Have you ever wondered how the birth control pill works on your body? Many women have been prescribed the pill many years ago and continue to take it every day without giving it a second thought. But the pill is relatively new to our world and its effects on the body long term are still being explored.

In fact, the pill was created in the 1960s to give women freedom to prevent pregnancy by their choice. Technically, the pill works by “tricking” the body into thinking it is pregnant. In a normal menstrual cycle, ovulation (release of an egg into the ovaries) in the female occurs when Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) peak above normal levels. Following this, Progesterone and Estrogen levels will also rise, in order to prepare for implantation of a potential embryo.

During pregnancy, progesterone and estrogen levels will stay high, to naturally prevent another ovulation while there is already an embryo in the womb. For this reason, the pill is composed of synthetic progesterone and estrogen that prevents your body from ovulating and potentially becoming pregnant!

The Ideal Timeline – How to optimize your chances of conception

Let’s say you want to get off the pill and try conceiving – how long in advance should you be planning? We’re told that ovulation and hormones return to normal immediately after stopping the pill, but is this true for everyone? There are certainly women who do become pregnant in their first cycle after the pill, but for many women, this is not the case. 

Ideally, at least 3 months after stopping the pill should be spent replenishing your body and getting ready for pregnancy. Studies have shown that the birth control pill may lead to delayed conception for the first three months after stopping pill use.¹ Other studies have shown that even for the next 4 – 10 months after, conception levels continue to be low.² Thus, some women may need even more than 3 months to prepare their bodies. 

The main reason for this is that some women may develop post-pill amenorrhea (lack of a period cycle).² It is unpredictable because for most women who stop taking the pill, their normal period cycles return within 6 months.³ But others experience a slower recovery of hormone-regulating functions. Newer research has shown that recovery can depend on many factors such as how long they were on the pill and previous hormone related issues that were “solved” (i.e. masked) by going on the pill.⁴ If you have not gotten your period back 6 months after being off the pill, consult a functional health practitioner who specializes in fertility.

Who Came First, The Chicken Or The Egg?

To be clear, there are no concrete studies showing whether the pill directly causes amenorrhea. There are, however, many studies that observe a correlation. It is possible that for some women, their bodies are so depleted of nutrients that they have a difficult time making the switch from synthetic hormones to relying on their own hormones. In addition, the synthetic “pregnancy” hormones in the pill forces physiological changes that align with pregnancy – your blood clotting abilities will increase (in case of severe bleeding during birth) and your body will take in more sugar into the cells than needed (to nourish the future baby), potentially leading to insulin resistance and high cholesterol.⁵

For others, the pill can mask their hormone imbalance issues that existed before the pill – after all, many women are prescribed the pill for conditions such as PCOS and endometriosis, or symptoms such as irregular periods and heavy bleeding. When these symptoms are masked with the pill and hormone levels are not naturally balanced, it is extremely difficult for your body to conceive healthily. In both cases, it is imperative to give your body time to restore its conceiving capabilities. Since everybody is different, you may need to talk to your functional health practitioner to determine your own needs.

Nutrient Deficiencies Caused by The Pill 

Although it is not commonly advertised, the pill can severely deplete your nutrient levels. The World Health Organization (WHO) advises women on the pill to pay attention to certain nutrients in their diet. For those that do have an adequate diet or healthy lifestyle, it is important to supplement. WHO has reported that the pill depletes levels of folate, vitamins B2, B6, B12, vitamin C, E, selenium and zinc.⁶ These micronutrients cover a range of healthy bodily functions; thus, it is important to replenish these levels as soon as possible (ideally when you are still on the pill!).

F Is For Fertility And Folate

If you’re planning to become pregnant, you’ve most likely heard of the importance of folate during pregnancy. But just how essential is it? And what is the best way to ensure you have enough? Folate in the mother’s diet is essential to prevent risks in the fetus such as neural tube defects (NTDs), preterm birth, or congenital heart disease.⁷ 

After the pill, your levels of folate are often very low, making it extremely important to supplement. In fact, Health Canada recommends that every woman of childbearing age should take a multivitamin with 400mcg of folic acid for at least 3 months before conception.⁸

However, folic acid is the synthetic form of folate, which is not as effective as a supplement containing folate.⁹ You want to look for supplements with L-methylfolate instead – they have shown to be more easily used by the body. If you take folic acid, your body will have to convert it into L-methylfolate, and 40 – 60% of the population have genes that prevent this conversion, which can be dangerous for the baby. 

Little Warrior Nutrition as well as other Functional Health Care Practitioners suggest taking 1000mcg of a methylated folate supplement daily. This can be found in a high quality prenatal such as the NFH Prenatal. If your prenatal contains folic acid, we recommend looking for a better brand that contains the methylated form. To help you, check out our Prenatal Scorecard where we have ranked the top 15 prenatals on the market and have a specific section that highlights which companies choose the high quality methylated form of folate for their product. You also want to ensure that the prenatal is providing 1000mcg of B12 so that these nutrients are well balanced. 

If you have been on the pill for a long time, have had a diet deficient in folate, experienced alcohol use disorder, have malabsorption issues, are over the age of 35, or have a family history of neural-tube defects or birth defects such as spina bifida, hydrocephalus, or mental retardation, you may benefit from adding in additional folate for a period of time to help replenish your levels.  

Strategies for Reducing Negative Effects Of Oral Contraceptives

If you were shocked by the number of nutrients depleted by the pill, do not worry. Many B complexes and prenatal supplements contain excellent formulas that can make it easy for you to replenish your body. Of course, nutrition and diet plays a large role in restoring fertility as well. Here is a list of foods to include in your diet after the pill:

• Folate – lentils, chickpeas, spinach, asparagus, rice
• B2 – almonds, eggs, spinach, chicken, beef
• B6 – potatoes with skin, turkey, poultry, avocado, salmon, spinach, banana
• B12 – clams, mussels, mackerel, beef, salmon, turkey
• Vitamin C – citrus, sweet red peppers, kiwi, strawberries, broccoli
• Vitamin E – almonds, hazelnuts, avocados, peanuts
•  Zinc – oysters, beef, turkey, beans, cashews, pumpkin seeds  
•  Selenium – brazil nuts, shrimp, salmon, brown rice, chicken, beef

In general, meals made up of a combination of proteins, healthy fats and some carbohydrates from healthy whole foods will ensure your blood sugar is stable, thus allowing your endocrine system to focus on reproductive functions rather than responding to high sugar spikes and crashes.¹⁰ 

Choosing to become a parent is undoubtedly the most important decision you will ever make, and although the steps are different for each individual, being educated and listening to your own body is key. If you believe you are ready for the next step, talk to your physician about stopping the pill and follow the steps above to start replenishing your body in preparation for conception. We are excited to support you on this incredible journey! 

References:

1. Bracken, M. B., Hellenbrand, K. G., & Holford, T. R. (1990). Conception delay after oral contraceptive use: the effect of estrogen dose. Fertility and Sterility, 53(1), 21–27. 
2. Schoenbaum, S. C., Linn, S., Rosner, B., & Ryan, K. J. (1982). Delay in conception for former 'pill' users. JAMA, 247(629). 
3. Rice-Wray, E., Correau, S., Gorodorsky, J., Esquivel, J., & Goldzieher, J.W. (1967). Return of ovulation after discontinuation. Fertil Steril, 18(212).
4. Dubofsky, C. (2019). Do you need a birth control detox? Retrieved from https://modernfertility.com/blog/birth-control-detox/. 
5. Lukes, C. L., Wachter, H., Perry, S., & Eldred, S. M. (2017). The Problem With Hormonal Birth Control: An Interview with Aviva Romm, MD. Retrieved from https://experiencelife.com/article/hormonal-birth-control-aviva-romm/. 
6. Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences, 7, 1804–1813. 
7. Greenberg, J. A., & Bell, S. J. (2011). Multivitamin Supplementation During Pregnancy: Emphasis on Folic Acid and l-Methylfolate. Reviews in obstetrics & gynecology, 4(3-4), 126–127. 
8. Health Canada. (2013). Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/publications/food-nutrition/prenatal-nutrition-guidelines-health-professionals-folate-contributes-healthy-pregnancy-2009.html. 
9. Bentley, S., Hermes, A., Phillips, A., Daoud, Y.A., & Hanna, S. (2010). Comparative Effectiveness of a Prenatal Medical Food to Prenatal Vitamins on Hemoglobin Levels and Adverse Outcomes: A Retrospective Analysis. Clinical Therapeutics, 33(2), 204-211. 
10. Garis, M. G. (2019). A psychologist's future-forward tip for handling your mistakes. Retrieved from https://www.wellandgood.com/good-advice/make-a-mistake/.