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Why am I getting acne now that I’ve stopped birth control?

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January 9, 2018
acne birth control, toronto naturopath, naturopathic doctor toronto

You started birth control years ago to deal with acne. 

Now you’re thinking it’s time to stop for good. 

But you’re worried that you’re going to start breaking out again. 

Does this sound familiar? You’re not alone. This is (unfortunately) a common thing that many people struggle with. Let’s figure out why this happens and what you can do about it!

Why does acne happen?

When  we start puberty, a bunch of our hormones get activated – estrogen, progesterone, androgens, etc. Sebum production increases from about 9 years old to 17 years old. Hormones like testosterone can trigger acne because it increases sebum production.

Birth control and testosterone

Birth control pills have a couple of effects on hormones:

  • Decrease androgens like testosterone, DHT and DHEA-S
  • Increases SHBG
  • Decrease serumproduction

The progestins used in birth control are actually pretty structurally similar to testosterone, and can therefore produce androgenic side effects. However the side effects are based on how ‘androgenic’ the progesterone is – this is known as the androgen index.

Progestins with a high androgen index may cause can cause acne, hair loss, weight gain, and insulin resistance. These progestins include: medroxyprogesterone acetate, levonorgestrel, norgestrel, and etonogestrel.

Progestins with a low androgen index may cause depression or anxiety, low libido, and suppress adrenal function. When you stop taking this type of progestin, your body may rebound by producing a lot of androgens because it doesn’t think any are available. These progestins include: drospirenone, norgestimate, cyproterone, and natural progesterone.  

Your skin on birth control

You might have noticed that when you started birth control, your skin became clearer. That’s because the hormones in the pill (estrogen and progestin) suppress androgens (like testosterone) and ultimately sebum. When your sebum levels are low, your skin will make more sebum to compensate. The estrogen and progestin will continue to suppress sebum production, and the cycle will continue on.

You’re probably not worried about this when you’re on the pill, because you’re not noticing any of it. Your skin is clear, your selfie game is strong, and you are able to get throughout the day without any embarrassment or frustration.

Your skin off birth control

At some point you’re going to want to get off the pill. Maybe you’re thinking of starting a family, maybe you want to experience a real period – whatever the reason is, you’re worried about what’s going to happen with your skin.

Because I believe honesty is the best policy – it’s important to know that you’re probably going to get acne once you stop the birth control pill.

Why does this happen?

It happens because sebum is not being suppressed anymore, and you have higher levels now than when you did when you started the pill. And because your ovaries are producing androgens again (another group of hormones that are effectively shutdown when you take birth control).

For the next 6-12 months your body is going to be withdrawing from the effects of the pill, which means that acne may be on the horizon for you.

Prepping your skin before you stop the pill

If you want to stop the pill, then consider prepping your skin about a month before you give the pill up for good.

Dairy-free diet

Cow dairy may cause inflammation and produce chemicals that increase inflammation and sebum production. This is especially seen with skim/non-fat milk products and ice cream. Dairy also contains hormones that can affect the body, by producing more testosterone.

Consider switching to alternative forms of dairy, or even choosing different animal dairy like buffalo (my fave), goat or sheep dairy. 

Sugar-free diet

Refined sugars may increase insulin, which can increase androgen production in the body. Plus let’s be honest, processed foods aren’t great sources of nutrients. If you can do better, choose better. 

Fix your digestion

Acne may pop up with leaky gut and food sensitivities. Normally whatever enters your gut, should (momentarily) stay in your gut. But if you have leaky gut, food from your gut may pass through some cells it shouldn’t, and end up elsewhere in your body. Your immune system will respond by mounting an attack against these food particles and cause a cascade of effects – acne being one of them.

So if you’ve cut the dairy and sugar for a couple of weeks, but are still experiencing acne – you may want to give the elimination diet a try.

Consider supplements

Supplements can be great at quick starting the healing process (especially since the pill depletes a bunch of nutrients). Ultimately, you should consider working with a health professional when supplementing because we make sure you’re taking the best product, dose, form and timing.

Some nutrients to consider are:

  • Zinc
  • Berberine
  • DIM
  • B vitamins

Go deeper

Acne may also be a sign of PCOS. Now before you tell me you don’t have polycystic ovaries (I hear this a lot), you can have PCOS without the cysts.

If you have irregular periods or don’t ovulate and have signs of high androgens (ex. acne), then it’s worthwhile to get some testing done. Check out my in-depth series on PCOS to learn more.

Next Steps

While the prospect of getting acne once you stop the pill is both frightening and frustrating (especially if you’re an adult), there is hope! Starting a skin-care plan before you stop is a step in the right direction.

And working with a professional can help you navigate all the ups and downs –particularly if you’re working with food sensitivities or PCOS. If you have any questions or tips and tricks, please share them below!

Endometriosis in Teens

December 10, 2018
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It’s time to listen to your body. 

Especially if you’re experiencing period pain. 

You might’ve been told that period pain is normal. But that’s not exactly true. Period pain is a common symptom, but isn’t always normal.

Cramping in your lower pelvis or back is normal around the start of your period, but experiencing severe pain isn’t. If you feel a stabbing, burning, or throbbing pain that doesn’t go away with pain killers, and is causing you to miss school or work, and affecting your quality of life – you need to figure out what’s going on.

One of the emerging causes of period pain in teens is endometriosis. Endometriosis happens in about 10% of women who menstruate (likely more!). It was previously thought that teens didn’t have endometriosis because research only looked at older women who were having trouble getting pregnant.

What is endometriosis?

Endometriosis is a gynecologic disease that occurs when endometrial tissue grows outside your uterus. This tissue can grow anywhere in your body (it’s even been found on the lungs and brain), but it’s most commonly found on the ovaries, fallopian tubes, uterine surface, bowel and the lining of the pelvic cavity.

When you experience your monthly period, you also experience internal bleeding and ultimately scar tissue will form. Sounds great, right? #noway

Common endometriosis symptoms in adults

Some of the common symptoms associated with endometriosis are:

Other symptoms include:

How does endometriosis present in teens?

You might notice pain that doesn’t quite sync with your period (aka. noncyclic pelvic pain). Also, if your mom or sister have endometriosis, or if you have a history of atopic disease (ex. eczema, asthma) – you should be checked!

Endometrial lesions might be found between your ovaries, peritoneum, pouch of Douglas, uterosacral ligaments and rectovaginal septum. Typically, the lesions may present differently than they would in adults. Yours might be more red and clear. 

Because of these differences, this may contribute to your delay in diagnosis, and ultimately treatment. Obviously this lag may negatively impact your quality of life. 

Warning signs in teens

Pay attention to these signs:

  • Extended use of anti-inflammatory drugs (ex. NSAIDs)

  • Family history of endometriosis (ex. mom and sister)

  • Frequent absence from school during your period, and skipping exercise because of pain or a heavy flow

  • Birth control prescription before you turn 18 because of pain

How is endometriosis diagnosed?

You can’t diagnose endometriosis through a blood test. Instead, the gold standard of testing is a laparoscopic exam. This is considered a minimally-invasive surgery where small incisions are made in the abdomen to both confirm the presence of and remove endometrial lesions.

Doctors may suggest ultrasounds to see if you have endo, but that test can’t completely rule endo out. 

Conventional Treatment of Endometriosis

Unfortunately there’s no cure for endometriosis. But treatment should include controlling pain and preventing lesion progression. 

The first line treatment in endometriosis is birth control (usually a combined pill). This may actually be worthwhile to try if the pain is incredibly severe, and not responding to regular painkillers. Nevertheless, there are a few things to consider if you plan on taking birth control: 

A huge study in 2016 investigated different types of birth control and how they were associated with antidepressants and a diagnosis of depression. Researchers found that teens (between 15 to 19) are more sensitive to depressive symptoms and antidepressants than adults. This was seen in teens using the combined pill or progestin-only pill. The study did show that the incidence of depression and antidepressants use decreased with age. 

Teens with endometriosis report impaired physical and mental health quality of life. As well as physical pain, difficulty in participating in daily activities, physical activities, and social events. Therefore all of these factors must be considered when determining the best treatment route, or adjunctive supportive therapies. 

Naturopathic Treatment of Endometriosis

Once again there isn’t a cure for endometriosis, but you can do a couple of things to manage the pain and improve quality of life. There are some supplements that you can take, but it should really be done under the supervision of a health practitioner like a Naturopathic Doctor. 

You may want to consider:

  • FODMAPs diet or an anti-inflammatory diet

  • Curcumin

  • N-acetyl cysteine

  • EPA/DHA

  • Selenium

  • Vitamin E

Next Steps

If you’ve been experiencing any of the warning signs, it may be time to talk to your doctor about endometriosis. 

If you found this information helpful, I would encourage you to download my 
FREE EndoDiet meal guide and plan. It goes through everything we discussed: foods that are safe and that should be avoided, and a 7 day meal plan and preparation guide!

References

Dowlut-McElroy, T. and Strickland, J. (2017). Endometriosis in adolescents. Current Opinion in Obstetrics and Gynecology, 29(5), pp.306-309.

Gallagher, J., DiVasta, A., Vitonis, A., Sarda, V., Laufer, M. and Missmer, S. (2018). The Impact of Endometriosis on Quality of Life in Adolescents. Journal of Adolescent Health, 63(6), pp.766-772.

Reid, R., Steel, A., Wardle, J. and Adams, J. (2018). Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis. The Journal of Alternative and Complementary Medicine.

Zannoni, L., Forno, S., Paradisi, R. and Seracchioli, R. (2016). Endometriosis in Adolescence: Practical Rules for an Earlier Diagnosis. Pediatric Annals, 45(9), pp.e332-e335.

PCOS in Teens

December 3, 2018
PCOS in teens, toronto naturopath, naturopathic doctor toronto, teen naturopath, danforth naturopath

Experiencing acne?

Missing a period or two?

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women including teens! Now before you roll your eyes and utter the sentence, “I don’t have cysts on my ovaries,” please note you don’t need to have cysts in order to have PCOS (I’ll talk about that below). 

PCOS is a collection of symptoms – both visual (like acne) and diagnostic (like serum testosterone). It’s also a diagnosis of exclusion among other androgen (male hormone) excess disorder. In teens, PCOS may present differently than it would in adults. 

PCOS Criteria in Teens

To be diagnosed with PCOS, you must have 2 out of 3 criteria, as defined by the Rotterdam Criteria. Criteria includes:

  1. Delayed ovulation or irregular menstrual cycles (anovulation)

  2. High androgenic hormones like testosterone

  3. Polycystic ovaries on ultrasound

In teens however, both irregular menstrual cycles and hight androgens are required. Ultrasound is not recommended for diagnosis. 

High Androgens (aka. hyperandrogenism)

What’s are androgens? It’s a group of male hormones which are present in females. The most common one is testosterone. When androgen levels are high in the body, it can lead to some unwanted symptoms.  

High androgens are the most common criteria seen in teens, because it includes clinical signs like acne and/or hirsutism (male-pattern hair growth) – caused by, you guessed it, high testosterone levels. 

But, just because you see a couple of zits or see some hair – it doesn’t mean you have PCOS. 

We’re talking about moderate-severe acne (ex. more than 11 red zits on your face) that isn’t affected by topical medications. When it comes to hair, you need to score between 4-6 on the modified Ferriman-Gallwey chart. One thing to note is that some ethnicities present with more hair growth, which should be factored in when calculating the score. 


PCOS, toronto naturopath, naturopathic doctor toronto

Source: https://pedclerk.bsd.uchicago.edu/page/hirsutism

You may also notice hair loss, around the frontal area (ie. where your bangs would be), and that can also be a sign of high testosterone.

Another way to determine if you have high androgens (like testosterone) is by testing them. A simple blood test will suffice (no need for the fancy tests) and can be done anytime during your cycle. Shortly after your period begins, serum testosterone reaches adult levels. 

Androgens that you may want to get tested include:

  • Total testosterone

  • Free testosterone

  • DHEA

  • Androstenedione

  • Sex Hormone Binding Globulin

Irregular Periods

Period length can actually vary based on when you first experience menstruation. Irregular cycles are defined as:

  • Normal in the first year of having your period

  • In the first 1-3 years of having your period: Less than 21 or greater than 45 days

  • After having your period for 3 years: Less than 21or greater than 35 days

  • After having your period for 3 years: Less than 8 menstrual cycles per year

Moreover, when you first start getting your period, it’s highly likely that you won’t be ovulating. Approximately 85% of menstrual cycles (in the first year of your period) are ovulatory. Six year in, only 25% of your cycles will be anovulatory (aka. no ovulation is happening).  

Within the first 2 years after your period starts, you may notice period irregularities and anovulation – and that’s okay!

Polycystic Ovaries

In case you missed it, you don’t need to have polycystic ovaries to have PCOS. In fact, the ASRM guidelines state that ultrasound should not be used for diagnosis in women who have had their period for less than 8 years because ovaries tend to have lots of follicles during this time. 

So what does that mean? You need to rely on the other 2 criteria to figure out if you have PCOS. 

Conventional Treatments of PCOS

It’s likely that if you go to your medical doctor, they’ll tell you to take the birth control pill. The pill is considered the first line of treatment. You may hear that the pill will regulate your cycle, but it will actually shut down your body’s natural hormones and replace them with the hormones in the pill – which may be a synthetic estrogen and progestin (depending on which you take). Periods that you experience while on the pill, aren’t true periods at all – they are simple withdrawal bleeds from the hormones. 

Here’s the thing. If you think of the pill as a bandaid, you won’t know if these symptoms are just going to come back once you stop the it. Most women stop the pill around the time they’re ready to start thinking of having kids. But if PCOS is still looming in the background, it may lead to fertility issues down the line. 

Something that you should also be aware of is that severe anxiety and depression is higher in adults with PCOS. And it’s likely also increased in teens. A huge study in 2016 investigated different types of birth control and how they were associated with antidepressants and a diagnosis of depression. Researchers found that teens (between 15 to 19) are more sensitive to depressive symptoms and antidepressants than adults. This was seen when teens were using the combined pill and progestin-only pill. The study did show that the incidence of depression and antidepressants use decreased with age. 

Birth control is not always bad, it’s provided choice and reproductive freedom to many, but it’s important to recognize why you’re taking, and understanding the risks associated with it as well. 

Approaching PCOS Naturally

When we’re dealing with PCOS in teens we want to do a couple of things:

  • Promote a regular menstrual cycle

  • Restore natural ovulation

  • Reduce/get rid of acne and hirsutism

  • Achieve weight loss if necessary (because this may lead to conditions like diabetes)

Yes, there are supplements you can take to help with the above four goals. But one of the main priorities is to promote a healthy diet and exercise in ALL teens with PCOS. I go into that more in previous articles, so please check those out. These have widespread effects in optimizing hormonal outcomes, general health and quality of life.  

This doesn’t mean you should be eating salads and hopping on a treadmill ASAP though. It’s important to take stock of your daily or weekly routine and see which changes can be made. Making some goals, writing things down (ex. a diet and exercise diary, as long as it’s not leading to eating disorder tendencies), problem solving with a parent or health professional, etc. 

Taking things slow is okay. Starting small is okay. One of my favourite quotes (that I usually see when I make a cup of tea) is “The creating of a thousand forests is in one acorn.”

Exercise and PCOS

Exercise guidelines are different between adults and teens. You should be aiming for at least 60 minutes per day of moderate to vigorous intensity physical activity, including activities that strengthen muscle and bone at least 3 times weekly. Group classes can be helpful, because of the social and community aspect. 

Examples of exercises that specifically strengthen muscle and bone are:

  • Dancing

  • HIIT workouts 

  • Hiking

  • Jogging/running

  • Jumping Rope

  • Stair climbing

  • Tennis

For more info on exercise and PCOS, check out my previous article here

Next Steps

Now that you’re familiar on how PCOS is presented in teens, here’s what you can do next:

  • Track your cycle length

  • Pay attention to any clinical signs, such as acne or hair growth

  • Get your blood work done (PS. NDs can order your blood work too!

Once you have these, figure out how you want to approach the solution. Will it be birth control or focusing on the root of the issue?

Now that you have a solid plan, please sign up for my monthly newsletter called The Flow for more informative and useful content like this! I want to make sure that you have a good flow!

References

Teede, H., Misso, M., Costello, M., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R., Andersen, M., Azziz, R., Balen, A., Baye, E., Boyle, J., Brennan, L., Broekmans, F., Dabadghao, P., Devoto, L., Dewailly, D., Downes, L., Fauser, B., Franks, S., Garad, R., Gibson-Helm, M., Harrison, C., Hart, R., Hawkes, R., Hirschberg, A., Hoeger, K., Hohmann, F., Hutchison, S., Joham, A., Johnson, L., Jordan, C., Kulkarni, J., Legro, R., Li, R., Lujan, M., Malhotra, J., Mansfield, D., Marsh, K., McAllister, V., Mocanu, E., Mol, B., Ng, E., Oberfield, S., Ottey, S., Peña, A., Qiao, J., Redman, L., Rodgers, R., Rombauts, L., Romualdi, D., Shah, D., Speight, J., Spritzer, P., Stener-Victorin, E., Stepto, N., Tapanainen, J., Tassone, E., Thangaratinam, S., Thondan, M., Tzeng, C., van der Spuy, Z., Vanky, E., Vogiatzi, M., Wan, A., Wijeyaratne, C., Witchel, S., Woolcock, J. and Yildiz, B. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility, 110(3), pp.364-379.

Peña, A. and Metz, M. (2017). What is adolescent polycystic ovary syndrome?. Journal of Paediatrics and Child Health, 54(4), pp.351-355.

Rothenberg, S., Beverley, R., Barnard, E., Baradaran-Shoraka, M. and Sanfilippo, J. (2018). Polycystic ovary syndrome in adolescents. Best Practice & Research Clinical Obstetrics & Gynaecology, 48, pp.103-114.