Birth Control Side Effects? Here's Your Expert Guide

Photo: Marija Savic

"I’m screwed if I stay on it and damned if I don’t," said my 34-year-old patient Ashley during her initial visit. She had been dealing with birth control side effects for years but was now more fearful of the side effects that came with coming off of it.

Despite numerous side effects during her 13 years (yup, 13!) on the pill, other problems occurred once she went off the pill including acne that, as she put it, "confined me to Netflix and chardonnay solo on Saturday night." She also hadn’t had her period since going off the pill, for nearly four months, but once she did—her flow was heavy, and the cramping was out of control. Unfortunately, Ashley’s former physician wasn’t much help when it came to these programs. She felt like he had reprimanded her for going off the pill and, baffled with her post-pill symptoms, put her back on to "regulate her period."

Let's get to the bottom of birth control side effects and hormonal issues.

When Ashley came into my office, I had to tell her that the pill wouldn't fix her period or her hormones. I explained that "the hormones stop your brain and ovaries from talking, and that is a big reason why coming off the pill can be so hard." Birth control and post-birth control syndrome each have their own set of symptoms, but getting off the pill and working with your body to restore hormone balance is the answer to both.

Post-birth control syndrome (PBCS) was a new term for Ashley, but despite her frustration about past experiences, she felt confident working with me and determined to ditch the pill and take back her body once and for all. As a doctor who helps women heal from post-birth control syndrome and reclaim their hormones, I’ve treated many women like Ashley struggling with the effects of being on the pill and going off the pill and other hormonal contraceptives.

Here's how the birth control pill really works.

When you really start to investigate the ins and outs of hormonal contraceptives, the side effects of taking them become a lot less surprising. Hormonal contraceptives work in three ways: They stop ovulation, thin the lining of your uterus, and alter your cervical mucus secretions. With all that interference, you can certainly expect some side effects when you're on them—and when you go off.

When Ashley’s first doctor prescribed the pill many years ago, he had assured her that staying on the pill long-term would be perfectly fine. When she was ready to have a baby, she’d be able to transition off the pill without any hiccups in her fertility or her period. Unfortunately, that wasn’t the case. Ashley experienced a bunch of negative consequences while on the pill and even more when she tried to stop taking it many years later. In my practice, I see a lot of women who are experiencing side effects they were never warned about.

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These are the birth control side effects you might be experiencing.

This can feel overwhelming, and if you are currently on birth control, don't panic. But do take note of these 11 common hormonal birth control side effects that could be majorly affecting your quality of life:

1. Birth control and thyroid issues.

The pill can increase thyroid-binding globulin, binding your free thyroid hormone. While the pill can increase total thyroid hormone, you can’t use that hormone, leading to thyroid imbalances including hypothyroidism.

2. Adrenal fatigue and birth control.

Tired all the time? The pill is inflammatory and depletes a few nutrients that are crucial for healthy adrenal glands, which is important when it comes to energy levels. In response, your adrenals crank out more cortisol because this stress hormone is anti-inflammatory. While that’s fine on a one-off basis, your daily dose for estrogen and that subsequent cortisol response becomes too much for your body long-term. The pill also raises cortisol-binding globulin, which grabs onto cortisol and holds it hostage. Inflammation increases, your brain and adrenal glands stop talking, and the perfect storm emerges for adrenal fatigue.

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3. Gut health issues and birth control.

Research shows oral contraceptives have an impact on gut flora, adversely affect estrogen metabolism, which has a few consequences like weight loss resistance. The pill also increases your risk for inflammatory bowel diseases like Crohn’s disease. Leaky gut and other gut issues also frequently trigger or exacerbate inflammation, and chronic inflammation paves the way for nearly every disease on the planet including obesity, and it certainly takes a toll on your gut.

4. Nutrient deficiencies and birth control.

The idea that the pill depletes vitamins, minerals, and other nutrients isn't breaking news. Research back in the 1970s discussed these deficiencies, including the need for extra iron as well as vitamins C, B2, B6, and folate for women on the pill. I’ve witnessed this in many ways, such as when women low in vitamins B6, B12, and folate have high homocysteine levels, paving the way for cardiovascular disease.

5. Mood swings and birth control.

Things like inflammation, blocked ovulation, and nutrient depletions can trigger or exacerbate anxiety, depression, and other mood issues. A more recent study has shown young women who use hormonal contraceptives, including the birth control pill, the ring, IUDs, and the patch have three times greater risk of suicide compared to women who have never used hormonal birth control. That being said, going off the pill doesn’t necessarily mean sunshine and rainbows follow. In fact, it can take some serious support to get your mood back and stabilized, but it is possible.

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6. Birth control and strokes.

Speaking of life-threatening events, the pill is also associated with increased risk of stroke. A 2015 Cochrane Review found a 1.6-fold increase in strokes among women using oral contraceptive pills compared to women who did not take the pill.

7. Chronic yeast infections.

The pill, and other forms of hormonal birth control, disrupt your hormones, your microbiome, and your vaginal ecology—all of which can cause an increase in yeast infections. In fact, one study showed that as much as 12 percent of recurrent yeast infections could be attributed to birth control pill use. Saying goodbye to hormones meant Ashley was making fewer trips to the pharmacy to manage uncomfortable yeast symptoms.

Coming off the pill isn't always easy: Here are the most common post-birth control side effects.

While Ashley felt relieved that many of these side effects dissipated once she went off the pill, she became frustrated to learn other side effects occurred post-pill, which I call post-birth control syndrome. "Breaking up with your hormones doesn’t necessarily mean sunshine and rainbows follow," I told her. "In fact, it can take some serious support, time, and patience to get your mood back and feel in control, but believe me, you can." Among the post-birth control side effects Ashley experienced were:

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1. Heavy, painful periods after the pill.

After about four months without a period, Ashley’s first post-pill period suddenly occurred during yoga class, when she felt a gush of blood surge into her new Lululemon pants. If heavy periods made you start the pill, chances are they’ll be back when you quit until you take steps to clear your estrogen, reduce inflammation, and support your nutrient stores. These symptoms prompted Ashley’s doctor to put her back on the pill, which left her feeling stuck and ultimately led her to my office.

2. Post-birth control amenorrhea.

If you’re a woman who had a regular menstrual cycle before starting the pill, you should expect your period to come back within three months of stopping the pill. For Ashley, it took over four months before the dramatic reappearance during yoga class! In my practice, I’ve found the longer your period stays away, the harder it can be to get it back. If you’re a gal who started the pill for irregular periods, it may take up to six months to get it back.

3. Hormonal acne after coming off the pill.

Post-birth control acne tends to peak about three to six months after stopping the pill, and unfortunately, it doesn’t just go away. Many patients I’ve seen struggle with endlessly frustrating skin problems including pimples, back acne, and for Ashley, persistent acne. The good news is that acne flare-ups are also something I've helped many women treat naturally, without putting them on (or back on) hormonal contraceptives.

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4. Post-birth control low libido.

While on the pill, Ashley had zero interest in sex, but she was surprised to find that going off the pill still meant almost zero action in the bedroom. The pill causes an elevation in sex-hormone-binding globulin (SHBG), which was grabbing onto all of her testosterone and stealing all her mojo.

The good news: Here's what you can do about birth control side effects.

Maybe you’ve weighed the alternatives to the pill and feel ready to work with a naturopathic or functional medicine doctor to transition off with minimal side effects. Maybe you've already gone off the pill and are experiencing post-birth control syndrome right now. Or maybe now isn’t the right time for you to call it quits, and you need support in minimizing side effects until you're ready. Rest assured that with the right strategies, you can reset your hormones and eliminate the side effects of the pill and transitions off the pill. Depending on your specific symptoms—and how long you’ve been on the pill—you may need additional support. Many of my patients require multiple visits and some detective work to uncover what creates these side effects as they taper off the pill.

For Ashley and many other patients going off the pill or who’ve been off the pill, I find these three strategies are the ideal to begin (if you’re staying on hormonal birth control these are for you, too):

1. Rebuild nutrient stores.

Never underestimate the power of food and nutrients to rebalance hormones, steady energy levels, and eliminate the pill’s side effects. We needed to replenish Ashley's nutrient stores, which required her to adopt a whole foods diet. We focused on anti-inflammatory, nutrient-dense foods including wild-caught fish, tons of leafy and cruciferous vegetables, and low-sugar fruits like avocado and berries. I used a professional-grade prenatal as well as anti-inflammatory nutrients like fish oil and curcumin to lower inflammation and get her hormones back on track.

2. Detox your body and support your liver.

I wanted to make sure Ashley’s liver was well-equipped to help eliminate excess estrogen and rebalance her hormones. To do that, we ramped up detoxifying foods like cruciferous vegetables and high-fiber foods like avocado and raw nuts. I also told Ashely how important it is to sweat every day, and luckily, her friend had a far-infrared sauna, and she also started doing hot yoga classes. I put her on a professionally designed detoxification plan that supplied clean protein and liver-supporting nutrients including glutathione, N-acetylcysteine (NAC), and lipoic acid.

3. Show your body AND your mind some love.

Minimizing stress, sleeping soundly, getting consistent exercise, and cultivating a can-do mindset helped Ashley reset her hormones and feel better. She gradually increased her sleep to eight hours every night, took several minutes out of her day to practice deep breathing, tried to stay more mindful and present, and began alternating burst training with yin yoga to build strength and resilience.

While these strategies become a solid foundation to eliminate birth control’s side effects, I want to emphasize the fact that everyone is unique. Eliminating birth control side effects and going off the pill demands an individualized approach. I strongly recommend finding a naturopathic or functional medicine practitioner who understands the potential side effects of being on the pill and transitioning off the pill and is comfortable addressing post-birth control syndrome.

The even better news: These are the positive side effects of coming off the pill.

If you're transitioning off the pill, we've now covered the unpleasant side effects you might be experiencing. But it’s not all bad, and there are some positive side effects of coming off hormonal birth control—like weight loss, the end of yeast infections, and a chance of getting your libido back too. Patience becomes key to feeling better here. Think about going on a detoxification program or starting a new workout program. You probably felt a little worse before you felt better, right?

While some benefits occurred almost immediately (like more energy), Ashley began noticing profound changes about two months after our initial visit. Persistence and regular visits meant we could address any lingering symptoms and help her feel better. Among those changes she noticed included:

1. A better mood.

"I still have highs and lows, but the lows aren’t so devastating," Ashley told me. She had been relying on Xanax for persistent anxiety, but she didn’t want another pill to solve her ailments. (Along with working with me, Ashley found a therapist who helped her work through some emotional issues.) Instead, we looked at what triggered her anxiety, including hormonal imbalances the pill had created. Cutting out sugar and eating a whole, anti-inflammatory diet further balanced her mood and helped her feel amazing. Over time, Ashley was able to manage her mood naturally and was feeling better than ever.

2. More pleasure with sex.

On top of having low libido, Ashley was avoiding sex because of persistent vaginal dryness, which made intercourse and using her vibrator painful. While she still needed lube (look for phthalate- and petroleum-free products!), Ashley felt less vaginal irritation and itching after being off the pill for several months. Her libido also returned ("with a vengeance," she added), which neither she nor her boyfriend was complaining about.

3. Healthy weight management.

Like many patients, Ashley gained weight on the pill. Not just weight but stubborn, refuse-to-vacate midsection belly fat that killed her confidence and made her hate her skinny jeans. Numerous diets nudged the needle a little, but that belly fat persisted. Yet once she ditched the pill, she lost 7 pounds the first month alone. And "those skinny jeans never felt so good," she shared.

4. Sustainable energy.

Those pill-robbing nutrients and hormonal imbalances can seriously crash your energy. For Ashley, that meant a steady supply of coffee and midafternoon lattes while she was on the pill. The dramatic post-pill shift occurred within several weeks. Ashley transitioned to green tea, no longer needing coffee’s caffeine to keep her revved up. Even after a grueling workday, she had the stamina to take a 6 p.m. spin class.

5. Improvements in hair, skin, and nails.

Whereas Ashley found clumps of hair in the shower drain when she was on the pill ("I’m too young for this!" she told me), within a few months of working on her diet and lifestyle, she discovered that her hair felt silkier, her nails stronger, and her skin looked significantly clearer.

About three months on my protocol, a different Ashley walked into my office. Her skin glowed, she felt stronger physically and mentally, she radiated confidence, her periods were completely manageable, and she felt mentally sharp and balanced in her moods at work and in her relationship.

Again, I want to emphasize that getting to this place takes work, but it's so worth it! It required some investigation into things like her lab work, listening to her symptoms, understanding her day-to-day habits, modifying her food plan, and addressing bumps in the road that occurred along the journey, but over time, Ashley began to feel like her body was her own again. She also discovered the amazing benefits of restoring your body from years on the pill and finally achieving hormonal balance. For the first time in 13 years, Ashley was pill-free and loving her body like never before.

Whether you’re staying on birth control, going off the pill, or struggling with post-birth control syndrome, I want you to know that I have your back. I’ve supported many woman on the same journey while they reclaim their body and break free from their dependency on hormonal birth control to manage their symptoms.

Here's why this woman felt healthier, happier, and sexier off the pill.

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