Post-pill PCOS happens when you had regular cycles before the pill (or another form of hormonal birth control), but they become irregular or vanish altogether once you stop taking it. In an article last week, I talked about the three main types of PCOS. The women who fall into one of those three categories have one thing in common: their problems did NOT come up as a result of using the contraceptive pill. They may have been told to use it to manage their symptoms and “regulate” their period. But their amenorrhea or irregular cycles are not caused by the pill.
There is, however, the not uncommon category of women, who start experiencing PCOS-like symptoms, or even secondary amenorrhea after they stop hormonal birth control. They quit the pill and they realize their period does not return. Or it returns for a month or two only to vanish off completely. This is part of something called post-birth control syndrome (PBCS).
I have post-pill PCOS. Now what?
First of all, don’t panic. If you’re not trying to get pregnant and go to your doctor, you might be told to get back on the pill. Please don’t! That is not a cure and the amenorrhea will still be there when you stop again. You have to realize that the pill works by stopping ovulation altogether. The bleed you see monthly is simply a withdraw bleed, not a real menstrual period. Real menstruation requires ovulation. The pill also basically stops the communication between your pituitary gland and the ovaries. Sometimes, after being “on pause” for a while, your body can’t get back into its normal rhythm. You need to also remember that for about 40% of women, the first cycle post-pill is anovulatory!
There are two situations for post-pill amenorrhea: one, where the symptoms and blood work looks similar to that of hypothalamic amenorrhea. Specifically, your LH, FSH, and estrogen will be low and there will be no sign your ovaries are producing any follicles even six months after stopping the pill. The second and slightly more common situation is post-pill PCOS. Here, LH:FSH ratio will be high, as it is with PCOS in general, there will be follicles on the ovaries (that most will qualify as a polycystic aspect). You might even have some elevated androgens. However, the difference from other PCOS types is that your periods were regular BEFORE the pill.
Check for hidden causes
If you’ve been on hormonal birth control for many years, there’s a chance you’ve developed a condition in the meantime. For instance, if you’ve been constantly undereating or working out too much, it’s possible to have actually developed hypothalamic amenorrhea. Since you were on the pill, you did not realize your body does not want to ovulate anymore, due to all the stress it’s being put through. But once you stop the pill, you start seeing the symptoms. If you believe you might be in this category, you might want to talk to a nutritionist or a functional doctor who will check your diet and lifestyle and see if there’s anything that might be causing an imbalance.
On the other end, you might have actually developed insulin resistance during the years of taking the pill. If a slight issue existed even before, but it was too small to give symptoms at the time, it may have worsened over the years. If you feel you have symptoms of insulin resistance, such as excess weight, inability to lose weight, or weight that piles around your waist, definitely get it checked.
Don’t forget about the thyroid. There have been studies linking thyroid issues to extended use of hormonal birth control. So try to request a full thyroid panel (NOT just TSH) to check for any issues.
In short, regular ovulation is a sign of health. Since you didn’t have on while on the pill, it is possible that a health issue began during that time and you did not realize it.
Don’t go back on hormonal birth control
If you don’t want to get pregnant right away, many doctors will tell you to go back on the pill (or another form of hormonal birth control) to “regulate” your periods. DON’T DO IT! Like I said a million times, birth control stops ovulation and the monthly bleed is simply a withdraw bleed, not a real period. If your problems are only post-pill and you ruled out hidden causes, it means your best option is to be patient. Depending on the type of contraceptive you were on, the side effects coming off might be worse. Yasmin (or Yaz) is one of the worst one as women usually experience a big androgen surge when coming off (think hair loss, hirsutism, acne, anovulation).
Treatment options for post-pill PCOS
Licorice and white peony are two supplements that are amazing for post-pill PCOS. If you have high LH, stay away from Vitex, as it will only worsen your symptoms. Make sure you reduce stress as much as possible, exercise regularly (but not too intense as that can stop you from ovulating as well). Eating a healthy, balanced diet, where you get enough calories from the right sources is essential. For more information, check out this great article by the PCOS Diva.
As always, if you like this article, please share it and help inform women about their health. If you experienced post-pill PCOS, leave a comment below and tell us how you’re treating it and how long it took to get your period back.