WHAT TO DO WHEN YOU'VE BEEN OFF THE PILL FOR A WHILE & YOUR PERIOD STILL HASN'T COME BAC

It can take quite a while for your cycle to return at all after coming off the pill and it can also take a while for your cycle to resemble something in the normal healthy range too. However, if it's been a year (or you'd like to give your body a helping hand), then this blog is for you.

One of the things the pill does is increase something called Sex Hormone Binding Globulin, let's call it SHBG, which does exactly what it says on the tin; binds up excess sex hormones so they no longer have effect. In a healthy functioning system, this is a great way of self regulation of our sex hormone levels get too high. SHBG synthesis takes place in the liver and is stimulated by oestrogen or oestrogen like substances (such as in the much higher levels of ethanyl oestradiol and mestranol in the combined pill).

When we take the pill these levels increase to around 10 times the amount that we usually have, but unfortunately, when we come off, our levels don't always come back down to the levels that non users have.

What does this mean? In some women they may get a very delayed return of ovulation and periods and very rarely, their periods disappear for yours or even never restart.

Ok, So What's A Girl To Do?

1. Detoxify Excess Oestrogen

OK, we know that SHBG raises when oestrogen raises, so we need to take a look at any excess oestrogen first. This includes both reducing oestrogens and things that have oestrogen like effects on us.

Plastic Not So Fantastic: Some sources of excess oestrogen are plastics, in particular BPA and BPS which seem to be lurking just about everywhere, but you can avoid these by switching your plastic water bottle and food containers for glass ones, using beeswax food wraps and switching out plastic bags for re-usable fabric bags. On a side note this is better for our planet too as less plastic bags will be in our oceans. BPA is also found on the lining of cans and tins, another great reason not to eat overly processed food which is poor in nutrients.

Love Your Belly: Also, we do have to talk about body fat. Our excess abdominal fat actually produces oestrogen in levels that can raise SHBG. The good news is that these can be partially cleared from the system with exercise at the right level of intensity for you, but it does require some experimenting with a personal trainer. I know this can be a sensitive subject, including for past me who struggled with weight due to PCOS. So I'd like to add, loving your belly regardless of its size can be really freeing and an important part of your health and well being.

Gluten Shmuten: Another culprit I see a lot with excess oestrogen is gluten. Gluten is the protein found in wheat, rye, spelt and a few other grains and is what gives bread that elastic texture when you work the dough. It's also often added to sauces to thicken them faster, or to rice in restaurants to make it sticky.

Both studies and my personal experience in working with women show that reducing gluten improves conditions such as endometriosis and endometriosis type symptoms such as heavy and painful periods.

2. Support Your Liver

Taste The Rainbow: When detoxifying excess oestrogen and trying to lower SHBG, both of which are cleared by the liver, it is important to ensure that you eat plenty of leafy green veggies and other vegetables and fruits. There is a lot of controversy over cruciferous veggies in the wellness world at the moment and thyroid issues. So here is a quick guide, for most people cooking them is fine and aim for 2 portions of cooked green leafy veggies a day. But, if you do have thyroid issues, make sure you monitor your symptoms as you slowly add them in.

According to Dr Sarah Gottfried MD, we need to eat 35-45 grams of fibre a day for optimal hormonal health, mostly in vegetables (or varying colours), some fruit, nuts and beans (stoked overnight to reduce inflammation). But most of us eat around 13 grams. The fibre is particularly helpful as provides nutrients to help the liver do its job, and bulk to keep us regular, so the hormones aren't re-absorbed in their transit out of our bodies. Remember it is important to not only eat more plants but a good range of colours and varieties to get your micronutrients.

Cut the Crap: when you take in poisons, such as alcohol and caffeine, your liver prioritises eliminating these first.

Taking It Further: There are also bitters, herbs such as milk thistle and tinctures that can help with clearing your liver which you can ask an herbalist more about. Finally, you will find home made remedies such as freshly squeezed lemon in hot water and olive oil that you may find on the internet.

3. Lowering Your SHBG itself

There aren't many studies done on cycling women but it is worth trying some of these to help lower your SHBG levels.

Good carbohydrate intake of mostly vegetables, some fruit and nuts, wait does this sound familiar? Studies have shown that low carbohydrate intake diets such as Low Glycaemic Index diets, and maybe only getting your 13 grams a day, can cause higher circulating SHBG levels in women.

Mighty Minerals: Magnesium is a pretty amazing supplement, it can help with so many things such as reproductive health, cramps and help to buffer stress. However, it can also lower SHBG levels too, so make sure you have it in your multi-vitamin or pre-natal. You can also absorb magnesium through the skin with an Epsom Salt bath, magnesium spray. It is also found in foods such as dark chocolate (at least 85% cacao), dark green leafy vegetables, fish, nuts, seeds and bananas.

Zinc, another favourite mineral often touted for improving egg health and reproduction, is also known to help lower SHBG. Again, it is often in your pre-natal or women's health vitamin. It is also found in oysters, beef, lamb, spinach, cashew nuts, pumpkin and squash seeds.

Boron is a more unusual mineral that we don't often discuss but is is an important trace mineral. We need it to help metabolise other minerals such as magnesium and calcium, prevent arthritis, prevent and treat yeast infections, reduce inflammation and peri-menopausal hot flushes. Boron can help activate sex hormones and vitamin D. It can also help to reduce SHBG. Food sources of boron include: beans, prunes, apples, oranges, pears, raisins, bananas, avocado, walnuts, almonds, chickpeas and sweet potatoes.

Mind the medications: I never advocate coming off a prescription medication without consultation with your primary care physician, but it is worth bearing in mind, some medications (other than the pill) will increase SHBG and keeping an eye on how it affects your hormones and cycles. Drugs that may affect your SHBG levels (and you can check by consulting a pharmacist) include anti-fungals, statins, anti-depressants, beta blockers and hair loss drugs.

Finally as with all hormonal issues, it is important to reduce stress levels.

If you found that interesting, check out the below blogs on how kick start missing periods:

Read more about Some Tips For Coming Off The Pill

Read more about Missing Periods

Read more about Spotting