Post-Pill Syndrome

Get your cycle and well-being back on track

Many have been through the same scenario: they stop taking the pill, look forward to life with a natural, regular cycle, but then ... nothing happens. Your period may arrive, or it may not. For some, it takes a week or two to appear, while for others, even several months. Doctors call this phenomenon "post-pill amenorrhea," or alternatively "post-pill syndrome1." However, the term "post-pill syndrome" does not refer exclusively to the absence of menstruation, i.e. amenorrhea. The "post-pill syndrome" is about the disease value that other symptoms bring with them. For example, when someone may suddenly suffer from a wide variety of mental and physical complaints, with or without amenorrhea, the diagnosis is post-pill syndrome. Common symptoms are mood swings, PMS (premenstrual syndrome), heavier or more painful menstruation, acne/unclear skin, loss of libido, vaginal dryness, breast tenderness, migraines, and digestive problems2.

Why you should not be afraid

If you feel this way, don’t worry too much at first. This is a normal adjustment process and usually takes care of itself within a few months1. If artificial hormones have controlled your cycle for months or even years, your body's own processes first have to get back into gear. Progesterone, estrogen, testosterone ... each may take a while until the interaction works again. For some, it works within a few days, while for others, it may take months or necessitate a doctor's support. Sometimes the same individual may have very different experiences with several pill breaks.

You may have benefited in more ways than one while you were taking the pill. For example, you may have enjoyed lighter, less painful periods, and clearer skin. It may be that some of these positive effects remain with you now with age and maturity. However, if you suffer from "post-pill syndrome," you may experience  significant delays in ovulation and menstruation, which is also perfectly normal. According to studies, up to 2% of all women wait three or more months for their first period after stopping the pill. In one study, as many as 6% of young participants had no periods or delayed periods during the first year after stopping the pill1.

Overall, if you feel bad psychologically or physically after stopping the pill, you should check in with your doctor. If the wait and the symptoms are troublingyou, you can feel assured that the natural balance of your fertility and other hormones are working to be restored, and you can also support your body in this process. While you are waiting for your first period after the pill, since ovulationcan happen at any time, you can begin trying for a baby right away if that’s part of your family planning journey.If you track your cycle withDaysy, you can identifywhen the first ovulation has taken place.

First self-help: Be good to yourself!

What to do with "post-pill syndrome?" Taking out the stress and not putting yourself under pressure can be the first step to improved well-being. According to current research, the pill has no long-term effect on your fertility - if you are young and healthy, your ability to conceive will probably return soon3. If more than three months have passed without ovulation and menstruation, you can get checked out by your gynecologist. They can find out if there are other causes behind the lack of periods - for example, hypothyroidism, another hormone disorder, or being underweight. They can also prescribe medication if it is necessary and useful. Your gynecologist or family doctor is also the right person to contact if you have persistent digestive problems, headaches, or psychological symptoms. If you have hair loss or skin problems, your dermatologist is the right person for you.

Most womenwith post-pill symptoms are given the all-clear: everything else is fine! After nine to twelve months, the cycles of almost all women  returned to normal1. In general,but especially if you want to have a baby soon, a healthy, low stress lifestyle is recommended after the pill. This can alleviate the symptoms of post-pill syndrome, give you mental and physical strength, and prepare your body optimally for conception.

So, if possible, it's best to treat yourself to:

  • a regular day-night rhythm and sufficient sleep
  • a light, vitamin-rich diet with lots of fresh ingredients
  • (largely) abstain from alcohol
  • a daily routine without cigarettes
  • breaks for rest and relaxation
  • regular exercise that you enjoy
  • Good reasons for nutrients, sports, sleep and supplements.

Why all this? Sleep helps you to reduce stress hormones, stabilizes your psyche, and makes (period) pain easier to bear. Fresh, light food reduces your risk of digestive problems and provides you with the nutrients you need now - including B vitamins, calcium, magnesium, iron, iodine, vitamin A, vitamin C, zinc, and folic acid. Most can be found in fruits and vegetables, vegetable oils, nuts, legumes, whole grains, salads, and sprouts. For "omnivores," high-quality meat, fatty sea fish, dairy products, and eggs are also recommended in moderation. Vegetarians and vegans can take good care of themselves with plant sources of iron and iodine or vitamin supplements.

If you want to become pregnant soon, folic acid and iron are indispensable for the undisturbed development of your baby. Overall, you need a good supply of nutrients for a stable immune system and to feel strong and well-balanced.

Alcohol and cigarettes, on the other hand, are highly detrimental to a healthy pregnancy - you probably already know that. Even beyond pregnancy, they can increase "post-pill syndrome" symptoms. This is because the "pleasure toxins" trigger inflammation in your body, which can exacerbate pain. Alcohol also puts additional strain on your liver, which is already stressed by the pill.

Exercise is recommended by all experts because it strengthens your immune system, your mental health, and has been proven to relieve period pain. There are convincing studies on some sports, for example yoga, especially with regard to period pain4. Choose activities that you enjoy and are motivated to do: running, cycling, dancing, gymnastics, swimming, or yoga are all good options. With some basic fitness, you are also well prepared for pregnancy.

Naturopathy - worth a try

Additionally, after stopping the pill, many women rely on naturopathic remedies (phytotherapeutics) that can help detoxify the liver after the long, daily dose of medication to gently rebalance hormones. These are available primarily as capsules, powders or teas, individually or in combination.  Depending on the indication, the preparations contain, for example, monk's pepper (mainly for hormonal balance against PMS and period pains), red clover (which is good in hormonal transition phases such as menopause), and/or milk thistle (considered to protect and support the liver) as well as the aforementioned vitamins5.

If you suspect a hormone disorder, vitamin or other nutrient deficiency, your family doctor or gynecologist is a good place to start and can recommend and prescribe high-dose preparations. Whether with or without medical support, the chances are excellent that your "post-pill syndrome" will soon be behind you.

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(1) Frank-Herrmann P et al.: Zyklusverhalten nach Absetzen von oralen Kontrazeptiva. J Reproduktionsmed Endokrinol. 2006;3(1):54-57. https://www.kup.at/journals/summary/5663.html

(2) https://www.christinehoffmann.de/post-pill-syndrom-und-polyzystische-ovar-syndrom-pcos/

(3) Yland JJ et al.: Pregravid contraceptive use and fecundability: prospective cohort study. BMJ 2020 (online) Nov 11;371:m3966. doi: 10.1136/bmj.m3966

(4) Yonglitthipagon P, et al.: Effect of yoga on the menstrual pain, physical fitness, and quality of life of young women with primary dysmenorrhea. J Bodyw Mov Ther. 2017 Oct;21(4):840-846. doi: 10.1016/j.jbmt.2017.01.014. Epub 2017 Feb 7.