Have you been off the pill for 3 months and your period still hasn’t returned? You’re not alone. This is called post-pill amenorrhea and it's more common than you probably realize. In fact, anywhere from upwards of 3-6% of women can lose their period post pill with studies suggesting that women with a history of irregular periods are at higher risk.
But just because you stopped the pill or other birth control doesn't mean we should assume that is the only cause. Since many women are prescribed birth control for symptoms, it is possible that birth control was delaying your diagnosis and masking an underlying condition that can lead to amenorrhea (a missing period).
For many women, coming off of the pill signals the beginning of a myriad of symptoms and can mean the end of regular periods. The threat of the return of acne, painful or heavy periods, mood swings or headaches are enough to give any woman pause when it comes to stopping the pill.
While it is true that some women are able to begin cycling regularly again and have minimal symptoms when they stop the pill, clinically I see that hormone imbalance and menstrual irregularities are more the norm for post-pill women.
Post-Birth Control Syndrome is real and it’s why many women can feel pretty fearful about taking the leap to get off the pill.Could the birth control pill be why your period has gone missing? #hormones Click To Tweet
What is Post-Birth Control Syndrome?
Post-Birth Control Syndrome is describes the constellation of symptoms that arise in women within 4-6 months of discontinuing the pill. You may not even realize the symptoms you have are because of having stopped the pill. Here are the many signs and symptoms associated with hormone imbalance following a withdrawal from the pill.
Common Symptoms of Post-Birth Control Syndrome Include:
- Menstrual Irregularities: Post-Pill Amenorrhea (loss of menstruation after taking the pill), heavy menstruation, painful periods, and short cycles (<24 days).
- Hormone changes such as infertility, hypothyroidism, hair loss, breast tenderness, acne, and adrenal dysfunction.
- Pain syndromes like migraines and headaches.
- Changes in body composition like breast size, gaining weight or difficulty losing weight.
- Mood Disorders such as anxiety, depression, mood swings and PMS symptoms.
- Digestive symptoms like changes in bowels, digestive upset, gas, or bloating.
- Inflammation and other immune imbalances.
What is Post Pill Amenorrhea?
Post pill amenorrhea is a symptom of Post-Birth Control syndrome is marked by the absence of menses that persists 4-6 months after the pill. If you're a woman with irregular periods, you are at a higher risk of losing your period for good!
This is huge given that the pill is the most common treatment for irregular periods associated with PCOS.
Period Gone Missing After the Pill? Here's What to Do First.
If you're concerned your period may not return then it is time to have testing done! This is the first step to understanding why your period hasn't returned and what is absolutely essential to restoring your hormone health.
13 Tests to Have Done If Your Period Has Gone Missing After the Pill
The symptoms of Post-Birth Control Syndrome arise from the many ways in which the pill affects your body—suppressing natural hormones, depleting nutrients, and disruption of the microbiome are only a handful of side effects. The following tests should be completed in any woman who has stopped the pill for 3 months or more and has not experienced a regular cycle.
- Estradiol (E2)
- Thyroid panel
- Free testosterone
- Fasting insulin
- HgA1C, fasting glucose or glucose challenge
- Pregnancy Test
1. FSH, LH, Estradiol
FSH and LH are brain hormones that help us understand if your period is missing due to your pituitary glands or ovaries. A high FSH is a sign that the ovaries are not responding appropriately.
It is important to note that these hormones should be repeated to get a clear picture as they often fluctuate.
If you are menstruating, on the 3rd day of your menstrual cycle (your period marks the first day) test FSH, LH, Estradiol. This will help you determine how your brain is signaling your ovaries and how they are responding.
2. 17-OH-Progesterone and Progesterone
17-OH-progesterone is produced in the adrenal glands and is a precursor to androgens. Secondary amenorrhea is associate with condition of the adrenal glands, like Addison's disease.
Genetic conditions like non-classic congenital adrenal hyperplasia (CAH) can also lead to a missing period. While classically CAH presents earlier in life, it is possible to have late onset of this condition.
Testing progesterone can help you understand if ovulation has occurred, but will also provide insight into your overall sex hormone balance.
If you are menstruating, having testing done between days 19 and 22 of your cycle (or 7 days before you expect your period again) for estradiol and progesterone to determine the balance of these hormones and understand if estrogen dominance is your issue.
If you're not cycling, then testing progesterone isn't going to be all that helpful, but I wanted to mention it here so you're aware of why your doctor may deny it.
If you’re period has gone missing (Post-Pill Amenorrhea), it is important to have labs testing to understand why and not to just assume that the only thing going on is quitting birth control.
Prolactin is a hormone associated with breastfeeding, but in some instances, it can be elevated and cause your cycle to shut down. A prolactinoma, which is a benign brain tumor, can cause hyperprolactinemia (eleveated prolactin).
4. Comprehensive Thyroid Testing.
TSH, Free T4, Free T3, Reverse T3, Anti-TPO & Anti-Thyroglobulin should be screened in women with amenorrhea. Learn more about how your thyroid relates to your menstrual cycle here.
Learn more about Why I Require a Complete Thyroid Panel
Considering both total and free-testosterone is a good idea, but at the very least, checking the bioavailable form of testosterone (free) is a must.
Certain conditions can cause an increase in androgens and will subsequently cause you to lose your period. PCOS, adrenal tumors, CAH, Cushing syndrome, and ovarian tumors are a few conditions that can lead to hyperandrogenism (high androgens).
DHEA-S (dehydroepiandrosterone sulfate) is a hormone produced in the adrenal glands that can be converted into testosterone.
DHEA is converted into androstenedione. Androstenedione is then made into testosterone. And this, my friend, can help provide valuable information about what might be causing your missing period.
Both cortisol and cortisone tested together can provide important information about your hormones. Elevated levels of cortisol can be indicative of an underlying issue and lead to amenorrhea.
Read more about How Your Adrenals Can Cause Hormone Imbalances.
Dutch Hormone Testing is the most comprehensive hormone testing available and shows you not only the total hormones, but also if you’re making harmful metabolites.
The one caveat with the Dutch is that it needs to be interpreted by an expert. I recommend having this test reviewed by an experienced doctor. This test gives a lot of info and can be very telling of certain risks, like cancer. Depending on your results, you may need additional testing or a referral to a specialist. Only a doctor, nurse practitioner, physician's assistant or other licensed practitioner can interpret, diagnoses and treat you based on your lab results and symptoms.
9. Fasting Insulin
A fasting insulin can help you understand if an underlying metabolic condition or PCOS is contributing to absent periods.
10. HgA1C, fasting glucose or glucose challenge
Your doctor may determine one of these tests necessary to evaluate your metabolic health and if PCOS is the underlying issue.
11. Pregnancy Test
If you're sexually active with a male partner then pregnancy should be ruled out. Remember, ovulation comes before menstruation so you can fall pregnant even before you have your first period off of birth control.
Post-Birth Control Syndrome and the loss of your period can be a lot to navigate on your own. Partnering with an expert such as a Functional Medicine practitioner will help you understand the specific needs of your body and help you create an individualized plan for healing.
Recover Your Period Post-Birth Control
Post-Birth Control Syndrome (PBCS) is something I’ve been helping women recover from for years in my clinical practice. As a doctor who helps women reverse PBCS and restore their natural hormonal health, I want you to know that you can heal your body.
And you can create easy, predictable periods, a balanced mood, glowing skin, and incredible energy naturally.
If you’re a woman who have ever taken hormonal birth control then the Birth Control Hormone Reset is for you!
In this program I give you the low down on the pill and the resources you need to kick the pill and your unwanted symptoms. Plus, you'll be joining a community of women on the same mission.
Hope to see you there!
Dr. Jolene Brighten