4 Reasons You May Have Lost Your Period + How To Get It Back
"Is my period ever going to come back?" Amanda asked during our initial consultation. She had gone off the pill five months ago. Since that time, her period had gone MIA.
For many women, coming off of the pill signals the beginning of unpleasant symptoms referred to as post-birth-control syndrome (PBCS), which can include moodiness, fatigue, and headaches, along with saying goodbye to regular periods1.
But to be clear: Women do not actually have periods while on birth control. Instead, what they experience is a withdrawal bleed during their placebo week. This is why going off of the birth control pill can reveal underlying menstrual irregularities.
An abnormal loss of menstruation is what medicine refers to as amenorrhea, and there are a few reasons this can happen. If you have just come off of birth control and are wondering where the heck your period is, let's break down the different types of amenorrhea and some tips for getting your period back stat.
First, what is post-pill amenorrhea?
For many women, discontinuing the birth control pill may be the first time they notice menstrual irregularities. After stopping the pill, missing periods can last for four to six months or even longer for women who previously had irregular periods. But in a woman with a previously regular period, we expect to see them return by month three.
However, we must also recognize that many women are initially given birth control for irregular or missing periods, which means that when you stop, we'd expect these same symptoms to return. This may be contributing to the higher percentage of post-pill amenorrhea statistics and is why irregular or absent periods need investigation before starting birth control.
If you're a woman who has come off of birth control and lost your period, it's important to work with a doctor to get proper lab testing to ensure there isn't another reason for your amenorrhea. Secondary amenorrhea, which is defined by the loss of a regular period for three or more months or the loss of an irregular period for six or more months, can be due to functional hypothalamic amenorrhea, hyperprolactinemia, primary ovarian insufficiency, or chronic conditions.
Other reasons your period might have gone MIA.
Prior to starting the pill, Amanda's periods had been regular and predictable, which meant her still-missing period needed further investigation.
Among its havoc, the pill depletes nutrients, raises inflammation, disrupts your stress response, affects thyroid hormones, can lead to insulin resistance, and may disturb your gut health. All of these things can affect your post-pill period (or lack thereof). Here are some of the factors I consider when working with a woman to get her period back:
Polycystic Ovary Syndrome
Nutrition and Lifestyle Factors
Lots of things can affect your period. Eating disorders or undereating, not getting the right nutrients, and super-intense exercise can certainly mess with your period. Feeling super-stressed and not sleeping enough? Definitely contributing factors for missing periods and may lead to a diagnosis of functional hypothalamic amenorrhea (FHA).
FHA is often associated with overexercising, low body weight, and stress, but it is a diagnosis of exclusion. This means that all other possible factors need to be investigated first.
The Endocrine Society guidelines4 clearly advocate against the use of the pill in women with functional hypothalamic amenorrhea solely to restore a period or even improve bone mass. They also recommend educating patients who are currently using the pill that it may mask these issues.
What to do right now to get your period back.
If you're worried that your period has gone missing for too long, it's time to go searching for it. You can start doing these eight things right now to help restore your menstrual cycle:
Try these tests.
If you've been off the pill for three months or more, and your period is nowhere in sight, talk with your health care practitioner about ordering the following tests:
- Pregnancy test. The first step for a missing period in a sexually active woman is to rule out pregnancy.
- FSH, LH, and estradiol. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are brain hormones that tell you how your brain communicates with your ovaries. An estradiol test can help you understand how your ovaries are responding to signals from that hormone.
- Prolactin. Prolactin blocks you from having your period by inhibiting the secretion of FSH. The same mechanism that causes thyroid-stimulating hormone (TSH) to go up can also elevate prolactin levels. It could be correlated with what's going on in the thyroid or due to a condition called prolactinoma, a benign brain tumor.
- Thyroid panel. If your thyroid isn't functioning properly or you're hypothyroid or hyperthyroid, it can affect your menstrual cycle, including whether or not you ovulate or get a period. This was one of the culprits in Amanda's missing periods as her labs revealed she was hypothyroid, which means the pill wouldn't have fixed the underlying cause of her missing period. Birth control can take a massive toll on your thyroid, leading to hypothyroidism and other issues that affect your entire body.
- Total and free testosterone. Elevations in testosterone can suppress ovulation and stop your period.
- Adrenals (4-point urinary cortisol and cortisone with DHEA-S). Your adrenals produce cortisol, especially during stressful times, which can decrease progesterone and leave estrogen unopposed. Your doctor may also consider testing ACTH and a morning cortisol. This provides information about how your brain is signaling and your adrenals are responding. Because we are beginning to understand how birth control can affect a woman's stress response, this is an important test to consider.
Dial in your diet.
Balancing hormones and restoring your menstrual cycle starts with what goes on the end of your fork. Whole foods—including the best sources of healthy fats and protein like wild-caught salmon—nourish your body and stabilize your blood sugar. Fill at least half your plate with fiber-rich vegetables. Aim for at least six to nine servings of vegetables per day. (If this sounds like a lot, start slow by adding one serving daily and increase each week.)
Track your symptoms.
Many of my patients track their periods (or lack thereof) and any associated problems or symptoms, which can help your health care professional better understand the overall picture of what's going on with your missing period. For Amanda, we got her going journaling her headaches, acne, energy, and the other symptoms she was experiencing.
Evaluate your exercise.
Talk to your doctor about your current routine, along with what you're eating to meet your body's needs. It's important to understand how your exercise regimen may be affecting your hormones and your health.
Give your liver some love.
Your liver is a huge player in hormonal health. Its job is to process both the hormones you make and the ones you take (like the pill) so they can be eliminated from the body. Liver-loving foods include beets, cruciferous vegetables, garlic, turmeric, and green tea. Your liver is amazing at naturally processing your hormones and the synthetic ones in birth control, but it does require the proper nutrients to do its job well.
Catch some zzz's.
When you're trying to recover a missing period, you want to support your body's circadian rhythm. Sleep quantity and quality are vital. To reset your circadian rhythm, create relaxing bedtime rituals. They might include sipping herbal tea, taking a bath, doing some light reading, stretching, or meditating. Sleep in a completely dark room, and avoid all light-emitting electronics (TV, computer, cellphone) for two hours before bed.
Manage your stress.
When it comes to things high on the period-stopping list, feeling constantly stressed ranks high. Both emotional stress and stress from illness are well recognized in their ability to make a period disappear. If this is your issue, managing stress can help you recover your missing period and optimize hormones. How you manage stress depends on what works for you. I love sharing a variety of practices with my patients like meditation, prayer, float tanks, acupuncture, massage, and even getting a mani-pedi to help you chill and master your stress response.
Get the right nutrients.
Optimal vitamins, minerals, and other nutrients help you better manage conditions like absent periods, PMS, PCOS, and PBCS symptoms. Because they work so closely with your hormones, these nutrients also play an essential part in recovering your missing period. For example, vitamin D has also been shown to play a role in women's cycles. One study5 found that 13% of women with low vitamin D (<30 ng/mL) reported amenorrhea. In women who have a history of using the pill, it is important to evaluate the key nutrients the pill depletes, which include:
• Vitamins B2, B6, B12, C, E, and folate
Any kind of zinc deficiency, for instance, will cause issues with your hormones overall and make it hard to recover your period.
Over the next few months using these strategies, Amanda was finally able to create predictable periods. By correcting her thyroid function, improving her nutrition status, getting her stress levels down, and supporting healthy digestion, she was able to recover her period. She was also able to balance her mood, boost her energy levels, and eliminate her confidence-sabotaging acne all without needing to go back on the pill.
But a heads-up: PCOS, PBCS, hypothyroidism, and the loss of your period can be a lot to navigate on your own. I recommend working with a naturopathic or functional medicine practitioner to help you understand the specific needs of your body and help you create an individualized plan for healing.
Jolene Brighten, N.D., is a women’s health expert currently working as the President and Chief Medical Officer at Rubus Health in Portland, Oregon. She received her Doctorate of Naturopathic Medicine at the National University of Natural Medicine and a bachelor’s in Nutrition Science from Cal Poly, San Luis Obispo. She is the best-selling author of Beyond the Pill, in which she shares her clinical protocols aimed at supporting women struggling with symptoms of hormone imbalance, including Post-Birth Control Pill Syndrome and birth control related side effects. Dr. Brighten has been featured in the New York Post, Cosmopolitan, Forbes, ABC News, and The Guardian.