Blog

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

Written by   in 
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!

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.

PCOS and Exercise

Written by   in 
September 24, 2018
PCOS and exercise, toronto naturopath, naturopathic doctor toronto

We all know that exercise is helpful in general, and that is especially true for those living with PCOS. Exercise may improve ovulation, insulin resistance and promote weight loss. Yet, it’s hard to say which type of exercise, the intensity, and how much PCOS-ers should be doing.  

Types of Exercise

Resistance Training

Resistance training (also known as weight or strength training) requires the body (muscles) to push against force that is practised against it. This includes bodyweight exercises, plyometrics, use of resistance bands, free weights or machine equipment. Resistance training is thought to be beneficial to PCOS-ers because it can improve insulin resistance, glucose metabolism and resting metabolic rate, lowers body fat and increases lean muscle mass. 

One study looked at progressive resistance training in women with PCOS. Women in the intervention group exercised for 1 hour per day, 3 times a week for 4 months. Exercises included: bench presses, leg extensions, front lat pull-downs, leg curls, lateral raises, leg presses (45 degrees), triceps pulleys, calf leg presses, arm curls, and abdominal exercises executed in alternating segments. At the end of this study, the women with PCOS experienced weight loss and increased muscle mass, lowered androgen levels, increased reproductive function, but no significant changes to insulin resistance.  

The 2015 Almenning study also evaluated strength training compared to HIIT in women with PCOS, and also found that at the end of the study while there was an improvement in body composition, there were not any changes to insulin resistance. 

Aerobic Exercise

A 2018 study looked at aerobic exercise in women with PCOS. Participants performed 40 minutes of exercise (including 5 minutes of warm up and 5 minutes of cool down), 3 times a week for 16 weeks. The exercise group completed their supervised exercise outside on a track. Interestingly enough, the study does not explicitly state what exercise the control group did, however it may have been unsupervised exercise for 150 minutes per week (this is what I am guessing).

Results demonstrated that there was an improvement in the health-quality of life score, an improved cardiometabolic profile, reduced BMI and waist circumference, and overall positive response doing exercise. However, no changes were seen in fasting glucose or insulin or HOMA-IR values in both control and exercise groups. 

High Intensity Interval Training (HIIT)

In men with insulin resistance, studies have shown that HIIT has had a positive impact overall, compared to continuous training (think walking or running). 

One study looked  at HIIT in women with PCOS. These women participated in a 10-week program where they would do HIIT three times a week. Two sessions were 4×4 minutes of HIIT at 90-95% of their maximum heart rate, separated by 3 minutes of moderate intensity exercise around 70% of their maximum heart rate. The last session was 10×1 minute of maximum intensity HIIT separated by 1 minute of rest or low activity. Mode of exercise was dependent on the individual, but could be the treadmill, outdoor walking/running/cycling. The control group were simply advised to do at least 150 minutes of moderate-intensity exercise per week.  

The primary outcome of this study was to measure the change in insulin resistance (via the HOMA-IR value) from baseline to post-intervention. In the group who did HIIT, IR values significantly improved (specifically fasting insulin), as well as overall body composition. 

PCOS and yoga, toronto naturopath, naturopathic doctor toronto

Yoga

So far the only studies looking at the effect of yoga on PCOS, have been done in adolescent girls. In previous studies, yoga has been studied in men and with poor insulin sensitivity as well as in people with obesity and diabetes.  

A 2012 study looked at adolescent girls and the effects of yoga on glucose and insulin levels. Girls were divided into 2 groups – 1 which practiced yoga (1 hour a day for 12 weeks), and the other which practiced conventional physical exercises. At the end of the 12 weeks, there was reduction in fasting blood glucose in the yoga group as well as a drop in the HOMA-IR score of 0.38. The control group actually had an increase in their HOMA-IR score of 0.29. 

A 2013 study by the same authors looked at the effects of yoga in adolescent women, but this time specifically looking at endocrine parameters (Anti-mullerian hormone (AMH), luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, prolactin, body–mass index (BMI), hirsutism, and menstrual frequency) before and after 12 weeks. Adolescents in the yoga study practiced for 1 hour per day for 12 weeks, while the other group simply practiced conventional physical exercises. At the end of the 12 weeks, they found that yoga was better at reducing AMH, LH, and testosterone and improving menstrual frequency. 

Final Thoughts

You obviously have your pick when it comes to exercise. I would choose something based on what you like to do (if you hate yoga, don’t do it) and what your goals are. I personally want to decrease my HOMA-IR value, so choosing HIIT and yoga might be the way to go for me. 

Something important to keep in mind is that exercise is not the be-all and end-all of treatment. In fact, doing too much exercise may impair your adrenal glands, causing more inflammation, thereby causing more insulin resistance. Sometimes taking it easy is key, and doing gentle exercises (ie. walking, yoga) will your best bet in your path of healing. 

Exercising Tips

One of my favourite authors, Gretchen Rubin, has some tips when it comes to sticking with exercise. Some of my favourites are:

  • Plan exercise with a friend who will not be happy if you don’t show up

  • If you’re travelling, figure out how you will schedule in some exercise

  • Keep track of how much you exercise (ie. I put stickers on my recycling calendar)

  • Pair activities (ie. Watching Netflix? Exercise at the same time)

If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

References

KOGURE, G., MIRANDA-FURTADO, C., SILVA, R., MELO, A., FERRIANI, R., DE SÁ, M. and REIS, R. (2016). Resistance Exercise Impacts Lean Muscle Mass in Women with Polycystic Ovary Syndrome. Medicine & Science in Sports & Exercise, 48(4), pp.589-598.

Almenning, I., Rieber-Mohn, A., Lundgren, K., Shetelig Løvvik, T., Garnæs, K. and Moholdt, T. (2015). Effects of High Intensity Interval Training and Strength Training on Metabolic, Cardiovascular and Hormonal Outcomes in Women with Polycystic Ovary Syndrome: A Pilot Study. 
PLOS ONE, 10(9), p.e0138793.

COSTA, E., DE SÁ, J., STEPTO, N., COSTA, I., FARIAS-JUNIOR, L., MOREIRA, S., SOARES, E., LEMOS, T., BROWNE, R. and AZEVEDO, G. (2018). Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome. Medicine & Science in Sports & Exercise, 50(7), pp.1357-1366.

Nidhi, R., Padmalatha, V., Nagarathna, R. and Ram, A. (2012). Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome. International Journal of Gynecology & Obstetrics, 118(1), pp.37-41.

Nidhi, R., Padmalatha, V., Nagarathna, R. and Amritanshu, R. (2013). Effects of a Holistic Yoga Program on Endocrine Parameters in Adolescents with Polycystic Ovarian Syndrome: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine, 19(2), pp.153-160.