This is a guest post by Laura Schoenfeld, a Registered Dietitian with a master’s degree in Public Health and a staff nutritionist for the Kresser Institute. You can learn more about Laura by checking out her popular blog or visiting her on Facebook.
One of the downsides of “the Pill” is that many women have a hard time getting back to normal menstrual cycles once they stop taking it. Some of my young female clients in their 20s and 30s who were taking birth control for a long time and then stopped haven’t had their periods for months, or sometimes even years!
It can be frustrating, especially for women who have stopped taking birth control, because they want to become pregnant. My clients also realize that having amenorrhea isn’t a good sign for their overall health regardless of their childbearing plans, so they have come to me to help them make the diet, supplement, exercise, and lifestyle changes they need to in order to get their periods back.
Post-birth control syndrome: 5 tips to get hormones back on track naturally.
So what can you do when your patient explains that her cycle hasn’t returned since stopping birth control? The underlying causes of post-birth control syndrome can involve nutrition deficiencies, HPA axis dysregulation, impaired liver detox, stress, and more. Fortunately, with diet and lifestyle changes, it can be possible to resume normal menstrual cycles without drugs. Read on to discover five tips on how to get your patient’s hormones back on track!
1. Optimize Micronutrient Status
As a dietitian/nutritionist, nutrition is always the number one focus in any of my health improvement plans. Women who aren’t having regular periods tend to be some of the fastest responders to a tailored nutrition and supplement program, primarily because the loss of menstruation is often a sign of underlying nutrient deficiencies. Even when eating a whole-foods, Paleo diet, many nutrients can be inadequate if a concerted effort isn’t made to include specific foods and/or supplements.
Accumulating evidence shows that oral contraceptives can deplete many nutrients in the body, including folic acid, vitamin B2 (riboflavin), vitamin B6, vitamin B12, vitamin C, vitamin E, magnesium, selenium, and zinc. (1) While there are likely dozens of nutrients that are important in regaining fertility and monthly cycles, there are a few in particular that I find to be extremely effective in helping to recover the menstrual cycle.
Zinc is a critical nutrient to consider, and many nutritionists recommend increasing zinc intake for female clients struggling with loss of menstruation following the use of the Pill. Some evidence demonstrates that women who take oral contraceptives have lower plasma zinc levels, so they may have higher need for this important mineral for fertility. (2)
Some healthcare practitioners theorize that taking oral contraception might either cause zinc deficiency or even copper overload, which could contribute to the loss of healthy menstrual function. Either way, I always include zinc as part of my recommendations for my clients with amenorrhea.
Foods with high zinc content include shellfish like oysters and clams, red meat, pumpkin seeds, and poultry, but often it can be difficult to get adequate zinc without additional supplementation, even in the context of a whole-foods diet. I usually recommend 15 to 30 mg of zinc per day for someone with post-birth control syndrome. Make sure your patients know to always take zinc with a meal to avoid sudden and intense nausea.
Magnesium is another mineral that I find beneficial for my clients with post-birth control syndrome. While many of us in the ancestral health community feel that everyone can benefit from daily magnesium supplementation, it’s especially important for those on birth control (or coming off birth control) to supplement with magnesium.
Magnesium is difficult to obtain in our modern diets due to food processing techniques and soil depletion. Some evidence shows that serum magnesium levels are reduced by oral contraceptive use (3). If your patient has a history of birth control use, I would recommend 200 to 400 mg per day of a chelated form of magnesium to supplement her food sources.
Finally, vitamin B6 is another nutrient that is not often discussed but can be very helpful in restoring menstrual function in those with post-birth control syndrome. A 2011 study found that those who used oral contraceptives had lower plasma vitamin B6 concentrations. (4) One type of amenorrhea caused by high prolactin levels was able to be treated using B6 supplementation, (5) suggesting that supplementing with B6 may be beneficial in post-birth control syndrome.
Vitamin B6 is found in a variety of foods and is generally safe to take as a supplement at doses below 100 mg per day. I like Designs for Health’s Sublingual Vitamin B6, which has the added benefit of providing a small amount of chelated zinc. At 50 mg per teaspoon, it’s a high enough dose to replenish any depleted stores, but not so much as to risk toxicity with long-term use.
There are other nutrients that I address with my clients, either making diet or supplement recommendations to address potential deficiencies in their diets. One nutrient that I find tends to be quite low in many of my young female clients’ diets is vitamin A. Encourage your patients to eat four to eight ounces of beef or lamb liver every week, which will provide plenty of vitamin A. Another important nutrient is vitamin D, which typically comes from adequate sun exposure but can be helpful as a supplement for those with blood levels below 30 ng/mL. High-quality extra virgin cod liver oil provides both vitamins A and D, along with omega-3 fatty acids.
There are many nutrients that may be negatively affected by long-term birth control use, and every person’s needs are unique. (6) Patients should be fully assessed for their individual nutrient deficiencies.
2. Entrain Circadian Rhythms
In our modern world of late-night TV, attachment to our cell phones, 24-hour artificial light, and inadequate hours of sleep, our circadian rhythms have taken a serious beating.
Following roughly a 24-hour cycle, circadian rhythms affect all endocrine hormone secretions, including melatonin, cortisol, thyroid-stimulating hormone, growth hormone, prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), insulin, leptin, and more. (7) While we don’t know how all of these hormones might contribute to healthy menstruation, we do know that prolactin, FSH, and LH are the key hormones regulating the menstrual cycle along with estrogen and progesterone.
So we can assume that if these hormones aren’t being released at the appropriate times, the reproductive system won’t be getting the proper signals that are needed to regulate the menstrual cycle. And some research does show that circadian rhythm disruption from sleep disturbances can wreak havoc on women’s reproductive function. (8, 9, 10)
There are dozens of factors that affect circadian rhythms, but I’ll just focus on the two most important: light exposure and sleep. Proper light exposure includes getting adequate daytime sunlight and appropriate elimination of bright light at night. The biggest influence is the light hitting the eyes, so tell your patients to get outside, or at least sit by a window, for most of the daylight hours. In addition, limiting blue light exposure once the sun has gone down is also important.
There are ways you can address this issue even if your patients, for whatever reason, cannot go outside during the day or shut off all the lights when the sun goes down. The first is to recommend a light therapy lamp that can help provide the right spectrum of daytime light during the day, which can be set up at a desk at work. The second is to encourage your patients to block blue light at night, and the easiest way to do this is by using these super-fashionable orange goggles. Also, you can suggest orange light bulbs as their evening lighting option.
And of course it should go without saying that sleep must be a priority. Stress to your patients how important it is to get a full eight hours of sleep every night, even if it requires significant changes in lifestyle or daily routines.
3. Ensure Enough Carb and Calorie Consumption
This is one of the most difficult recommendations for many of my clients, as frequently those dealing with post-birth control syndrome are also trying to lose weight. And more often than not, their weight loss attempt includes reducing their food intake and cutting down on carbohydrates.
While this strategy may help with short-term weight loss, it’s definitely not conducive to hormonal health to significantly limit food intake in this way. It’s a well-known phenomenon in the medical world, called the female athlete triad, where women undereat and overtrain so much that they lose their menstrual function, and even put themselves at risk for osteoporosis. (11)
Many women face hormonal imbalances if they are overly restrictive with food intake, and I’ve worked with many patients who have lost their menstrual function after switching to a low-carb Paleo diet. It’s not the Paleo diet that is the issue per se, but those who switch to Paleo often get stuck in an overly restrictive, low-carbohydrate approach that does not support healthy endocrine function through various effects on the hypothalamus–pituitary–adrenal (HPA) axis and thyroid hormone conversion.
Practitioners should evaluate how restrictive their patients’ diets are and ensure that they’re getting enough calories and carbohydrates to support their activity levels. I generally recommend at least 30 to 40 percent of calories from carbohydrate for my patients who aren’t getting their period, and I provide them an appropriate calorie range for their body size and activity levels. Estrogen and leptin are both produced by fat cells; if too much weight is lost, a woman’s body can cease ovulating because it senses the lower levels and thinks it is starving. Trying to quickly lose weight while dealing with amenorrhea is rarely a good combination.
And the other side of this issue is avoiding overtraining, which is another problem I see in many of my young female clients trying to “lean out.” As I mentioned, this overtraining and undereating combination is known as the female athlete triad and is well known as a cause of amenorrhea. Overtraining means different things to different people; what might be a normal training schedule for an elite athlete may cause burnout and hormonal disruption in a non-athlete. Start a discussion with your amenorrhea patient about her training regimen to make sure that she is not overdoing it.
4. Manage Stress
This is another big issue for many of my young female clients experiencing amenorrhea. Stress is generally unavoidable in our modern lives, but that doesn’t mean it should disrupt hormone regulation.
Chronic stress causes hypothalamic–pituitary–adrenal (HPA) axis dysregulation, which is also known as “adrenal fatigue.” Unfortunately, the hypothalamus and pituitary glands are also key regulators of the menstrual cycle. (12) Thus, chronic stress is easily able to cause irregular menstrual cycle activity and can even lead to a condition known as hypothalamic amenorrhea (13). This is very similar to what happens in the case of the female athlete triad and is typically caused by the chronic physical and/or emotional stress that is unfortunately common among young women.
For those trying to overcome post-birth control syndrome (or any type of amenorrhea, for that matter), getting stress under control is very important. This includes the recommendation above regarding eating enough and avoiding overtraining, but it also deals with managing daily stress from work, relationships, financial issues, and more.
I always help my amenorrheic clients find a stress management protocol that works for them, which can include yoga, meditation, journaling, deep breathing, and more. Anything your patients enjoy doing that helps relieve stress is a great choice and can make a big difference in returning them to normal menstrual function.
5. Boost Liver Detox Capacity
Having a strong ability to detoxify is crucial for recovering from post-birth control syndrome, as one of the primary issues with taking oral contraceptives for a long period of time is hormonal buildup. The liver is responsible for clearing these hormones through the bile, and if detox isn’t supported enough, the liver is ineffective at eliminating these excess hormones.
There are many ways to boost detox capacity—too many to get into in this article—but I’ve written another article in which I recommend that increasing intake of certain foods can support the body’s natural detoxification process and help boost hormone clearance. Another option is taking a supplement that contains a variety of nutrients and botanicals that support the body’s natural detoxification process. Liver Detoxifier and Regenerator from NOW Foods is a popular choice.
And wouldn’t you know it, the gut flora can even help detoxify excess hormones. This podcast I’ve linked to is all about the “estrobolome,” the complete set of bacterial genes that code for enzymes capable of metabolizing estrogens within the human intestine. (14) So taking a high-quality probiotic and eating fermented foods, especially fermented cruciferous vegetables like sauerkraut, are important parts of recovering from post-birth control syndrome.
What to Do If Your Patient Is Still Amenorrheic
These are my best general recommendations for how to restore your patient’s period after she stops birth control, and I’ve used these strategies successfully with many young female clients. It’s important to address all these factors, as any one of them can be enough to disrupt menstrual function, which is a sign of suboptimal health.
Of course, sometimes this isn’t enough to get every patient back on track hormonally, especially if birth control was taken for many years or if birth control was used as a method to address hormone issues in the first place. In this case, you may need to perform some additional testing to identify any issues that may be causing the amenorrhea. Polycystic ovary syndrome (PCOS) is a common condition that can significantly disrupt hormonal function and will require further exploration.
A book I often recommend to my clients is Taking Charge of Your Fertility. Surprisingly, many women know very little about their cycles. This book teaches a fertility awareness method to help women understand their fertility and overall health, which can be very empowering.
Referring your patients to a knowledgeable nutritionist can help to identify any missing pieces in their recovery plans to ensure that you’re doing everything possible to get their hormonal health and menstrual function back.
About Laura: Laura uses her knowledge of traditional and biologically appropriate diets to improve her clients’ health. Growing up with a family that practices Weston A. Price principles of nutrition, she understands the foods and cooking practices that make up a nutrient-dense diet.
With her strong educational background in biochemistry, clinical nutrition, and research translation, she blends current scientific evidence with traditional food practices to help her clients determine their ideal diet, without excessive restriction or stress.