PCOS and Stopping the Pill #25

I would like to stop the pill. What should I consider?

Happy Sunday!

Today’s newsletter addresses the topic of discontinuing the pill.

This week’s question:

I would like to stop the pill. What should I consider?

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The pill is usually the only solution offered by gynaecologists for the treatment of PCOS. For those that take it, it can do an incredible job at offering a break from PCOS symptoms. We will have a beautiful guest post coming in a couple of weeks on Eden’s experience on/off the pill.

However, there comes a time when giving up the pill might be something you desire: either because you’d like to have a baby or for other reasons. If the pill has helped you in your PCOS journey, you might fear how your body will react. This is understandable and getting support is essential. Let’s break down what you should know if you are ever considering this decision.

How does the pill work?

The pill works its magic by making the brain think that FSH and LH are not needed, so as a result, ovulation is prevented. Responsible for this are the synthetic hormones in the pill, which mimic oestrogen and progesterone. This is the case for the combined pill (such as Yasmin). There are also pills that mimic only progesterone but they work more or less the same way. Because you are taking the same hormones every day, it’s like a hormonal deja vu.

This hormonal deja vu can reduce testosterone levels by up to 61%. Due to its effect on testosterone, it helps manage hair growth, weight gain, and acne. If you want to know more about how this happens, please read my guide on PCOS and the Pill.

Does the pill cure PCOS?

Unfortunately, the cause of PCOS is unknown and to this date, there is no cure. The pill doesn’t cure PCOS but it can help with the management of symptoms.

As you can see above, the pill pretty much mimics your hormones and synthetically creates this environment where your natural rhythm of hormones is somehow regulated. The moment you take away the pill, your own hormones will take back control of the situation. This is where we need to discuss expectations.

When I was first given the pill for PCOS (at 19 years old), I naively thought that it was treatment. Exactly like antibiotics will kill bacteria, I thought the pill would solve my issues. That is not completely true. The period you get on the pill is not really the real period and whilst the pill can keep symptoms managed, it doesn’t solve underlying issues.

What should I expect when I come off?

This is extremely hard to predict and to my surprise, I couldn’t find any research describing the experience of women with PCOS. For those without PCOS, research suggests it can take 3-9 months for the reproductive cycle to return to its regularity. In addition, 83.1% of women who discontinued contraception were able to fall pregnant within the first 12 months.

Your experience might be influenced by the following:

• the severity of your symptoms before getting on the pill

• how well are you currently managing your symptoms (lifestyle choices)

• any nutrient depletions

• how long you have been on the pill

What should I consider?

Here are my recommendations if you are considering coming off the pill:

1. Discuss it with your doctor

Any medication discontinuation needs to be discussed with the doctor who prescribed it. They might suggest other medications for PCOS management or offer support with other contraceptive alternatives (if you don’t want to conceive). Even if you choose to manage your PCOS without medication, it is essential to have a conversation. I found doctors open and encouraging of my desire to manage it without pills.

2. Keeping track of your symptoms

Keeping track of your symptoms for about three months after stopping the pill can be a great way to be in tune with your body and identify symptoms. When we equip ourselves with data, we can find the right type of support, be better advocates for ourselves and measure progress.

This is my mood and anxiety over my past cycle. You can see my Mood decreasing and my Anxiety increasing as I progress through my cycle: from my period to the Luteal Phase. Even if you are on the pill now, keeping track of variations through your cycle can be very useful.

3. Optimising habits

Depending on how good your lifestyle is whilst on the pill, creating a plan for optimising your habits could be a good idea. Given we don’t know entirely how your body will react off the pill, working with a healthcare provider to create a plan that includes tailored advice for you can be reassuring. For example, if historically you had signs of high testosterone, planning on a nutrition plan to help you keep them low, together with some supplements, can be helpful. If you are also scared, investing in working with someone might alleviate some anxiety.

4. Considering supplements

If you have been on the pill for a while, you might want to wait to see how your body acts without it before jumping on PCOS-specific supplements (assuming you have not taken any). However, there are certain nutrients that we know the pill tends to deplete. Research shows that women on the pill might require higher needs of folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc. All of these are extremely important for the well functioning of our endocrine system and body. Considering a multi-vitamin or a nutrition plan focused on these nutrients can also help.

I hope you have enjoyed today’s newsletter. Coming off the pill can feel overwhelming if you had a good experience whilst on them. If you require additional support, don’t hesitate to get in touch.

See you next Sunday.

Francesca

¹ Reference

1. Girum, T., & Wasie, A. (2018). Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and Reproductive Medicine, 3(1). https://doi.org/10.1186/s40834-018-0064-y

Gnoth, C., Frank-Herrmann, P., Schmoll, A., Godehardt, E., & Freundl, G. (2002). Cycle characteristics after discontinuation of oral contraceptives. Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology, 16(4), 307–317. https://doi.org/10.1080/713603100

Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences, 17(13), 1804–1813. https://pubmed.ncbi.nlm.nih.gov/23852908/

Disclaimer: We are all so unique in our own ways, so this information is for educational purposes only. In my communications, I summarise research data and bring in my own experience. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs.