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.
PCOS is serious for many. We struggled a bit with our second. I had to come off birth control due to the development of severe migraines that they attributed to the surge of hormones in my body from the pills. Once I got that regulated many of my headaches went away.
Wow, I never knew such a thing exists. My partner and I have spoken about trying for a baby sometime in the future. I have a lot of concerns about it, as I had my firstborn via c-section. Now I’ve got to watch out for PCOS. Thank you for sharing.
Diet is so commonly overlooked with health issues, especially female health issues!! I’m glad you have that listed in your article. A major source of issues is actually from soy — I am not scientist but it can mess with hormone levels heavily.
This is fascinating! I am embarrassed to admit, that I really didn’t have a clue about any of this! I always knew that Birth Control Pills couldn’t be great for a girl, but now I understand why. I’ve had my tubes tied for almost 10 years now so I don’t really have to worry about it anymore but I remember that when I was in my teens I went on the depo shot and that gave me all kinds of issues when I went off of it! Thanks for sharing such an informed article, I am looking forward to reading more!
Thank you for sharing about Post-Pill PCOS, I found it very informative. I don’t have any personal experience with PCOS, however, my daughter has.
Excellent information, thank you. PCOS is a nasty problem for many women and in my experience many doctors know little about it.
This was very informative! As i used to take pills to regulate my periods. I did not know that post pill pcos is also a thing. My periods have always been weird 😅 I’ll have to keep records to check for the symptoms.
I didn’t even know post pill PCOS was a thing! I’ve learned something today. I’ve heard plenty of women say they are on the pill to regulate a period or even other things related to it, when they don’t need to be. They aren’t sexually active, don’t have periods due to eating disorders, and a host of other things that don’t really seem related or necessary. Your post certainly opened my eyes to this issue! I’m so glad because it is something more women need to know about.
It’s really good that you share your knowledge with people so that if they need medical help they can obtain it right away. I am so happy we live in this digital age where we can get a wealth of information right at our fingertips. I am really unfamiliar with what exactly PCOS is and never was on birth control so this was never a concern. But apparently, it is for a lot of people. Thanks for doing the research and sharing it!
That is such an important post! Pills are the most common way of contraception so it’s very important to know the goods and the bads of it esp when ending it
This is such an informative post and I wished more and more women read this. Self medication without knowing the pros and cons at times could be damaging.
This is a great source of information. I didn’t know that there was a difference in thyroid tests–that’s really good to know!