It's time to learn all those things they never taught us in health class - periods, pregnancy and pelvic floor!
I'm a women's health educator, a nerd when it comes to learning "all of the things", and my obsession is teaching women how to take control of their health and create a life they love!
Did you know that the pill was the very first medication that was prescribed to perfectly healthy women to treat something that was not a health problem?
Instead, it works by shutting down a completely natural process of the female body – ovulation.
The pill has been responsible for many changes in our society since it was first put on the market in 1960 and it’s now estimated that there are about 10 million women using the pill worldwide.
But, how well do you really know what effect that tiny little pill is actually having on your body?
Did you know that the pill was the very first medication that was prescribed to perfectly healthy women to treat something that was not a health problem?
Instead, it works by shutting down a completely natural process of the female body – ovulation. And, that little fold-out pamphlet of information that you get with all medications these days, the one that lists ingredients, how to use it and most importantly, the side effects? Well, it was the pill and the disclosure of its many side effects that led to drug companies actually having to include that information with the medication.
The pill has been responsible for many changes in our society since it was first on the market in 1960 and played an enormous role in women’s sexual revolution at that time. And it’s estimated that there are about 10 million women using the pill worldwide. But, how well do you really know what effect that tiny little pill is actually having on your body?
If you currently take hormonal contraceptives, or have in the past, how well did the doctor who first prescribed it to you actually explain what it does and its potential side effects. I certainly was never told. And to be completely honest, I don’t think I ever would have taken the pill in the first place if someone had actually sat me down and told me properly about it, and most important of all, if someone had told me that there were other options that were equally as effective.
In today’s episode I am diving deep into the pill. This episode has been a long time coming and I have so much to say that I’m breaking it up into two episodes. So, in this episode, I’m going to be talking about the pill itself, how it works, its potential long- and short-term effects on your body and your fertility, and how long it takes for your menstrual cycle to normalise and your fertility to return after stopping hormonal contraception. Then, in the next episode I’ll dive deeper into what to expect in your cycles and your fertile signs after coming off contraceptives and I’ll take you through step by step how to come off the pill and explore fertility charting as your birth control method.
So, let’s start at the beginning with how the pill actually works to prevent pregnancy. Most pills will come in a 28 day pack – that magic 28 day cycle pops up once again – and the pack has both hormone pills, usually containing both an artificial version of oestrogen and progesterone, as well as a week of sugar pills. And when you take the sugar pills, you’ll have a withdrawal bleed until you start taking the hormone pills again. But this is not a period. This was basically added in by the pill designers so that women wouldn’t freak out about not having a period at all. So they felt more normal. And because you’re not really having a period, you didn’t ovulate so there’s no need to menstruate, this means your bleeding is lighter, regular and often less painful – again, because it’s not really a period. And it does help women with symptoms of polycystic ovaries and endometriosis and it’s often prescribed for these types of concerns to make their lives more bearable and avoid scarring and damage that can occur with a menstrual cycle. It’s also been suggested that the pill can reduce your risk of uterine, ovarian and bowel cancers. See, I’m sharing the positives about the pill too – I’m being as unbiased as I possibly can here!
The pill works by ultimately over-riding our body’s normal hormone feedback system. The end result is that the body does not release the hormones that we need to stimulate the release of an egg, meaning that when we’re on the pill, we do not ovulate. As an extra backup, the pill also stops the cervix from producing that fertile quality mucus we need to keep sperm alive and get it to the egg – because if you’ve been listening to this podcast for any length of time now, you’ll have heard me say that your cervical mucus is the key to your fertility. So if you know anything about how the cervical mucus usually changes throughout a menstrual cycle, and if you don’t, I’d recommend going back and listening to the Menstrual Cycle Masterclass Series of this podcast, you would know that on any day you see this slippery, wet cervical mucus you are fertile. And any time you feel dry around your vulva or see a sticky, thick mucus, you are not fertile. Guess what kind of mucus you’re going to be seeing most days on the pill? Yep, that non-fertile sticky stuff that closes the cervix, blocks sperm and creates an inhospitable environment for them to survive. The pill also stops the uterine lining from thickening up in preparation for implantation of a fertilised egg. So basically, it stops ovulation, it stops sperm from reaching and fertilising an egg (that likely hasn’t been released), and as a final fail-safe, it stops the endometrium from thickening up so that even if an egg was released and sperm made it through to fertilise, it wouldn’t be able to settle in to the uterus and develop into an embryo.
So what this means that for the length of time that you are on hormonal contraceptives like the pill, you are effectively in a menopausal state. And whether that’s one year, five years, ten years, twenty years, you’re not ovulating, you’re not menstruating, your menstrual cycle has been switched off.
All of this just for that 5 day window of time when you could actually get pregnant.
And while for some women, especially those with irregular, unpredictable or painful periods, the pill is a blessing because it switches off those symptoms. And that’s why the pill is prescribed for so many different problems – acne, endometriosis, painful or heavy periods, the list goes on and on.
But unfortunately, it’s a band aid solution because sure it’s making the symptoms disappear, but it’s not addressing the reasons why these symptoms are appearing in the first place. So if you first go on the pill as a teenager because of period symptoms that may just be happening because your body is still getting used to having a period – if you stay on the pill for the next 10, 15 years until you’re ready to have a baby. You stop taking the pill and guess what will come back – those symptoms that were covered up when you first started taking it. And this is exactly why I recommend that women stop taking hormonal contraceptives about 2 years before they’re ready to get pregnant. And I know that is easier said than done, we don’t always know where we’ll be 2 years from now. But unfortunately this is how long it can take for some women’s periods to return to some degree of normal when they stop hormonal contraception. And this isn’t all women. I was on the pill for 10 years and my period came back within a month. But it wasn’t the normal, healthy period I see now. It was 2-3 weeks long (for some women it’s the other extreme, 2-3 months long). My cycle was really short, my periods were really light and it took months of particularly focusing on nutrition to balance my hormones and really restore my menstrual cycle to something that was natural and normal for me.
Irregular bleeding – so some women will find that they spot during their cycles or if they try to skip a period. Some feel nauseous, complain of sore boobs, headaches, bloating, skin changes, mood changes, weight gain and they all kind of sound like those typical PMS, hormonal imbalance type symptoms that we’ve heard of before right?
But there are also some serious side effects, like blood clots and deep vein thrombosis, they say if you smoke then you should not be on the pill for this reason. And blood clots can lead to stroke, heart disease. It can cause crippling migraines and headaches, high blood pressure, heart and liver disease, and it can increase the risk of breast cancer.
I’ve heard of so many women who have experienced crippling mood swings and depression on the pill. But the pill was never really considered as the reason, instead they were prescribed antidepressants. And it wasn’t until they stopped taking the pill that they noticed a shift in their moods and they no longer needed the antidepressants. And after having a baby, it’s really not recommended to go straight back on the pill for the first 6 weeks, and not while breastfeeding as it can affect your milk supply and increase your risk of clots.
And that’s not to mention to the nutritional deficiencies many women end up with after long-term pill use. The way our body absorbs nutrients from our food can be affected, and many women end up with deficiencies they never knew about. And this is another reason why it’s ideal to have a window of time to restore your normal menstrual cycle and hormonal balance before trying to conceive.
Now, I do not say these things to scare you. I’m not here to pill-bash. As I said, I was on the pill for 10 years. For some of it, it was birth control because I was taught that being on the pill was the responsible thing to do and the only real way to prevent pregnancy. And I think a lot of women my age were taught the same thing. But for a lot of that time I stayed on the pill for the convenience. It cleared up my skin. And the knowledge that my period came reliably on a Tuesday morning at around 11:00 and it would be over in 3 days. If the timing didn’t suit me, if I was travelling, I skipped it.
And shout out to my mum who sat me down at 18 and advised me against going on the pill. I was too busy being mortified that my mum knew I was having sex to pay attention to what she was really saying – increased risk of breast and endometrial cancer, blood clots, high blood pressure, depression, low libido – all these things I definitely was never told about when I asked for my first prescription.
My gripe, and I know the gripe of many women out there, is that nobody ever told us this stuff. Nobody ever warned us of the potential side effects. Ultimately, it’s about informed consent. As young women, likely still developing and our menstrual cycles are still regulating – who’s telling us about the long-term effects on our fertility and our overall health when we’re asking for a prescription because we’re discovering sex and we want to be responsible. Because high school sex ed told us that the only sure thing to avoid pregnancy is to be on the pill. That’s my gripe. Because if I had actually listened to my mum, if my doctor or pharmacist had given me more information and not just handed it over, I wouldn’t have been on it for 10 years. I wouldn’t have been on it at all.
And all women deserve the right to informed consent, to know what they’re putting in their bodies every single day. To understand that we can’t get pregnant every day and that there are simple, natural and effective methods of birth control available that are equally as effective as hormonal contraceptives.
Well, that’s the question we’re all asking at the other end of things, when we’re ready to stop or have recently stopped taking them, either because we want to explore other non-hormonal options or we’re ready to start a family. And the problem is that this varies a lot for every woman. Some women will ovulate and then get a period almost straight away, others will be waiting months for their first period, and they might end up being 2-3 month long cycles. And these cycles are so long because the body is attempting to ovulate multiple times before it’s actually successful. And if you’ve listened to the Menstrual Cycle Masterclass series, so episodes 12-15 of the podcast, where we dove in deep to each of the four phases of the menstrual cycle, you would know that we can’t move on to the luteal phase of our cycle until ovulation occurs, meaning we can’t prepare to have a period if we have not yet ovulated. So the follicular phase, that phase between our period and ovulation, ends up being far longer that we expect, and if our cycle is 60 days long, we will likely not ovulate until day 45 or 50!
If you started taking the pill purely just for birth control and you weren’t using it to manage a period problem, so if you can remember back to before you started taking the pill and your cycles were pretty normal and regular with no real concerns, you’re most likely to fall into that category of your period and ovulation returning quite quickly. So, you will ovulate a couple of weeks after stopping the pill and then will have a first period another couple weeks after that. this is most likely if you experienced regular length cycles with no dramatic symptoms before you started taking the pill and for the majority of women it should have normalised within six months. In rare cases it can take up to a year or more for ovulation to occur and periods to return, but the pill itself is not the reason why you haven’t had your period after a year. It’s because the pill was likely to have been masking an underlying condition like PCOS or thyroid issues that has caused a period not to return. This concern has probably always been there, but it’s been masked while you were on the pill.
Even if you are one of those lucky ones whose period returns quite quickly, you may still have a cycle that’s a little wonky for a few cycles until your hormones have rebalanced and your body has recovered. We’ll talk more about what to expect in your chart and what your cycle might look like in the next episode, which is part two of this one, but what you’ll likely see is hormone imbalance and likely low progesterone. It’s very common in the first couple of cycles after stopping the pill to notice abnormalities in your mucus in particular and it is also common for women to notice not much mucus for the entire cycle but this will normalise. Your regular mucus patterns will come back as your hormones rebalance.
It is also quite common for women to experience thyroid issues when coming off hormonal contraceptives, and again it’s all related to hormonal imbalance. You might notice this if you track your temperature, your temperature for the duration of your cycle might actually be a little lower than expected and this is why charting the return of your fertility when coming off the pill is so important. Because it’s pretty common for women to have been on the pill for so long that they can’t really remember what a normal menstrual cycle ever looked like before the hormones. So, they just don’t know whether there was an underlying condition pre-pill.
And so, I don’t say I don’t say these things to discourage you. Unfortunately, we just aren’t given enough information about the pill when we first consider it for birth control and it’s not until the other end of things, when we want another option, when we want to start a family, that we go looking for the answers as to why things aren’t happening like we thought they would. And it’s such a common question, women just don’t know what to expect when coming off the pill and they don’t know what’s normal and what they need to be investigating. And that can be incredibly frustrating, especially if you’re on a timeline and planning on starting a family.
One time when I was at the doctor’s getting a new script, he asked me whether I used the pill for birth control or period control. I would have been far too embarrassed to admit I was actually having sex, so I’m positive I would have told him period control. But there were no follow up questions. And it’s now, years and years later, that I think about that conversation and how different things could have been if we had actually had a conversation following on from his question, if he had actually had the answers and explanations I needed. I mean, I’d likely still be in the same position I am right now, but maybe I wouldn’t have been on the pill for 10 years out of pure convenience? How many of us didn’t even bother listing it as a regular medication we were taking when filling out forms? I’m certainly guilty of this – because it wasn’t a health problem, it didn’t count. When god knows the effect that it was having on my body.
And what about those countless other teenagers and young women who are prescribed the pill because of acne, painful periods, and other symptoms that are likely signs of an underlying health condition that probably won’t be investigated until it’s time to start trying to have a baby and things just aren’t working. I’m not here to pill-bash, there’s a lot of pill bashing in the line of work that I do, and honestly every method of contraception has its place. But I think if we were better educated about the potential side effects of the pill and it wasn’t consistently used as a band aid solution for so many problems, there wouldn’t be as many 16-17 year old females rushing out to get it as soon as they became sexually active.
And I was one of them. I became sexually active and off I went to go on the pill. Because I didn’t want to get pregnant and I thought that was the responsible thing to do. I remember when my parents found out I was sexually active; the conversation was more centred around the pill than the having sex. I have a family history of breast cancer and I vividly remember a conversation with my mum about the increased risk of breast cancer on the pill and why she stopped taking it. And sure, my parents were likely not pleased that their daughter was having sex but I was just so confused. I thought I was being responsible and doing the right thing. And here I was being told that I shouldn’t be on the pill. And I remember telling my boyfriend that I couldn’t go on the pill and so we couldn’t have sex anymore. And guess what happens when you tell a teenage boy who’s just discovered sex that he can no longer have sex? Yeah, we had a big fight full of teenage drama and angst. And I continued to take the pill and we continued to have sex. Because looking back, in my head, if you were having sex you had to be on the pill. Otherwise you’d get pregnant.
And I think that this is something that is so true about our world. From our teenage years we are taught that we only have two options – take the pill, or some method of hormonal birth control, or get pregnant. But there is another option. Learning to interpret what your body is telling you is the other option. And it’s free. And has zero side effects. And it’s equally as effective. And I know if someone had told me about this option when I was considering birth control and trying to be responsible, I would have taken the time to learn about it 10 years earlier than I actually did.
I totally get it, coming off hormonal birth control is terrifying. I have been there and it honestly took me months of consistent charting to really work through my fear of getting pregnant. This fear is real and it’s something that I think sticks with us from the moment we first learn about sex, and then when we start having sex.
This has become so ingrained in us over time that we actually forget that there are other options out there. Women believe they have no choice but to continue to take the pill right up to when they know they’re ready to get pregnant because they believe that by not taking the pill, by not taking hormonal birth control, it’s just a matter of time before they get pregnant.
And it’s this idea, that we’re just a ticking time bomb unless we’re on the pill, that keeps us on it so much longer than we need to be or that we even want to be. Because we really don’t believe there is any other alternative! I mean, what kind of a life is that?
Now don’t get me wrong, barrier methods are still extremely important in preventing sexually transmitted infection. But what happens when you’re in a committed relationship where there isn’t a risk of STDs? When you still need a reliable method of birth control? That’s where we’re taught that hormonal birth control is our only option, right? And in my sex ed experience, we were kind of taught both like, yes use a condom but condoms fail. They’re 98% effective when used correctly – but what about that 2%? They’re good as back-up. You need to be on the pill too to really make sure none of that sperm gets through, right?
And we’re basically being taught that unless the method is hormonal, it’s not really a legitimate form of birth control. Translation, unless we are willing to put our bodies in a state similar to menopause during our late teens, twenties and thirties – in what are really our prime fertile years – unless we’re doing this, we’re not really doing the whole birth control thing properly.
So let’s set the record straight and bust this myth wide open. Not only is it possible to avoid unplanned pregnancies effectively without hormones, but learning to understand your body’s fertile signs and use a method of fertility awareness as your main birth control empowers you to choose exactly how you want to manage your fertile window during every cycle. And the best part is that is can change! You can use a combination of withdrawal (another method we’re taught doesn’t work), condoms, diaphragm, abstinence on your fertile days – you can change your mind and actually do what works for you! Mix and match a couple, use them all – you have options!
And in next week’s episode, I’m going to talk the process of coming off the pill.
If you learnt something new or found value in today’s episode, I’d love to hear from you! Send me an Instagram DM, post it on your stories – share a story of yourself listening to the podcast – and let me know what you want me to talk about. This podcast is for you and so I want to talk about the things that are most important to you!
You can get today’s show notes with everything I talked about in this episode, as well as links to freebies and other related episodes at fertilityco.com.au/19
And in case you didn’t hear it in the intro I have a brand new freebie for you – my fertility roadmap! This is my super simple 3 step system to understanding your body’s natural fertile signs and pinpointing ovulation day so that you can use this knowledge to achieve (or avoid) pregnancy. If you want to say goodbye to hormonal contraceptives and the potential effects that we’ve talked about today, or if you’re ready for pregnancy and you want to improve your chances of conceiving quickly and naturally, then head over to fertilityco.com.au/roadmap, check out my brand spanking new website which I am completely obsessed with and get your hands on this roadmap.
I will see you in next week’s episode, which is the second part of today’s episode where we’ll talk specifically about how to prepare for coming off the pill and what to expect in your menstrual cycles and your fertility as your hormones re-balance and your body recovers. If you enjoyed today’s episode, you won’t want to miss Part 2.
Ok, bye for now and don’t forget that knowledge is power!
When you truly understand your body, you are empowered to make informed decisions and take control of your health! Until next time.
Want to say goodbye to hormonal contraceptives and their weird and unpleasant side effects?
Want to improve your chances of conceiving quickly and naturally?
You need my Fertility Roadmap– My simple 3-step system to understanding your body’s natural fertile signs and pinpointing ovulation day so that you can use this knowledge to achieve (or avoid) pregnancy.
Episode 20 – Coming Off The Pill (Part II)
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