Coming off hormonal contraception?
Whatever the reason (mental health, fertility, changes in weight, libido, nausea), we’re here for you. It will likely take some time for your body to adjust ‘back’ to its natural state and this may well affect your menstrual cycle, bleeding, and skin. Mute that Zoom chat and join us as we take a closer look at symptoms of going hormone-free.
Bleeding and skin changes
You may be experiencing some vaginal bleeding since stopping hormones. You might not have had a period for years, even for over a decade, or perhaps what you’re experiencing now is different from what you remembered. Sit tight and take notes if that's your thing as we’re kicking things off with vaginal bleeding:
Most of you will experience your first period within a few weeks. The first period after stopping the contraceptive pill is known as a "withdrawal bleed" and the following one is your natural period.
See our article on the menstrual cycle to understand all the factors at play here. Your general health, body weight, stress, exercise, and medical conditions such as polycystic ovary syndrome (PCOS), can all influence your menstrual cycle.
So, with those things in mind, your bleeding maybe just like before, or it may be somewhat different from your 'usual. 'It takes our bodies varying times to get back into our natural hormonal cycle, so you may not get to ‘normal’ for you until month 3 or 4. The main thing here is allowing your body to adjust to your new normal with regards to your reproductive hormonal cycle.
We all respond differently and need different ways to manage the side effects. Bleeding can have a huge effect on our lives, so please don’t suffer in silence, and get support when needed. We are here to inform, but if you’re concerned about anything raised, please do seek medical review.
A small number of you may experience irregular periods for a while after you’ve stopped hormonal contraception.
You don't need to get medical advice if you have always had slightly irregular periods, as often an irregular cycle is normal for an individual. However, there can be underlying causes including:
Puberty or menopause– your periods might be irregular for the first year or two when you start having periods, and also the year or two when you end having them.
Pregnancy – especially in early pregnancy (so take a test to rule this out!)
Lifestyle factors- weight loss gain, excessive exercise, or stress.
Medical conditions – such as PCOS or a problem with your thyroid gland.
If your periods don’t settle into a regular cycle within a few months, or you’re concerned about any of the above, make sure you speak with a healthcare professional. We know it’s not the easiest of times to seek medical attention, but please remember that GP practices are open and taking lots of telephone consultations.
For some of you, it may take some time until the first period after stopping hormonal contraception. If you don’t have a period within 4-6 weeks of stopping hormones, take a pregnancy test and visit your GP for a check-up. This may be completely normal for you, and it may be taking a bit of time for your hormones to get back to normal, but it’s a good idea to get checked.
Taking it back to basics, the reasons we have a menstrual cycle is in order to have a baby and therefore a reflection of being fertile. If we are not menstruating, it’s our body’s way of saying we should not be getting pregnant. The reasons are wide-ranging from bodyweight being too low to support a pregnancy, stress, causing a fight or flight reaction affecting our periods.
Medical reasons for the absence of periods (called amenorrhea) can include:
Lifestyle: stress, extreme weight loss, or excessive exercise can affect our menstrual cycles.
Low body weight: If you exercise at a high level and do not take in enough calories to expend on exercise as well as to maintain your normal menstrual cycles, your periods may stop. Energy imbalance and weight loss can disrupt our menstrual cycles by affecting the hormonal balance and function. Eating disorders can also cause an absence of periods.
Drug-induced: Mainly hormonal medications can stop normal periods, and this may be a reason you’re here – to re-establish your usual menses. ☺
Other reasons include physical or genetic abnormalities, and natural reasons such as breastfeeding or menopause.
The bleeding you’re experiencing may be heavy or painful. This may have been what your cycle was always like, but the hormonal contraception was masking this, or it may be a new thing.
Heavy periods are common, but can have a huge impact on some people’s lives. They aren't necessarily a sign something’s wrong, but there are ways to manage the physical and emotional effect that they can have on your life.
About half of you who experience heavy bleeding do not have any underlying reason for it, but the other half of you may have an underlying issue, such as:
A condition in the womb: you can have growths called fibroids which are non-cancerous and their presence causes heavy periods.
Endometriosis: this is a condition whereby the lining of the womb is found outside of the womb such as on the ovaries, and this can cause pain and heavy bleeding at the time of your period.
Pelvic Inflammatory Disease: this is an infection in the upper genital tract (the womb/ ovaries/ fallopian tube) that causes bleeding, pain, fevers, and vaginal discharge.
PCOS: a syndrome that involves cysts on the ovaries, and can affect your menstrual cycle- whether that’s being irregular or heavy
Underactive thyroid (hypothyroidism)
Medical Treatments: such as the copper coil (IUD), anticoagulant medicine (taken to prevent blood clots), some chemotherapy medication, amongst others.
Other, much less common things, include cancers and blood clotting disorders.
Your first period after coming off hormones may be so light, it’s like spotting and only just needs a pantyliner. However, some of you may experience spotting between your periods too, and sometimes this needs to be checked out.
Blood coming from the vagina is generally from the lining of your womb (the endometrium- which is what your period is), but it can also be from other areas too including the vagina, the cervix (the neck of the womb) or if you’re pregnant, from the pregnancy itself.
The main causes of spotting come from:
Ovulation: some of you have a spot of blood when you ovulate (roughly day 14 of their cycle)
Bleeding from implantation: when a fertilised egg implants into the womb- note, if you’re falling pregnant!
Trauma: any damage to the vulva, vagina, or cervix can cause bleeding. Even areas further up in the reproductive organs (such as inside the womb or fallopian tubes). Even the use of sex toys or more aggressive sex can cause some tearing in the area and lead to a spot of bleeding.
Perimenopause: this is the time around the menopause, when your periods are stopping. The average age of menopause is between 45 and 55, but some women can go through early menopause.
Uterine or cervical polyps: a small growth (usually non-worrying) that protrudes from a stalk coming from inside the womb or neck of the womb. These are normally easily removed.
- Sexually transmitted infections: some can cause bleeding, so if you’ve had unprotected sex and not been tested since, it’s worth having a check-up. Right now, in response to COVID-19, most healthcare services are experiencing limitations and it might be harder than normal to access sexual health services. If you need to see a healthcare provider it is important you seek help, but please call ahead before attending a clinic.
There are other things to keep in mind with PV bleeding, including the health of your cervix (the neck of your womb). Abnormal bleeding, such as bleeding between periods and after sex, can indicate that something may be amiss around your cervix. It could simply be a benign cyst (a fluid-filled sac that is not worrying), an STI, or it may be a sign of something more worrying. From the age of 25 in the UK, you’re invited for your cervical smear, which is a test to help prevent cervical cancer. The test screens for HPV (Human Papilloma Virus) which can lead to cervical cancer if not picked up. Read more about HPV here. It’s super important you go to them, as they’re the best way to protect yourself against cervical cancer.
The best thing to do if you’re concerned your bleeding is not normal for you, is to see a health professional. They will be able to take a detailed history and examine you to ensure everything looks healthy. ☺
Some people experience skin changes when using hormonal contraception or when coming off hormones, including acne.
If you’re prescribed hormones to help with acne, please be aware your acne may return once you stop taking hormones. Be prepared for your body to go through a detox stage as it would when any other chemical substance is removed, and in this detox you may experience skin changes.
The synthetic hormones can cause suppression of the level of sebum (oil) produced in your skin, therefore reducing outbreaks. However, in response to this restriction our body counteracts it by increasing the natural production of sebum. When you stop taking hormones, this excess sebum production continues and potentially leading to outbreaks.
The normal flow of oil in the skin may take a week or two to settle down, but for some, it can take 12-18 months. As you’ve heard a lot throughout Hormone Harmony - every person is different, and your body will regulate in its own time.
Your skin sebum production and bodies androgen hormone levels will return to normal in time, but can be a huge strain on mental health. If you’re struggling with your skin after ditching hormones, make sure to book an appointment with your GP or dermatologist for further advice.
Got any more questions? Join the HANX community and talk it out over on our no holds barred forum here or feel free to slip into our DMs, they're always open. Thinking about going hormone-free but looking for a little structure? Get your hands on a Hormone Harmony Kit, including in-depth surveys and personalised report here.