get adequate levels is to supplement with a high quality fish oil that provides EPA and DHA and, depending on your specific needs, consider adding in an omega-6 fatty acid like GLA (gamma linoleic acid).
Step 4: Support your liver
I've gotta start this section with a quick little RD rant here: don't be fooled by the millions of "detox" teas/juices/cleanses/etc that flood the internet. Our body is equipped with a damn good detoxification ability that is largely completed by our liver. The ONLY "detox" that is actually worth your while is something that supports the liver's natural ability to remove toxins from the body. Anything other than that is a shameless ploy to take your money. End rant. Our liver works hard day in and day out to process harmful compounds like chemicals/toxins/hormones/medications/alchocol while also completing a plethora of other vital processes that keep us healthy. Over time of flooding the system with synthetic hormones from BCPs, sometimes the liver gets bogged down and just needs a little TLC. Your first line of defense here is to increase the amount of cruciferous veggies in your diet: broccoli, cauliflower, cabbage, kale, brussels sprouts. These veggies contain a compound called sulphoraphane glucosinolate (SGS, for short) that is amazing at improving detoxifcation pathways in the liver. (Note: if you've got thyroid issues, aim to eat your cruciferous veggies cooked instead of raw). You can also add in specific supplemental support for the liver that is packed with vitamins, minerals and detox specific nutrients like SGS, alpha lipoic acid, green tea extract and curcumin (from turmeric). My go-to for this is Estrofactors by Metagenics. Should you find you need even more hormone-detoxing support, other options would be Indole-3-Carbonol or Diindolmethane (DIM) - I would strongly recommend working with a practitioner or, at the very least, doing a little more reading (resources below) before experimenting with these. And, just to emphasize the importance again, we've gotta increase fiber and water if we are increasing liver detoxification so that the toxins/hormones released have something to bind to to exit the body.
Step 5: Reduce Stress
Arguably, this could have been step #1 because it is SUCH a significant step toward normalizing hormone levels. When we have chronic stress, that means we are producing abnormal (too high/too low/or both) levels of the stress hormone cortisol. In small doses, cortisol helps to boost energy and prepare us to deal with the stress at hand; however, long term exposure leads to things like midsection weight gain, poor sleep/circadian rhythm issues, and a bunch of hormonal imbalances. Without getting too technical here, cortisol can be thought of as a greedy hormone in the body, stealing up all of the resources we have to make all of our hormones. This means that if we are overproducing cortisol, there aren't enough raw materials left in the body to make our other, extremely important hormones like progesterone, DHEA, estrogen and testosterone. It is for that reason that we can't possibly expect to balance hormones if our stress response is out of control. No doubt I will have a post on this topic alone in the near future, but some of the best, science-backed things you can start trying right away include: meditation (check out the Head Space app - it's my fave), yoga, deep breathing exercises and journaling. I was very resistant to trying these techniques because I can't quiet my mind for the life of me (which is why I prefer a guided meditation like Head Space) and journaling seemed silly but I assure you if you make a point to add in these mindful practices, you will learn to love them! Another major change I made was to reduce my caffeine intake (still crying over this!) While working and completing my MS, I developed a VERY high intake of coffee that put a lot of unnecessary stress on my adrenal glands. It was in the back of my mind for a while to try to reduce it (you would think the heart palpitations would be motivation enough but, #coffee) but I put it off until I was all out of things to try. Reducing my intake to 1 real cup of coffee a day and even several days a week just having decaf had a profound impact. I felt less anxious and jittery (didn't even realize how anxious I was previously), I had more stable energy all day and I slept much deeper at night.
Aside from these techniques, adequate B-vitamins, vitamin C and omega 3 fatty acids are very helpful in bolstering our stress response. There are also a handful of supplements called "adrenal adaptogens" that can be very, very potent stress-reducers but I would recommend doing more research (below) or working with a practitioner to determine which route would make the most sense for you.
Step 6: Herbal Support
The primary goal in recovering from hormonal BCPs is to get our body to ovulate on a consistent basis. When we do, our hormones are produced at optimal levels helping us look and feel our best. Sometimes regaining ovulation occurs simply by following the steps listed above: solid diet, gut health, managing stress and reversing any deficiencies we've formed over the years. However, for some women (myself included) this is not enough. One of the main reasons it is difficult to regulate your cycle post-BCP is due to very low progesterone levels (the pill brings this process to a complete halt). The herbal extract Vitex (also known as Chaste Tree or Chaste Berry) is designed to promote ovulation and healthy progesterone levels. This herb is widely used and well studied but you need to be choosy about the brand you pick, how you dose it and how long you use it - all things that can be alleviated if you work with a professional. For me, I used Chaste Tree from Pure Encapsulations (pharmaceutical grade, so I know it is pure and potent) at 500 mg for about 6 months. I would take a 5 day break from it each cycle. This worked wonders for me! It boosted my progesterone levels which improved my mood, my sleep and my energy levels and it helped regulate my cycles. Another common herb used for hormone balance is Maca root. I haven't used this one regularly enough to have a valid opinion on it but I have had some clients use it with mixed results - some loved it and some did not. From a purely observational standpoint, it seems that if you battle with low estrogen levels Maca can be very helpful but if you have high levels of estrogen, this isn't the route for you.
What worked for me:
Nutrient dense diet (obviously)
Stress reduction: changed up my workout routine, prioritized sleep, practiced guided meditation/deep breathing, journaling exercises
Reduced caffeine intake
Higher carb intake (very low carb did more harm than good for me. more on that here)
Core support: Multi, Magnesium glycinate (300mg/day), B-complex (Thorne B-complex #6 for the higher dose of B6)
To boost progesterone: Vitamin C 1,000mg/day
To boost testosterone: Zinc 30mg/day
Essential fatty acids (essential for reducing inflammation and building hormones): Fish oil (3-4g/day), GLA (240mg/day)
Liver support: plenty of cruciferous veggies, lots of fiber and Estrofactors
Herbal support: Vitex (chaste tree) - taken for 6 months
Great reads for more info:
The (baby) elephant in the room: what in the world to do about birth control??
Without a doubt one of the scariest things about going off BCPs is the fear of no birth control, in fact, many of you reached out to me after Part 1 to ask this question. As much as I am 'team: no synthetic hormones', I am also a proud member of 'team: no accidental babies'. One technically non-hormonal option would be the copper IUD; though I don't know enough about these yet to be able to decide if that's a viable option but I can't say I'm crazy about the idea. The other option involves fertility awareness so you can plan for (or be extra careful) during the 5 or 6 fertile days each month. Isn't that crazy, we legitimately can only become pregnant 5 or 6 days out of the entire month?? Knowing when those days are and planning accordingly sounds like the ultimate freedom from BCPs to me.
Fertility Awareness: one of the most empowering things we can do as women is to be in-tune with our bodies and have an understanding of where we are at in our cycles all the time. The normal ups and downs of hormones throughout the month contribute to changes in the way we think/sleep/move/etc. The beauty of awareness of where we are in the cycle is that we know when we are fertile (so we can be extra careful) but we also know what's going on with our hormonal fluctuations that can explain things like mood, energy, motivation, sleep, creativity and even body composition. It goes without saying that in order to practice 'fertility awareness' you have to be ovulating on a regular and predictable basis (if that's not the case for you yet, keep working it, it takes time).
Once you are ovulating regularly, it takes tracking body temperatures and noticing the symptoms that indicate your fertile days. I don't know about you, but that sounds like a lot of work and I'd be lying if I said I liked the idea of leaving 100% of the pregnancy-prevention responsibility on my ability to accurately track my cycle. Fortunately, I came across a company called Daysy when listening to a few podcasts and I'm going to be testing out their fertility calculator that aims to take the guess work out of fertility awareness. I'll be writing a post all about it after I've tested it out for myself so stay tuned, I hope I love it and am able to recommend it to all of you! In the mean time, if you want to read more about them, click here. (affiliate link disclaimer: If you purchase through this link, it allows me to make a small kickback.)
Whew! That was a long one. I hope it was helpful! I'd love to hear about your own experiences, questions or topics that you'd like to hear more about. Thanks so much for reading!