Tag Archive | headaches

The Good, the Bad, and the Ugly of Going OFF The Pill

So after years of yo-yo ing with the pill (at least 5 different brands) primarily to mitigate symptoms of PCOS, and also not get pregnant, I finally have had enough.  I recently opted instead to address the PCOS from a blood sugar/insulin resistance treatment method (diet changes and the addition of some key supplements, which I’ll talk about at a later date).  And I decided to get the Mirena IUD for birth control.  Best decision ever, on both fronts.

That being said, just as their are undesirable side effects of being ON the pill (depression, headaches, forgetting to take it, mood swings, nausea, etc), there can also be some great and not so great side effects while your body adjusts to going OFF the pill.

(Becca Schmidt/Flickr via Compfight)

Photo credit: (Becca Schmidt/Flickr via Compfight) Source: http://commonhealth.wbur.org/2014/09/ditching-the-pill

Like me, Veronica Thomas (guest contributor to Wbur’s Common Health: Reform & Reality) was caught off-guard by the unexpected side effects of going off the pill. And to help others avoid similar unpleasant surprises, she spoke with three experts about what to expect when you ditch the pill for another birth control method:

Of course, just as each woman has a unique reaction to the pill, she’ll also have a unique reaction to going off. According to the feminist women’s health organization Our Bodies, Ourselves, there is “enormous variability in any individual’s response to her own hormones or any synthetic hormones she takes.” One woman’s skin may break out in pimples, while another’s clears up completely.

With this disclaimer in mind, here are eight possibly unexpected changes you might experience when you cancel your monthly refill of that crinkly foil packet:

1. Most of the side effects should disappear in a few days.

First off, while many women decide to have their period before pitching the pack, it’s safe to stop taking the pill at any point. However, you should stop immediately if experiencing any serious side effects, like headaches or high blood pressure, says Dr. Jennifer Moore Kickham, the medical director of a Massachusetts General Hospital outpatient gynecology clinic.

Because they are taken daily, the synthetic hormones from oral contraceptives leave your system in a couple days. This is why you have to use another form of birth control after missing more than two doses of the pill. But it’s also why most acute side effects, like nausea, will go away pretty soon after giving the pill the boot. Other issues, such as mood swings or irregular bleeding, may take a bit longer. If they persist, you should visit your doctor to investigate possible other causes, Dr. Kickham says.

In addition to migraines, I had major stomach bloating while on the pill—a side effect so perpetual that I came to view it as normal. I also experienced anxiety and a general irritability that I’m sure my family and boyfriend didn’t particularly enjoy. Eventually, after six years of being on and off the pill, I couldn’t tolerate it anymore. I decided to ditch it for good. I felt better almost immediately. After a month, my headaches and bloating vanished. (I had no idea I could eat without my stomach inflating like a balloon!) My mood issues took a bit longer, but eventually faded away, too.

When you stop the pill after a few years, you may actually realize you were experiencing mild side effects the entire time, like bloating or breast tenderness. According to Dr. Kickham, “Some women come off and say, ‘I didn’t realize I had a low-level headache the whole time I was on the pill, and now it’s gone.’”

2. But some of the pill’s benefits will go too.

Though I may have started this story with a little pill-bashing party, oral contraceptives do have major benefits that usually outweigh any negative side effects. “The pill is an effective form of contraception with a lot of great benefits,” Dr. Kickham says. “So as long as it’s safe for patients to use and they’re not having horrible side effects, it can be a really great option.”

While about half of my friends are dumping the pill in favor of IUDs, the other half have had serious commitments with the same oral contraceptives for years with little or no side effects. “There are some women who are very sensitive to the hormones and switch a variety of times and always have some type of side effect,” says Dr. Goldberg of Planned Parenthood. “Then, other women can tolerate most formulations without much difficulty.”

Because most versions of the pill include both estrogen and progestin, it also has a number of health perks that you can’t get from progestin-only or hormone-free methods, like IUDs or condoms. In fact, many women who don’t actually need birth control take the pill for its other health benefits, like lighter periods and reduced cramping. Other benefits of the pill include some protection against: acne, PMS symptoms, iron deficiency anemia, endometrial and ovarian cancer, and additional health problems.

When you stop taking the pill, you may lose these benefits. It’s like flipping a coin. The benefits you got on the pill morph into the new side effects of being off it, whereas the side effects you had turn into benefits. The light, regular periods you had on the pill may be replaced by spotting and cramping, and your porcelain skin may turn into a pimply mess. But, on the flip side, your sex drive may return and your irritability may evaporate.

“All these choices are a balance of risks and benefits,” Dr. Kickham explains. Do the benefits tip the scale in the pill’s favor, or are the side effects weighing you down like a bag of bricks? “For any medication, if the risks or negative side effects are outweighing the benefits, then they should consider other options,” she says.

3. You’ll need to use another form of birth control. Immediately.

Protection from an unwanted pregnancy is one crucial—and obvious—benefit of the pill that will vanish almost instantly. Just as acute side effects should stop in a couple days, the contraception will too.

“Most women resume ovulation pretty quickly after stopping the pill,” Dr. Goldberg explains. “So, the most important thing for women to know is that when they stop the pill they are at risk for pregnancy almost immediately.” It’s crucial to find a new method as soon as possible without any gaps in coverage, she says.

4. Your normal period might not return for a while.

Although my teenage self would hate me for saying this, I actually looked forward to having a regular period when I went off the pill. The low-dose oral contraceptive that I had taken for the past three years made me stop having one all together. I waited for eight months. No period. I had no idea this wasn’t normal at first. I just thought it was part of transitioning off the pill.

After a number of doctor visits, blood tests and even a rather uncomfortable ultrasound, I was diagnosed with secondary amenorrhea—the absence of menstruation. I had to take two weeks of progestin-only pills, then restart the pill for a month in order to “jumpstart” my hormones and ensure my body could cycle.

I dropped the pill last September without knowing what changes to anticipate in my body. I eagerly welcomed most of them, but my unexpectedly absent period made me worry about fertility and my future. In fact, this surprising change was my impetus for writing this story.

According to the experts I spoke with, if your period hasn’t returned for three months after stopping the pill, you should visit your doctor, who can investigate other potential causes. I’m not alone in my post-pill amenorrhea. It took one of my friends nine months to regain her period after stopping the pill.

But for most women, ovulation should resume in a few days and periods should return within a couple of months. “If you stop the pill and you don’t get a regular period for a month or two, it’s just a delayed menses—give it a little more time,” Dr. Goldberg says.

Even if your period does return right away, it might be different. The pill often lightens bleeding and reduces cramping, while also making your periods more regular and predictable. According to Dr. Kickham, this is why many women love the pill.

When you stop taking the pill, you may experience irregular periods for a few months or even years, especially if you had erratic menstruation pre-pill, says Judy Norsigian, executive director of Our Bodies, Ourselves. If you had heavy, crampy periods before the pill, they might also return when you go off.

5. You may find yourself more interested in sex.

Lying down with a heating pad on your stomach is not the only thing you might be doing more of in bed. After discontinuing the pill, you may also find yourself wanting to get sexually intimate more often. The combination pill limits the amount of free testosterone in the blood, which creates anti-androgenic (“anti-masculine”) symptoms in some women, including lower libido and sexual dysfunction.

“Where the pill helps with acne and hair growth, some of my patients will come back saying ‘I don’t have the desire I used to and I don’t know why, I’ve noticed a difference,’” Dr. Kickham explains. Other women may actually experience increased libido while on the pill because it reduces their anxiety about getting pregnant.

Several studies over the past 30 years have found that oral contraceptives hinder sexual function by decreasing sexual interest and arousal, as well as the frequency of sexual intercourse and enjoyment. When you stop taking the pill there is more free testosterone in your system, so don’t be surprised if you notice a big boost in your sex drive. Reminder of No. 3 above: You need new protection right away.

6. Your skin may break out like a prepubescent teenager’s.

For the first time in a while, you’re not bloated or moody, and you’re the one initiating sex. You’re feeling confident and sexy—like a million bucks. But then, a pimple pops up on your chin. Then, a few more. Soon, you feel like a prepubescent teen desperately trying every acne face wash and zit-zapper from the drugstore. So much for that boost in libido.

This is exactly what happened to me. After years of clear skin and a mostly pimple-free adolescence, a painful mess of cystic acne covered my chin and jaw—often where hormonal acne appears in adults. The pill can help mitigate hormone-related symptoms like acne and hair growth, so when you stop taking it, these issues may, literally, surface.

Cue a visit to the dermatologist. After a couple months of very unsexy, painful acne, I finally got my skin under control with salicylic acid and spironolactone (a medication that reduces circulating androgens), but I’m left with red acne marks and blotchy skin.

Some women with post-pill acne may actually find out they have Polycystic Ovary Syndrome—a common hormonal disorder often accompanied by acne. “If a woman has been on the pill for a long time, like 10 years, other pathologies could have developed and be unmasked when she comes off,” says Dr. Goldberg. Say a woman had mild PCOS before going on the pill but wasn’t diagnosed. The pill may help improve or control the symptoms of acne and irregular periods so much that the PCOS doesn’t become apparent until she stops taking it a decade later, she says.

For many women, cystic acne is worse than any side effect they experience while taking the pill. For me, I’d still rather apply an extra coat of concealer every morning than risk ruining my relationships because of my erratic mood swings and irritability.

7. Your emotions and mood swings might get better—or worse.

Although this change is difficult to prove and slightly resembles a daytime talk-show confession, I finally feel like “myself” since ditching the pill. I have more energy and excitement about school and my relationships, and don’t find myself wanting to strangle a friend who asks about my day.

According to Judy Norsigian, mood swings, depression and general brain “fogginess” are some major reasons women go off the pill and use other birth control methods.

On the other hand, women who use the pill to treat severe PMS or premenstrual dysphoric disorder may actually experience improvements in their mood while taking it. If they have mood fluctuations related to their natural cycle, the balancing effect of the pill’s synthetic hormones can help, so mood issues may return when they go off, Dr. Kickham explains.

“It is hard to predict who will respond in what way to the variety of pills,” she says. “For instance, I’ve definitely had people call me a couple weeks after starting the pill saying, ‘I’m crying all the time, I’ve noticed a huge change in my mood.’ So we have them come off it right away, immediately.”

Since the hormones metabolize out of the system within a couple days, your mood issues should improve once you go off the pill—if it was actually to blame.

8. You might still have side effects with your new method. (Sadly, it turns out there is no perfect birth control.)

If you’re going off the pill and still need a birth control method, there are a number of other options to choose from. “I usually just go through the whole list of contraceptives and try to decide with my patients what they’re looking for based on their goals and their response to the pill,” Dr. Kickham says.

Regardless of the new method you’re choosing, sadly, no birth control is perfect. Since both the patch and the vaginal ring contain a combination of estrogen and progestin, you might have similar side effects with these that you had on the pill, like breast tenderness and nausea.

The birth control shot, which injects progestin every three months, is associated with irregular bleeding and weight gain, as well as osteoporosis. Another of its biggest drawbacks is the inability to take the hormones back out once they’re injected. Unlike the pill, the hormones will not metabolize out of the system until after the three months.

The implant, which is a matchstick-sized rod placed in your arm for up to three years, also releases only progestin. Since both the shot and implant don’t release estrogen, you might miss out on some of its perks. For instance, you won’t have the benefits of more regulated periods, reduced acne or protection against reproductive organ diseases, like endometrial cancer.

Though it has its own cult following, even the IUD—a T-shaped device placed in the uterus—is also not without fault. The ParaGard, which does not release any hormones and works for up to 10 years, is associated with heavier and crampier periods. The hormonal IUDs, Mirena and Skyla, release progestin and last for three to five years. Unlike the ParaGard, they may lighten your period and actually get rid of it entirely. But on the flip side, IUDs don’t provide the benefits linked to estrogen.

As with the pill, experts say you should stick with your new birth control method for at least three months as long as you’re not experiencing any severe side effects, since it can take that long for your body to adjust.

 

Bottom line: As with many things, trial and error comes into play to find a birth control method that suits you. Each body and its hormonal makeup differ significantly, so what works for your friend(s) may be a disaster for you (just like with dating! ha!).  Key in to how YOU feel with the method(s) you’ve tried and go with what makes you feel best.

Ciao for now!

-E

The Skinny on Artificial Sweeteners

It started out as an innocent way to save some calories…I put Equal or Splenda in my coffee and tea, used sugar-free creamers, sugar-free syrup on my pancakes, and dumped sugar-free flavored packets into my water (I’m cringing now thinking back on it). Even after I started really focusing on my health mid-way through 2006, I’m a little embarrassed to stay that I continued to use artificial sweeteners…partly because my body had become addicted, partly out of sheer habit, and partly because I was afraid that I’d blow up like a blimp if I started using real sugar, honey, maple syrup, etc.

Now until recently, when I’d heard negative things about artificial sweeteners, I pretty much swept the information under the rug. And honestly, so many people I knew used them too, so it wasn’t like I stood out like the yellow packet-toting renegade that I was…

sweeteners in coffee
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But as 2012 was coming to a close and it was time for resolutions, I started thinking about this dirty little habit I’d held onto and decided to be honest about how this crap was affecting me. I’ll start with some personal observations:

  • The more artificial sweeteners I used, the more I needed to use…what started out as 1 Splenda in a mug of coffee had turned into 3, and virtually every liquid I consumed had artificial sweeteners in it.
  • I was craving sweets all the time, and when I indulged, I was never satisfied.
  • Instead of giving in to every craving, I would just drink more coffee (with Splenda of course) or diet soda, or suck on some sugar free candies…it was becoming a vicious cycle.
  • My metabolism felt sluggish, and for the amount of exercise I was doing and as clean as I was eating, I felt like I should have been in better shape.
  • Most of the people I knew who were naturally thin and seemed healthy to me used real sugar, not Splenda (or artificial sweeteners).
  • With most things in life, if it sounds too good to be true, you should probably check into it!

Now for some of the information I finally decided to listen to about these super sweet, non-caloric chemical packets of doom:

  • Studies show that artificial sweeteners stimulate high insulin levels in the blood which promote storage of body fat (especially around the mid-section). Your body is pretty smart and prepares for the arrival of food/nutrients before anything even crosses your lips. When you trick your body and give it fake food (non-nutritive or non-caloric sweeteners), it gets understandably confused. Your taste buds sense the sweet taste from artificial sweeteners, and the pancreas secretes insulin unnecessarily. Over time, your body gets used to this and basically goes on strike (i.e. insulin resistance, type 2 diabetes, metabolic syndrome, etc).
  • Artificial sweeteners may save you calories but there is strong evidence that they promote hunger and increase your appetite–so you many end up eating more food throughout the day. You ingest artificial/calorie-free food with the intention of reducing your calorie intake, but this does not satisfy your body’s need for nutrients and energy. So, you end up feeling ferocious about eating more and more until you satisfy that need. Think about it—we’re currently surrounded by low-calorie, “health conscious foods” and diet soft drinks that contain artificial sweeteners, yet obesity is on the rise.
  • Aside from weight gain and insulin resistance, other health issues include: headaches, gastrointestinal problems, toxicity to the liver and kidneys, and increased cancer risk.

Taking into account my own personal observations, combined with the endless information on the internet and in medical studies about why artificial sweeteners are bad, I decided to give them up in 2013. I went cold turkey.

artificial is bad
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Here’s what happened:

For a week or so, I went through withdrawals—headaches, stomach cramps, mood swings, etc. But rather than making me want to go back to them, this further solidified that I’d become addicted to a poisonous chemical that was likely wreaking havoc on my insides. I stuck with it. I started using a reasonable (2 tsp or so) amount of raw sugar in my morning coffee, using honey (if anything) in my tea, and drinking plain old water. After a couple weeks, I noticed that I started craving less sweets, was eating less overall without feeling deprived, and could actually taste my food better than ever. I had more energy and actually started to feel my metabolism revving again. Now, 7 months later, I can’t believe I ever even used the fake stuff. I’d never go back…

feeling great!

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Now I’m not suggesting that you start dumping mounds of sugar in your coffee, drowning your pancakes in syrup, and eating pastries for dinner. And if you’re diabetic, you should talk to a doctor or nutritionist about managing your glucose levels and sugar intake. What I am saying is stop confusing your body. If you are craving something sweet have a little sugar, but stay away from “fake” foods. Eating a whole-foods, balanced diet and occasionally indulging in a few real sweet treats is a better alternative than tricking your body with artificial sweeteners – which ultimately leads to a sluggish metabolism, obesity, and a host of other issues.

Do yourself a favor and put down the yellow (or blue, or pink) packets of fake chemicals that are doing damage to your precious body, and eat real food for a while. Take it from a former addict, the change is SO worth it.

Ciao for now!

-E