I got on the birth control pill when I was 15 years old. I was living in Northern California and my mother took me to see a gynecologist right after I started my period for the first time. I don’t remember much of that appointment, but I do remember the doctor telling me that I had a condition known as Polycystic Ovary Syndrome (PCOS) and that I would “need help getting pregnant” when the time came. He then quickly wrote up a prescription for a contraceptive pill and sent me on my way. It all happened very fast and I didn’t think much of it. The idea of getting pregnant seemed like lightyears away so that didn’t worry me at all, and the notion of taking a daily birth control pill seemed easy enough. I was used to daily pill-popping back then anyway. It was the early 2000’s and antibiotic use in America was highly prevalent. It seemed like I was always being prescribed a course of antibiotics, whether it were for the common cold, teenage acne, or any other minor allergy. So my mother filled my prescription and I followed orders.
I was on the birth control pill for the next few years until I moved to Mexico to start college at 18. The stress of the move caused my Anorexia to relapse and I reached a very low body weight. I went to see a nutritionist, per my family’s advice, and the nutritionist suggested that I stop taking the birth control pill. She said that my monthly periods were causing me to lose a lot of iron that my body needed to store. Once again, I didn’t question this either, and just simply stopped taking the pill. Doing this stopped my periods from coming completely, also known as amenorrhea. So I went from having a monthly period to only having about one or two periods per year. But again, this didn’t really bother me nor did I put much thought into it.
Fast forward another few years, I was back in the US on summer vacation and went to see a different gynecologist for my yearly check-up. She did a quick examination, determined everything was fine, and then told me she was prescribing me a hormonal birth control pill. This time I asked, why? In Mexico, doctors don’t jump at the chance to put you on pharmaceutical drugs like they do in the US. I wasn’t used to taking daily pills anymore and the thought of having to refill a prescription every month sounded tedious. She told me it was “just a good idea to always be on the pill,” as if that were some sort of official explanation. So I left, decided not to get back on the birth control pill, and resumed my pill-less life.
Fast forward another few years. I was living in Paris. I went in for my yearly gynecological check-up in France for the first time and the doctor decided to do a thorough examination. She confirmed that I had PCOS and sent me on my way. There was no talk of the birth control pill. About a year and a half later, I went back in to see her because of unbearable pelvic pain and she told me that I had Endometriosis and needed to have an operation called a Laparoscopy to get the endometrial cysts removed. The whole operation was organized and finished within a week. And during my follow-up she told me that I needed to go on the birth control pill because it would “help keep the Endometriosis from coming back.” At that point, I would have done anything to prevent the horrible pelvic pain from reappearing, so back on the contraceptive pill I went.
Fast forward another five or six years. It was 2019 and I was living in Serbia. A lot of things had changed, including my relationship with my body. Over recent years, I had become a yoga teacher and started getting more in tune with myself. I began noticing how my body felt after eating different foods and how it reacted toward environmental stressors. A key realization for me was that medicine only masks symptoms; it doesn’t get to the core of the problem. In the US, we are so used to taking a pill for any minor inconvenience that it has become the new norm. In my journey toward holistic living, I’d learned what an important factor diet and lifestyle played in how I felt. This also meant digging into my daily contraceptive pill. What I discovered was how little I actually knew about the birth control pill, and how little I knew about PCOS and my menstrual cycles.
PCOS is an endocrine disorder where the reproductive hormones are out of balance. The name itself, ‘polycystic’, refers to cysts covering the ovaries, however, not all women with PCOS have cysts on their ovaries. Women with PCOS have irregular periods and/or anovulation, meaning that they almost never ovulate- which is very important for reproduction. Infertility is a common characteristic and there is no known cure or much known about the origin of PCOS. Endometriosis, on the other hand, is a disorder in which a tissue similar to the tissue that grows inside of the uterus grows outside of the uterus, like on the ovaries, the bowel, or the pelvis. Over time, this tissue cultivates and becomes inflamed and painful. It eventually breaks down and gets trapped in the pelvis, which can cause irritation, scar formation and infertility.
A typical female hormone cycle naturally lasts an average of 28 days, with higher estrogen in the first half of the cycle (Follicular phase) and higher progesterone in the second half (luteal phase).
- Day 1 of your cycle is the first day of your period, which happens because estrogen and progesterone both drop, triggering the lining of your uterus to shed, resulting in a “period” of 1–7 days. The drop in hormones also sets off a series of events: the brain releases FSH (follicle stimulating hormone), which stimulates the growth of the follicles in your ovaries to get an egg ready for ovulation.
- Day 8: Estrogen begins to rise, causing lady parts to plump up and become more pronounced, ie: fuller lips, curves, etc.
- Days 9/10: Testosterone rises, making you more in the mood for sex by elevating your libido. When you have sex you can retain the sperm for about 3–5 days, in hopes that once the egg is released you’ll become pregnant. The egg lives for only 24 hours, but you are considered fertile for 5–6 days per month.
- Days 12–14: Estrogen spikes to trigger the release of LH (luteinizing hormone), which marks the beginning of the ovulatory phase and stimulates ovaries to release an egg, a.k.a. ovulation. During this time, the egg travels down the fallopian tube and implants in the uterus if it is fertilized by the sperm, or it dissolves and passes out of the body along with the uterine lining during your period.
- Days 15–28: Progesterone becomes the prominent hormone.
Women with Polycystic Ovary Syndrome, however, have irregular periods due to a hormonal imbalance. Every month, a follicle matures and gets released by the ovaries to be fertilized, but because of the hormonal imbalance seen in PCOS, the follicle doesn’t mature or get released; it stays in the ovaries instead. High levels of testosterone interfere with the menstrual cycle and prevent ovulation. Without ovulation and the hormonal events that lead up to it, the uterus does not have the stimulation it needs to shed its lining.
Most birth control pills deliver a large synthetic dose of both, estrogen and progesterone, the entire month, which is nothing like a natural menstrual cycle where hormones fluctuate. These heightened doses of hormones suppress the pituitary gland from releasing the follicle stimulating hormone and luteinizing hormone (FSH and LH), which is how ovulation is prevented. The brain perceives that there are more than enough hormones in the body, so it diminishes the signal that would demand the body to make more. This means that there is no natural hormone rhythm and no ovulation. So when you take the week of placebo pills, you’re not actually getting a period because you never ovulated, instead it’s called ‘withdrawal bleeding’. Basically, the pill’s job is to stop your brain from communicating with your ovaries. And when your brain and ovaries aren’t communicating, it affects all your hormones and seriously wreaks havoc in the body. This can have longterm consequences.
In Jolene Brighten’s book “Beyond the Pill”, she states that 60% of women take the birth control pill for reasons other than pregnancy prevention. Many get on it to ease menstrual cramps or irregular periods. I suffered from acne as a teenager due to PCOS, and being on the hormonal contraceptive pill brought the testosterone levels down, which in turn lowered oil production and helped eliminate acne. However, all the symptoms that prompt women to get on the birth control pill mask a deeper imbalance, and all of these reasons will still be there when they get off of it, along with a bunch of new ones. As Dr. Brighten says, “the pill won’t fix your period.” These symptoms usually re-appear within 4–6 months after discontinuing pill. So instead of getting on the pill in the first place, it’s a better idea to dig deeper into the root of these imbalances and then treat the underlying cause.
To begin, it’s important to figure out which hormone imbalances you suffer from in order to be able to correct them, which is something that can’t be done while on the birth control pill since the body is being deceived by synthetic hormones. It is also possible to have multiple imbalances at once. Some examples are as follows:
- Too much estrogen- causes heavy and painful periods, fibroids, cysts on ovaries, breast tenderness, associated with an increased risk of cancer
- Too little progesterone- higher risk of infertility, anxiety, insomnia, uncontrollable crying and irregular cycles (typically shorter)
- Too much cortisol- wired and tired feeling, body is exhausted but mind can’t stop running, leads to belly fat
- Too little cortisol- linked to adrenal fatigue, leaves you feeling exhausted with a weakened immune system, you get sick all the time or have wounds that take forever to heal, chronic headaches, it can be hard to get out of bed in the morning
- Too much testosterone- commonly found in women suffering from PCOS, symptoms include oily skin and acne with lots of rage, can lose hair on head and develop hair in unwanted areas like chin/chest/abdomen
- Too little testosterone- causes you to lose muscle mass and your libido, leaves you feeling less motivated.
Other than the birth control pill disrupting your hormones, it also really burdens the liver. The liver is key to metabolism, detoxification, nutrient absorption, blood sugar balance and immune system function. It helps detoxify the body by eliminating hormones the body no longer needs, including synthetic hormones from the birth control pill. The liver has a much higher burden today than it did 100 years ago, from the cosmetics we use, to foods and alcohol we ingest, to medicine and drugs we consume.
The best way to stop burdening the liver is to get off of the pill. But if you choose to stay on it, then it can help to eat liver healthy foods like beets, broccoli, cruciferous veggies, complete protein, dandelion root tea, garlic, grapefruit, green tea, leafy greens, and turmeric, to name a few.
The gut is also highly affected while on the birth control pill. And our gut has everything to do with our hormones. We need a healthy gut to remove excess estrogen and other waste from the body. Estrogen is moved out of the body through bowels, so when gut function is compromised, estrogen goes back into circulation in your body, which can lead to bloating, cramping, heavy periods, and irritability. In other words, you have to poop every day to remove the extra estrogen. The best way to improve gut function is to get off of the pill, but if you choose to stay on it, then you can eat gut promoting foods like sauerkraut, dill pickles, water kefir, coconut yogurt, and fermented foods. This should go without saying, but it is important to stay away from dairy and lactose. No good comes from dairy and lactose.
The pill also leads to insulin resistance and elevated blood sugar in some women, as does Polycystic Ovary Syndrome. PCOS is one of the primary non-contraceptive reasons women are prescribed the pill because many doctors prescribe it to help with acne, weight gain, excessive hair growth and irregular periods. The pill is, once again, just a hormonal band-aid and doesn’t actually get to the root cause of the symptoms.
Women with PCOS already have an increased level of insulin in the blood and are more susceptible to type-2 diabetes. Insulin resistance is one of the root physiological imbalances in PCOS. This is where the pancreas needs to pump out more and more insulin in response to high blood sugar levels. This can be made worse by eating foods that cause rapid rises in insulin such as simple carbohydrates and sugar. High insulin levels tell the ovaries to make more testosterone. The most common contributor to insulin resistance is a highly refined carb and processed food diet. Women with PCOS are often told to go on medications such as Metformin to control insulin levels. Aside from medication, however, eating a low-glycemic diet can help naturally reduce insulin levels. A low-glycemic diet consists of eating foods that cause little changes to insulin levels such as whole grains, vegetables and fruit.
A healthy diet can help balance your blood sugar and hormones, but it can only help so much if you’re struggling with the inflammation caused by the pill. Inflammation causes cells to become rigid so they are no longer able to receive the signal from insulin to transport the sugar out. When all of that sugar is left to wander the bloodstream, the pancreas makes more and more insulin. Inflammation then leads to insulin resistance and high blood sugar. Hence why women with PCOS and high insulin levels are at a higher risk for type-2 diabetes.
As you can see, women with PCOS tend to have problems ovulating due to an imbalance in estrogen and progesterone. Plant-based diets encourage the consumption of vitamin and mineral-rich whole foods that can help this condition tremendously. Consuming iron-rich foods can lower the incidence of ovulatory infertility. For men, consuming a plant-based diet of lower amounts of proteins and fats along with higher amounts of carbohydrates, fruits and vegetables showed an improvement in fertility and semen quality.
If you want to get pregnant and are just getting off the pill, then it is important to remember that many nutrient depletions have occurred in the body while on the pill. You need to have time to rebuild those nutrient stores so that your health and your baby’s health can be at their best when you do get pregnant. The pill causes inflammation, which has been associated with miscarriage, so it is important to optimize your health before trying to conceive because the focus needs to be beyond simply “getting pregnant”. Growing a human is a big deal, and it takes a lot of necessary resources like nutrients, energy, healthy hormones and a well-functioning gut. A healthy and happy mother creates a healthy and happy baby. Focus your energy on your health and wellness before trying to conceive and before the baby arrives.
During my teenage years and throughout all of my twenties and early thirties, I was shocked that no doctor or health practitioner had ever asked about my diet and lifestyle. Polycystic Ovary Syndrome didn’t used to be such a common syndrome among women. When hormones and steroids started being injected into animals around the 1950’s, processed and manufactured foods became a staple in people’s diets, causing an array of hormonal disorders.
The first thing we should always do is change our lifestyle, primarily our eating habits. A holistic approach to health is the best way to establish a lifetime of health. Plant-based diets have been found to improve many health conditions associated with PCOS, including:
- Decreased insulin resistance
- Decreased risk of type-2 diabetes
- Decreased cholesterol levels
- Decreased risk of heart disease
- Decreased inflammation
- Healthier gut microbiome
You may have noticed that I am passionate about using food to manage PCOS and I am firm believer that this is always the first thing that you can do. What I like best about plant-based diets is that they are rich in nutrients and fiber, both of which have numerous health benefits on inflammation, the gut microbiome, insulin resistance and risk of disease. I was on and off the birth control pill for more than 15 years before I decided to get completely off of it in the Spring of 2019. I did a detox cleanse and slowly changed my dietary habits before going fully plant-based in late November 2019. By February 2019 I became pregnant naturally, without any of the fertility help that my gynecologists guaranteed I would need.
As a woman, I know that we are sometimes willing to suffer the worst ramifications for our freedom; in this case, taking the birth control as pregnancy prevention. And I understand if you are unable to stop taking taking the contraceptive pill. But even while on the pill, gearing toward a plant-based diet can have enormous benefits on health.
For more info on PCOS and the birth control pill:
Beyond the Pill- Dr. Jolene Brighten