It’s an all-too-familiar story: a young woman with an irregular cycle goes to the doctor and ends up being recommended, if not pressured, to start taking hormonal birth control as a treatment. Doctors often advise girls and young women to take the Pill indefinitely. They tell the women to simply stop when they want to get pregnant. It’s seen as a win-win: a woman gets symptom relief while she stays on the Pill, and because the body typically eliminates the synthetic hormones from its system within a few days, she’s led to believe that there will be no long-term effects from taking the Pill. But when the topic of “post-pill amenorrhea” is searched online 1,600 times per month, the data suggest the transition off birth control may not be so smooth after all. How can you, or someone you know, treat post-pill amenorrhea? Read on.
What is post-pill amenorrhea?
The main symptom of post-pill is the failure to resume menstruation within three or six months after discontinuation of oral contraceptives, depending on which resource you consult. The condition remains loosely defined in large part because it is not recognized as an “official” medical diagnosis—more on that later. Mayo Clinic sums up post-pill amenorrhea plainly: “The pill prevents your body from making hormones involved in ovulation and menstruation. When you stop taking the pill, it can take some time for your body to start producing these hormones again.” (Importantly, menstruation cannot occur without ovulation–which is the true “main event” of the cycle.)
Post birth control syndrome
As the post-Pill woman’s body readjusts to the absence of synthetic hormones, amenorrhea is only one symptom out of many that, as a whole, are referred to as post birth control syndrome. Dr. Jolene Brighten, a well-known naturopath, laments that many women who experience everything from missing periods to anxiety to acne “are told there is no relationship to birth control, and this is just their new normal.”
So, how common is post-pill amenorrhea really?
Anecdotally, post birth control syndrome seems to be nearly universal. Nearly all women experience some effects, whether short- or long-term, when transitioning off birth control. The reasons why are not well-understood. Various theories center on what we know about the Pill’s systemic effects on the body. It depletes key nutrients in the body. It negatively effects the gut and the brain. And it impacts other bodily systems like the immune and cardiovascular systems.
When it comes to post-pill amenorrhea specifically, an estimated 3-6% of women (according to Dr. Jolene Brighten, citing a 1974 research study whose abstract is not publicly available through the National Institute of Health’s PubMed site) may not get their period back within three months after coming off the Pill [1]. Not unexpectedly, women with a history of irregular periods are more likely to experience a significant delay in the return of ovulation. This is despite the persistent belief that the Pill can be used to “regulate” the cycle.
How can such small risk percentages translate to so many affected women?
As another old study pointed out (showing just how long post-pill amenorrhea has been a problem), the percentage of birth control users who experience post-pill amenorrhea is relatively small [2]. But when millions of women worldwide take birth control, even a small percentage still means a large number of women are impacted. Ironically, the authors of this study seemed to use the staggering statistics about hormonal birth control usage to actually downplay the issue. They made it out to be nothing but a numbers game. “Persistent amenorrhea … would not be a major problem except for the fact that an estimated 50 million women worldwide use [oral contraceptives].”
It’s worth noting that this particular study dates back to 1979, and it only addresses oral contraceptive use. In the four decades following its publication, the number of worldwide users of the Pill tripled to 151 million in 2019. Plus, many more women now use alternative forms of hormonal contraception, such as IUDs, arm implants, patches, shots, and more. While I’m focusing this particular article on post-pill amenorrhea, it bears mentioning that other types of contraceptives also lead to missing periods. Over 400 million women worldwide use some form of hormonal birth control, including oral contraceptives, IUDs, implants, and injectables. So, this is an issue relevant to 21% of all women of reproductive age across the globe.
An underacknowledged issue
Wondering why the research I’ve cited is so old? This case report of an obese woman who utilized traditional Korean medicine treatment for post-pill amenorrhea is from 2019 [3]. But the next most “recent” study appears to date back to 1987 [4]. Why is that?
Why post-pill amenorrhea isn’t a medical diagnosis
As previously mentioned, post-pill amenorrhea is not an officially-recognized medical diagnosis. It’s true that the failure of menstrual cycles to resume may be due to a different underlying medical reason. Any symptoms experienced after getting off the Pill are often assumed to be simply the return of symptoms of the underlying condition. Healthcare providers often don’t consider them evidence of ‘post-Pill syndrome’ or post birth control syndrome. As one doctor holding this viewpoint describes, “Within a week, most of [the synthetic hormones from hormonal birth control] have left the system and you’re back to your baseline… And your baseline might be that you don’t have regular periods or you don’t have periods at all, or you do have problems with acne.”
It’s not normal to not have your period
Whether post-pill amenorrhea is due to an underlying condition or to lingering effects of Pill use arguably remains an open question. But women should not be gaslighted into believing that the reproductive symptoms they are experiencing are just their “natural state.” Nor should they be told, implicitly or explicitly, that the only way they can live free of such symptoms is by taking a drug which only further disrupts their body’s hormonal and reproductive health. The reality is that hormonal birth control doesn’t fix underlying health problems. And it cannot “regulate” the cycle.
After all, while stopping birth control may or may not cause periods to go missing, using birth control definitely does. For a woman experiencing post-pill amenorrhea, for whom birth control masked an ongoing problem, what shows up as a lack of periods when she isn’t on the Pill likely points to an underlying problem that was always there. In other words, post-pill amenorrhea is a possible indication that a woman’s body might not have ovulated regularly on its own prior to Pill use. But it’s definite proof that, rather than addressing the issue with ovulation at its source, the Pill only ensured that she didn’t ovulate at all.
How do you treat post-pill amenorrhea?
What’s the good news for women who wonder how to treat post-pill amenorrhea or other symptoms of post birth control syndrome? Healthcare providers trained in restorative reproductive medicine (RRM) can help women actually get to the root cause(s) of the problems for which hormonal birth control is often prescribed. Even better, RRM-trained healthcare providers may also be able to help them restore their hormonal health after years of birth control use.
Through fertility awareness method cycle charting, women learn to recognize the signs and biomarkers of their own bodies. They can then understand their natural cycle and what’s normal for them—and what’s not. This is why the woman’s cycle can be referred to as the “fifth vital sign”!
Charting helps women pinpoint symptoms when they arise in relation to the timing of their cycles. Then they can work with RRM-trained healthcare providers to address many of the most common reproductive issues. These include irregular cycles, endometriosis pain, migraines, menstrual cramps, and acne.
Unlike hormonal birth control, fertility awareness methods can unlock solutions that don’t suppress the body’s natural hormones–or ovulation. This puts the power in women’s hands to understand, support, and restore their own reproductive and hormonal health.
References:
[1] Buttram, V C Jr et al. “Post “pill” amenorrhoea.” International journal of fertility vol. 19,1 (1974): 37-44. [2] Molitch, M E, and S Reichlin. “Management of post-pill amenorrhea.” Drug therapy vol. 9,9 (1979): 93-102. [3] Hwang, Ji Hye. “Treatment of postpill amenorrhea with abdominal obesity by traditional Korean medicine treatment focused on pharmacopuncture and moxibustion: A case report.” Medicine vol. 98,35 (2019): e16996. doi:10.1097/MD.0000000000016996 [4] Said, S et al. “Ovarian morphology and histopathology in post pill amenorrhea.” Asia-Oceania journal of obstetrics and gynaecology vol. 13,1 (1987): 15-9. doi:10.1111/j.1447-0756.1987.tb00002.xAdditional Reading:
Lisa Hendrickson-Jack explains how normal menstrual cycles are “the fifth vital sign”
FAM Basics: Your natural cycle vs. your cycle on the Pill
Worried about acne returning after getting off the Pill? Read this.
What every woman getting off the Pill needs to know before trying to have a baby
