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

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January 9, 2018
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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!

Can the birth control pill fix my period?

October 29, 2018
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Short answer: No. 

You can’t fix your period with birth control because birth control doesn’t ‘improve’ your hormones. The birth control pill actually shuts off your period. 

How does the pill work?

The pill stops your natural menstrual cycle. More specifically, it prevents follicle stimulating hormone (FSH) and lutenizing hormone (LH) from being produced. This prevents follicles from maturing and releasing estrogen, and it prevents ovulation from happening, which produces progesterone. Because LH is not being produced, this causes cervical mucus to thicken affecting sperm movement and endometrial development (this is the lining that’s shed during your period). 

The birth control pill does have its own hormones: estrogen and progestin. These are not the same hormones that our body produces, but mimic them. 

If you are using a 28-day packet, 21 pills will contain the synthetic hormones and 7 will be placebo. When you take placebos, your body will experience a withdrawal bleed (often mistaken as a period). 

6 ways that these hormones are different

1. They enter your body differently

The hormones from the pill enter your bloodstream through your GI tract and portal vein (an important vein in your liver). Your ovarian hormones enter your circulation through veins in the ovary and the inferior vena cava. 

2. They have different concentrations

When you take the pill everyday, the hormones enter your body in a single, large dose. Your body’s hormones are always being produced based on where you’re at in your cycle. 

3. They have constant levels

Once you take the pill, those hormone levels don’t change. Your body’s hormones levels may change based on what’s going on with your hypothalamic-pituitary-gonadal axis. 

4. They stay in your body longer

Because the pill’s hormones are synthetic, they are designed to be more resistant to metabolism (aka. they don’t break down as easily). Therefore, they stay active in the body longer than your body’s natural hormones. It’s been thought that they can remain inside your body for at least 6 months after discontinuation. 

5. Progestin is not progesterone

Progestin is similar to progesterone, but they’re not the same molecule. Some progestins like levonorgestrel may cause hair loss because they are testosterone-like (and have a high androgen index). Progestins may also cause acne, as they suppress sebum production. 

Some progestins may have a low androgen index, and while may not cause hair loss while on the pill, they may cause hair loss after the pill is stopped because the body’s androgen levels increase. 

6. They have different actions

The hormones from the pill have a different action on hormonal receptors inside the body, compared to our hormones. This is because the structure, type, and concentration of pill hormones are different than your actual hormones. 

Then why use the pill?

The pill is the first line treatment option for many common conditions like PMS, PCOS and endometriosis. And it’s often given with the reasoning that it will regulate your period and stop the problem. But when you stop taking the pill, your problems will likely come back. 

There are times when the pill should be considered. For example, women taking accutane (which is a category X drug) should not be conceiving while on the drug. Or for women who have endometriosis, taking the pill may make the biggest difference for their pain and quality of life. 

How do I fix my period?

Ultimately, it’s important that you understand your symptoms so you can support your body. Especially if you’re using the pill to ‘fix’ the problems. You may want to figure out why these symptoms are happening, and see which dietary and lifestyle changes you can implement to support your longterm health. 

How do I start?

  • Review my articles about PMS, PCOS, and endometriosis

  • Track your symptoms, diet and your period

  • Get some blood work done (if applicable)

  • Find a Naturopathic Doctor to work with (feel free to contact me to find someone in your area)

  • Implement key dietary and lifestyle changes

  • Give your body time to adjust to your treatment plan

When I work with period problems, I figure out why they’re happening. I use information that you give me (diet/symptom/period trackers, blood work, your personal story) to determine the root cause and create a plan from that info. 

It’s not always a quick fix, but change takes time!

If you found this information helpful, check out my handy chart of the nutritional deficiencies caused by the pill!

References

Sims, S. and Heather, A. (2018). Myths and Methodologies: Reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases. Experimental Physiology, 103(10), pp.1309-1317.

What are Fertility Awareness Methods

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Fertility awareness methods allow the opportunity for people to track their cycle, with the goal of knowing when ovulation occurs. There are a variety of methods (as listed below) and are about 76-88% effective, with a possible increase in effectiveness if you use multiple methods together. 

With most of these methods, it’s wise to track your period and these particular signs for at least 3 months (6 months for calendar methods) to get an idea of your body’s rhythms before you use any of the methods for contraception. 

The Temperature Method

If you’ve been following my blog for a while, you might remember a blog post discussing basal body temperature and fertility.

A quick recap: body temperature changes throughout the menstrual cycle. It’s lower in the follicular phase and slightly higher in the luteal phase. This slight rise in temperature occurs after ovulation, and happens after the formation of the corpus luteum which releases progesterone (the hormone responsible for the temperature change). 

By following this method, you would measure your basal body temperature everyday and chart it (on an app or on paper).  

Days are considered safe once 3 days has passed since the initial rise of temperature, as well as a drop in temperature before the onset of the next menstrual cycle. This is an opportune time to have unprotected vaginal sex (with or without ejaculation). 

During your fertile days, you can avoid sex or use another birth control method. 

The Cervical Fluid Method (The Billings Method)

This method is based on cervical fluid changes, another topic I covered a while back. 

A quick recap: During the follicular phase, increasing estrogen levels will lead to the production of cervical fluid. Cervical fluid will change in colour, texture, and amount during the period, and is considered especially fertile around ovulation. 

Similar to the Temperature Method, cervical fluid needs to be charted everyday, starting from the end of the menstrual cycle. The changes that you may see will give you an idea of when ovulation may occur – which is great if you are hoping for pregnancy (unlike temperature, where it tells you that ovulation has passed).  Record everything daily: your period days, dry days, wet days, sticky days, cloudy days, and slippery days.

There are 3 ways to check your cervical fluid: (1) Before urination, wipe the opening of your vagina with white toilet paper or tissue. Observe the colour and feel of the fluid. (2) Look at your underwear for any discharge – note the colour and texture. (3) Insert your clean fingers into your vagina, and note the colour and texture of cervical fluid on your fingers. The best way to feel the consistency of your fluid is to rub it and stretch it between your thumb and index finger.

This fertility awareness method may not be best for people who don’t generally produce any cervical fluid. 

Source https://pregprep.com/wp-content/uploads/2013/08/131107_pregprep_chart1.jpg

The Symptothermal Method

This method combines cervical fluid, cervix changes, basal body temperature, and calculation to determine the beginning and the end of the fertile period. At the very least, you should be tracking cervical fluid and basal body temperature to determine when to avoid or engage in sex (depending on your goals, obviously). 

The Calendar Method (The Rhythm Method)

This is one of the methods that need at least 6 months of charting your period. 

Mark the first day of your cycle on an app or on a calendar. Remember, the first day is when you notice significant bleeding – not spotting. Mark the first day of your next cycle. Count the number of days in between your period. You’ll find the fertile part of your cycle, once you subtract 18-21 days from the shortest cycle (of the 6 cycles that you have tracked). You would find the end of the fertile part of your cycle by subtracting 9-11 days from your longest menstrual cycle. 

A real life example:

Dec – Jan = 30 days
Jan – Feb = 33 days
Feb – Mar = 28 days
Mar – April = 26 days
April – May = 32 days
May – June = 27 days

My shortest cycle was 26 days 
My longest cycle was 33 days

Start of my fertile phase is (26 days – 21 days) and (26 days – 18 days) = Days 5 to 8
End of my fertile phase is (33 days – 11 days) and (33 days – 9 days) = Days 22 to 24

Therefore, I would be considered fertile between days 5 to 24 of my period. Many couples may find this way a bit constricting, and may need to have another means of contraception if they still want to engage in vaginal sex. 

This method may be unreliable if you experience irregular menstrual cycles. 

The Standard Days Method

This fertility awareness method identifies a standard window in which someone may be fertile. You can only use this method if your cycle is really regular and is never shorter than 26 days and never longer than 32 days. You must also be cool with not having vaginal sex or using another contraceptive method between days 8 and 19 of your cycle – as they are considered the most fertile. 

Final Thoughts

There are at least 5 ways of practicing fertility awareness. Your best bet is paying attention to your basal body temperature and cervical mucus, and doing so for at least 3 cycles if you’re choosing this as your primary method of birth control. Speak to your Naturopathic or Medical Doctor to determine if these methods are right for you.