Post-Pill Amenorrhea

Have you recently stopped taking hormonal birth control pills and haven’t gotten your period yet? You may be experiencing post-pill amenorrhea. If you’re not sure what post pill amenorrhea is or why you’ve got no period after stopping birth control, then we’ve got the article for you. Read on to learn what post pill amenorrhea is, what causes it, and when to worry. Whether you’ve recently stopped the pill, are TTC or are just managing your hormone health, we'll cover the things you need to know about your first period after stopping birth control, how to support your cycle naturally, and what to do if you need help. 

What Is Post-Pill Amenorrhea?

Amenorrhea is defined as not having a menstrual period, but an amenorrhea definition also distinguishes whether it is primary amenorrhea or secondary amenorrhea. Primary amenorrhea is when you have never gotten your first period (by the age of 15), and secondary amenorrhea is when you have previously had a period but you haven’t had one for at least 3 months. 

Post-pill amenorrhea is a type of secondary amenorrhea defined as having no menstrual period for 3 months post-pill. For most women, there’s an adjustment phase when you come off the pill, and your period will usually return within the first 3 months. But if you took the pill to regulate your menstrual cycle, perhaps because you have a history of irregular periods or PCOS, it can take even longer for your hormone production to recover. Of course, those aren’t the only reasons, and other risk factors for post pill amenorrhea include a family history of amenorrhea, being underweight or overweight, stress, chronic illness, and over-exercising.

Common reasons for a missed period include pregnancy, breastfeeding, and menopause. If it’s been longer than four to six months and you still haven’t had your period return, there may be an underlying reason. 

The main difference between post-pill amenorrhea and other types of secondary amenorrhea is that it is directly related to stopping birth control pills, as opposed to other forms of secondary amenorrhea that are the result of other medical factors. For example, hypothalamic amenorrhea is a disruption in menstruation caused by an issue with the hypothalamus (the region in the brain involved in hormone release) rather than because you stopped taking the pill.

Symptoms of Post-Pill Amenorrhea and Hormonal Imbalance

The following symptoms may indicate post-pill amenorrhea or could be a sign of a deeper hormonal imbalance.

• Menstrual irregularities - no period for three or more months after stopping the pill, no signs of ovulation such as cervical mucus changes, or LH surge.

• Skin & hair changes - acne flare ups, hair thinning or shedding, and even breast tenderness or other changes

• Mood - mood swings, irritability, heightened PMS, fatigue or low energy 

• Physical changes - digestive upset, bloating, gas, changes to weight or difficulty losing weight, and low libido

What Can Cause Post-Pill Amenorrhea?

Now that we know what post-pill amenorrhea is, let’s look at what can cause you to have no period after stopping birth control. 

As you can see, when you dig deeper there are a number of factors involved in post pill amenorrhea. Hormones affect so many processes in the body, it can be hard to pinpoint the exact cause of your symptoms. Navigating your hormone health can be especially difficult when you are dealing with no period after stopping birth control. If you’re looking for guidance, Mira’s Hormone Health Clinic offers a personalized approach to improving hormonal health and fertility. Our team of fertility experts can help you get a better understanding of your hormone health and develop a personalized action plan for post-pill recovery while offering practical and emotional support.

When to See a Doctor and What Tests to Request

If you’ve stopped birth control with no period, and after three months your period still hasn’t returned (with no credible reasons for missed period), it’s time to see your healthcare provider. To restore and manage your hormonal health, you may want to request the following tests to help you understand why your period hasn’t returned and rule out any other possible issues. Doctors typically assess the organs involved in menstrual regulation, including the hypothalamus, pituitary, ovaries, and uterus. 

Reproductive Hormone Tests

Hormone tests can provide valuable information about your fertility status as well as indicate many issues with your health. Hormones control everything, so it’s only natural that if you have no period after stopping birth control, you would get your reproductive hormones tested.

• FSH (Follicle-Stimulating Hormone): Responsible for the growth of ovarian follicles and essential for egg development. The test determines if the ovaries are functioning properly. 

• LH (Luteinizing Hormone): Triggers ovulation and is key for egg release. Testing LH can help diagnose fertility issues, pituitary gland disorders, and issues with your period.

• Estradiol (E2): A form of estrogen that regulates your cycle and egg maturation. Estradiol levels are directly related to the maturation and release of an egg, so testing can determine underlying problems with menstruation.

• Progesterone: Supports the uterine lining for a possible pregnancy. Testing can determine fertility issues as well as problems with your adrenal glands.

• AMH (Anti-Mullerian Hormone): Indicates the number of eggs left and overall ovarian reserve. This test can help determine how well you’ll respond to fertility medication, how close to menopause you are, as well as hormonal disorders like PCOS.

Androgen & PCOS Markers

PCOS can interfere with a range of hormones in the body, and in turn interfere with ovulation. This often involves elevated androgen hormone levels, especially with steroid hormones like testosterone, androstenedione, and DHEA-S. 

• Free Testosterone: Supports ovarian functioning and bone strength. Elevated testosterone (including free testosterone) levels are associated with PCOS.

• Androstenedione: Used to make estrogen and testosterone. Elevated androstenedione levels are associated with PCOS and adrenal gland disorders.

• DHEA-S (Dehydroepiandrosterone Sulfate): Also used to make estrogen and testosterone. Elevated levels are associated with PCOS and adrenal gland disorders.

Thyroid and Pituitary Screening

Both the thyroid and pituitary glands play a critical role in regulating hormones, especially to do with your period. Testing the hormones associated with these glands can help uncover underlying hormonal problems that may be contributing to post pill amenorrhea. 

• TSH (Thyroid-Stimulating Hormone): TSH helps to stimulate the production of thyroid hormones T4 and T3 that play an essential role in regulating the menstrual cycle. Testing for TSH, Free T3, and Free T4 can be used to assess thyroid function and pituitary gland function, diagnose thyroid disorders, and determine whether or not your thyroid is interfering with your cycle. 

• Prolactin: Supports lactation and breast tissue development. Elevated prolactin levels are associated with PCOS. Abnormal prolactin levels can cause symptoms like irregular menstrual cycles and may be one of the reasons for missed period. 

• Anti-TPO (thyroid peroxidase) & Anti-thyroglobulin: Elevated levels can indicate thyroid dysfunction which can lead to issues with your menstrual cycle. 

Metabolic and Insulin Markers

Irregular or absent menstrual cycles may be associated with insulin resistance. The following tests can help determine if this is impacting your hormonal balance and contributing to post-pill amenorrhea.

• Fasting Glucose and Insulin: Insulin helps regulate blood sugar levels and elevated insulin or fasting glucose levels are a sign of insulin resistance.

• HbA1C (haemoglobin A1c): Provides a long-term picture of your overall blood sugar control and helps diagnose insulin disorders.

• Glucose Challenge: Frequently used to test for gestational diabetes in pregnancy, when PCOS is suspected, it can help with early detection and risk factors for diabetes.

At-home Testing for Reproductive Hormones

At-home hormone testing typically involves collecting a sample of blood, saliva, or urine to provide insights into various hormonal levels that can play a crucial role in your menstrual cycle. These tests are for screening purposes, not for conducting diagnostic tests, but they are often less expensive than a lab and are an ideal way to initiate the process. 

Home tests are simple and discreet and can help start a conversation with your healthcare provider. For instance, Mira’s Panorama Fertility Lab Test is a simple finger prick blood test that screens your AMH, TSH, fT4, prolactin and free testosterone hormones. The test can help identify hormone imbalances that can indicate things like PCOS, fertility issues, and yes, even issues after you’ve stopped birth control with no period. 

Other Considerations

Chronic stress and the continued production of stress hormones, such as cortisol, can cause your body to experience a prolonged hormonal imbalance. This can lead to ovulation disruptions, missed periods or irregular periods. Elevated cortisol levels are associated with PCOS, so if you are experiencing no period after stopping birth control, you may want to get your cortisol tested.

Once you’ve ruled out pregnancy through hCG testing, getting your cortisol levels tested can help identify why your period has been delayed. Your hormones, in part, are regulated by the hypothalamic-pituitary-adrenal (HPA) axis, a type of “hormone communication system” that’s crucially involved in stress management. Elevated cortisol levels are associated with a condition known as hypothalamic amenorrhea (i.e. the absence of menstruation due to a disruption in the HPA axis). 

Cortisol can be measured through blood, urine, or saliva samples. A blood serum cortisol test has some limitations, but saliva tests are more than adequate. You can either get a cortisol saliva test at your doctor’s office or use a home testing option. 

Another option for cortisol testing is the Dried Urine Test for Comprehensive Hormones, also known as the DUTCH test. Although it can be seen as controversial, the DUTCH test measures cortisol metabolites along with your free cortisol pattern, melatonin, estrogen metabolites, androgen metabolites, and other basic hormones. Although test samples can be collected at home (via dried urine), an expert must review your results, as they provide a complex snapshot of your hormones at a single point in time and require interpretation.

How to Support the Return of Your Period Naturally

There are practical steps you can take to support the natural return of your period. Since what we eat can have a direct impact on our hormonal balance, it’s important to have a balanced diet. This includes a balance of healthy fats, protein, and complex carbohydrates, while also providing essential nutrients such as magnesium, zinc, B-complex vitamins, and vitamin D.

In an ideal world, these nutrients would be obtained from your diet, but the reality is that sometimes we need support from supplements and vitamins. The combination of vitamins and minerals found in Mira’s Prenatal Vitamins can help promote hormone balance in women, especially among individuals trying to conceive now or in the future. Similarly, Mira also has a supplement specifically designed for those with PCOS (but can help many others!) that supports ovarian health and promotes hormonal balance. They assist with metabolic function to help restore balance and menstrual regularity.

Lifestyle factors can play a big role in your reproductive health, so if you’ve been taking a period stopping pill for any length of time, it’s a good idea to examine some of the factors that may be influencing your hormones. 

Major lifestyle areas to address for the return of your period:

• Stress - Both physical and emotional stress can wreak havoc on hormonal balance. Try different techniques to reduce physical and emotional stress to avoid health issues.

• Exercise - Exercise helps reduce the presence of adrenaline and cortisol in your body. Aim for at least 150 minutes of “moderate-intensity” aerobic activity per week.

• Sleep - Not getting enough sleep can have a negative impact on many areas of our health, including hormones. The National Sleep Foundation emphasizes the importance of maintaining a consistent sleep schedule for optimal health and to enhance the circadian rhythm.

As you can see, the impact of lifestyle and wellness on period delays is intricately connected to your hormones. Free tools like the Mira App offer comprehensive tools for cycle tracking, even if you don’t have Mira’s at-home hormone monitor. Tracking your cycle with tools like the Mira Hormone Monitor and Mira Wands can provide valuable insights into how your hormones or lifestyle may be affecting your period. Paired with the Mira App, you can monitor and understand these fluctuations more easily, not to mention having readily available data to share with your doctor if need be.

Is This Post-Pill Amenorrhea or Something More?

Generally, a delay in your first period after stopping birth control is expected, but an extended delay could be something more. Post-pill amenorrhea can serve as a warning sign for a deeper issue so it’s important to watch for certain signs and seek medical help if needed. 

Red flags to watch for when it comes to menstrual irregularities include weight loss, extreme fatigue, as well as no signs of ovulation for three months or more. Your doctor may order a number of hormone tests to rule out conditions like hypothalamic amenorrhea, PCOS, thyroid disease, and issues with the pituitary gland, like prolactinoma.

When faced with complex hormonal issues, you may benefit from seeing an endocrinologist - a doctor that specializes in conditions related to hormones. Endocrinologists often focus on the treatment and diagnosis of conditions, whereas a functional medicine provider will focus on prevention and root cause treatment. Your healthcare provider can help you determine which route is best for you and your specific concerns.

Conclusion: Be Patient, but Proactive

Delays in your period, especially after stopping birth control, can be a normal, albeit stressful, experience. There are many reasons why you might be experiencing post-pill amenorrhea and many women have been here before. Even though you may be worried, you’re not alone and there are practical ways to try and address the issue. Be patient while you navigate the return of your first period after stopping birth control, since it can take some time to come back. Understand what’s normal for your body, but be proactive to address any underlying issues. You know when something isn’t right so it’s important not to ignore your symptoms and allow the issue to escalate. 

Frequently Asked Questions

Is it normal to miss a period on birth control?

Since the pill prevents your body from naturally making the hormones involved in ovulation and menstruation, it’s not uncommon to miss your period on birth control. 

I stopped the pill over 3 months ago, but my period still has not come back. What could be causing this and what should I do?

It can take several months for your body to start producing the necessary hormones for ovulation and menstruation again, especially if you used the pill to regulate your menstrual cycle. Take a pregnancy test just to make sure, and see your doctor if you still have no period after stopping birth control. 

I just stopped the pill. How long will it take for my period to come back?

The first period after stopping birth control can take some time to come back. Your body needs time to start producing the proper hormones, but your period will usually start a few weeks after stopping the pill.