Post–birth control syndrome is real – and the symptoms can be debilitating
Search “birth control” on TikTok, and you’ll be met with more than 130,000 videos, many of them about quitting hormonal contraception. In some, people share how doing so drastically improved their lives (“I finally feel like myself again!”), but in a significant number of posts on TikTok and beyond, others deliver a warning. They tell stories of day-to-days thrown into disarray, of mood swings, fatigue, acne, hair loss, or irregular periods. Unbeknownst to them—and to the majority of people considering, using, or stopping hormonal birth control—this kind of experience has a name.
Post–birth control syndrome, or PBCS, affects an estimated 1 in 5 women. It covers what happens when someone goes off hormonal birth control (any form but most commonly the pill) and suffers one or several of the aforementioned issues in the following days or months, says Aviva Romm, MD, author of Hormone Intelligence. To clarify, PBCS isn’t a disease or official medical diagnosis, she adds. It’s more of a catchall term that groups together and acknowledges the post-pill symptoms many people have been reporting for decades.
The science behind PBCS makes sense: Birth control works by swapping or replacing the natural hormones in your body with a steady supply of synthetic ones that usually mimic oestrogen and progesterone. This process effectively shuts off ovulation (aka the release of an egg from your ovaries), which keeps you from getting pregnant. “When you get off birth control, you lose that even dose of hormones, and your body has to recalibrate,” explains Dr. Romm. The sudden change could also send your biological systems into a tizzy.
Natalie knows this all too well. She stopped the pill cold turkey on her 30th birthday after 12 years of use. The next six months were so bad, she barely recognised herself. She was consumed by fatigue, out-of-control menstrual cycles, and feelings of anxiety and depression. She told her gynaecologist, who responded that these new symptoms were “only a problem if I wanted to become pregnant,” Natalie remembers.
Emalee, now 26, went on the pill as a teen to help manage adenomyosis, a painful condition where endometrial tissue grows into your uterine wall. When she quit after 10 years, she suffered mood swings, acne, and hair loss. “My cycle didn’t regulate for a full 18 months,” she adds. Her doctor suggested ibuprofen and... going back on the pill.
Emalee’s body eventually re-regulated. Natalie is still working through it. They both say that a lot of their angst and frustration could have been avoided had medical professionals told them about the potential for PBCS ahead of time. Doctors don’t often warn patients though, likely because to most physicians, the pill is a cure-all that goes beyond providing birth control—it can help with everything from skin issues to health conditions like polycystic ovary syndrome (PCOS). In their minds, the pros outweigh the potential cons, so the latter tend to fall off their radars.
Obviously, we’d all be better off with more information up front, and this is especially true for those whose PBCS goes deeper than a list of short-term symptoms. Taking synthetic hormones for an extended period of time, starting at an early age, “can mask chronic hormone-related conditions,” explains reproductive endocrinologist Jaime Knopman, MD.
That’s exactly what happened to Amy. She started on the pill at age 15 in an attempt to alleviate her acne. Ten years later, when she stopped, she almost immediately “knew something was wrong,” she says. “I thought I was going crazy.” She felt exhausted and moody, and her periods became painful and irregular. She bounced between doctors for nearly five years before one ordered in-depth hormone testing. The results found that her PBCS symptoms were actually the result of PCOS and a thyroid condition—both of which had been previously held in check by the birth control pill she’d been on for a decade. (While chronic conditions like Amy’s can’t necessarily be prevented, better awareness about what could happen post-pill would make ID’ing and treating them easier.)
Right now, “practitioners have to go out of their way to learn information about PBCS,” says Jolene Brighten, NMD, a naturopathic endocrinologist based in Portland, Oregon. Some do, because they believe that their patients deserve better and that the traditional “set it and forget it” mentality around birth control is a terrible standard protocol. But until change happens on an institutional level and more doctors are trained to talk to their patients about PBCS, the best thing people can do is advocate for themselves by asking questions about what could occur after they’re done taking hormonal contraception.
At the end of the day, everyone deserves the full picture about what’s happening, and what may happen, to their bodies. Experiencing PBCS can be uncomfortable, but it’s usually temporary. The lack of education around it is what can really make people suffer unnecessarily, says Dr. Knopman. “If you feel prepared for what’s coming, a lot of anxiety can be abated.”
This article is not intended to be a substitute for professional medical advice or diagnosis. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition and before taking a new medication or supplement.
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