Coming off hormonal contraception without the breakouts
Standard medical treatment for women with acne is the oral contraceptive pill. But, how do you stop hormonal contraception and avoid the dreaded rebound acne?
The Pill works by shutting down the brain signals for your natural hormones and raising sex hormone-binding globulin. As the name suggests, sex hormone-binding globulin locks up hormones, so they are less active. This means your androgen levels reduce (mostly) to that of pre-puberty levels.
Less available androgens result in clear skin because androgens stimulate sebum production and enlargement of pores.
So, what happens when you want to stop hormonal contraception?
Maybe you want to start a family.
Perhaps you’re experiencing some of the side effects from the Pill such as reduced libido, weight gain, anxiety or depression.
Maybe you don’t want to be on the Pill anymore and want to see what’s happening with your natural hormones.
Rebound acne and the Pill
Rebound breakouts from coming off the Pill is defiantly a thing. Post pill acne is the reason many women are worried about stopping hormonal contraception.
That’s because the Pill does not fix the underlying reasons for your hormonal acne. It puts a brake on them, but if you haven’t addressed the cause, then things are very likely to return to how they were before the Pill.
The story usually goes something like this:
You stop the Pill. After a month or two, you get your period back. Your skin is looking good. Phew!
You hit the three to four-month mark. There are a few little breakouts, no need to worry; it’s all mostly good. Fingers crossed.
At four to six months – Noooo! The breakouts are back, perhaps worse than ever.
It’s at this point many women turn back to hormonal contraception and think that it’s their only solution for clear skin.
It’s not. But what can you do?
Why is there a delay in the acne after stopping the Pill?
First, what’s with the delay on the breakouts? Why was your skin clear for the first three months?
There’s a couple of reasons for this. The elevated sex hormone-binding globulin from the Pill takes a little while to wear off. So even though you’re not taking hormonal contraception, you’re still getting the benefit of locked up androgens.
Also, when this wears off, you can get a surge of androgens. They overshoot the mark before settling back to a lower level. It’s a double whammy less sex hormone-binding globulin and temporarily elevated androgens.
When you first come off the Pill – even though you have a monthly bleed, you may not be ovulating. Anovulatory cycles are frequent in this phase. You need to ovulate to make sufficient levels of estrogen and progesterone which keep androgens in check. Estrogen, in particular, helps suppress sebum.
Is there any way to come off the Pill and not get breakouts?
Well – nothing is 100% guaranteed. My clinical experience has shown it is possible to minimise the severity of the rebound. This involves some preparation work before stopping the Pill. The focus is on looking at what the underlying cause of your acne is and supporting that. We also address diet and lifestyle triggers of excess androgen production.
I like to start on this preparation work about two months before women stop the Pill. The aim is to optimise your overall health which will flow on to hormonal health. The five areas I focus on are:
A nourishing, nutrient-dense diet that keeps blood sugar and insulin in check. Ensuring adequate protein and healthy fats to support hormone production
The Pill is known to cause nutrient deficiencies including zinc, B Vitamins and magnesium. Zinc is particularly important as having sufficient zinc reduces testosterone from transforming into dihydrotestosterone which 3-5 times more acne promoting than testosterone.
Please don’t self supplement. Work with a qualified health professional to get assessed. For example, too much zinc can interfere with other minerals, including iron.
Support hormone detoxification pathways
To ensure hormones aren’t recirculating but are getting processed and eliminated efficiently out of the body.
Nervous system support
Implement sound stress management practices and ensure good quality sleep.
If indicated in the case history testing for insulin, thyroid and liver function so we can start to address any issues in these areas.
So, yes, there is a way to come off the Pill and reduce the likelihood of breakouts.
Hold off on the hormone testing
One final tip. Please wait to test your hormone levels.
I know many women are keen to test hormones (especially if you’re looking to start a family) but don’t do it for at least three and I would say six months after you’ve stopped the Pill. Give your cycle a chance to establish so you can get your accurate hormonal picture.
Take care and be well.
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Norelle Hentschel is an experienced naturopath with a clinic in Crows Nest, Sydney and Telehealth consults Australia wide. She has helped many women get clear skin by naturally treating the underlying cause of their acne.
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