130. Post-Pill Hormone Reset: Acne, Hair Loss & Ovulation Recovery

Acne and hair shedding after stopping birth control can feel alarming—but they’re often signs that your hormones are waking up and asking for support. In this episode of Cycle Wisdom, Dr. Monica Minjeur explains why post-pill acne and hair loss happen, how long it typically lasts, and when testing actually helps (and when it doesn’t). Through Allie’s story, you’ll learn how SHBG, testosterone, progesterone, nutrients, and ovulation recovery intersect—and what truly helps your skin, hair, and cycles rebalance without panic or unnecessary medications.

If post-pill symptoms are leaving you confused or discouraged, you don’t have to navigate this transition alone. At Radiant Clinic, we specialize in cycle-informed, restorative care that supports hormone recovery without masking symptoms.
 Schedule a free discovery call at radiantclinic.com to learn how we personalize care for skin, hair, and fertility health.

Transcript

Speaker: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if your acne, breakouts and hair shedding after stopping birth control, aren't your body falling apart, but your hormones finally speaking up and asking for support while they get rebalanced? Today we're going to decode post pill, acne and hair. How long it typically lasts, what to test and when, and the steps that actually help your skin and hair while restoring healthy ovulation and getting your hormones back on track. So let's start off with a story about a patient of mine who will call Allie. Now. Allie came to see me at about 26 years of age, and she had stopped taking birth control after six years because she and her husband were going to try and get pregnant within the next year. However, within six weeks of stopping birth control, she noticed significant acne breakouts and her shower drain was full of hair. She told us that every time that she brushed, she was losing handfuls of hair and she started to panic. She actually considered restarting the pill again, afraid that she had messed up her hormones for good. Luckily, a friend of hers told her that this could be just from coming off of the pill and sent us to see our clinic for additional evaluation. When she first came to see us, Allie mentioned that her first couple of cycles were a bit farther apart. One cycle lasted 35 days and the next was 40 days. Between her menstrual cycle. She was uncertain if she was actually ovulating, as she couldn't pick up on any biomarkers to say that there had been any shift and significant symptoms of, again, this acne and diffuse hair loss. She did not have any bald spots. She did not have any issues as far as cystic acne, the really deep, painful spots. So we talked through some of what's normal, what's not, and how we can approach a change that would help to transition her through this timeframe. So we started off with testing some labs initially to assess where her body might be struggling with things like thyroid dysfunction or where she might be missing out on vital nutrients. Specifically B vitamins, which are very common to see deficient while on birth control pills, as well as iron and vitamin D. After starting some supplements to help out with low vitamin D. B and borderline thyroid dysfunction. We then waited another couple of cycles off of birth control to get baseline hormones evaluated again after coming off of the birth control pill. It can take a while for your hormones to get regulated, and we didn't want to assess something too soon and make a rush judgment. So after a couple of cycles off birth control, we found that Ally's testosterone was elevated and she had low SHBG or sex hormone binding globulin, and this really was a lot of the reason why she was having so much of the acne troubles. We also found that she was continuing to struggle with low progesterone levels from poor ovulation function. And so over the next few months, we focused on balancing the hormones, improving her SHBG levels by treating the underlying thyroid dysfunction. And over the next couple of cycles, Ali's acne calm down, her hair shedding stabilized over the next five months or so, and she started to see a return of true ovulation. A couple months after seeing us. So why does this happen? Why do women have such a significant shift in change when stopping hormones? In fact, many women feel like while they were on hormones is when things should have been more crazy. But if my body is getting back to its normal baseline, why do things get so much worse? So one of the very common things that we see is that being on birth control pills will actually raise. SHBG or sex hormone binding globulin. This will actually suppress testosterone and suppress your symptoms of it. And so this can oftentimes make your skin seem more clear. You have less acne, less troubles as far as excess testosterone. However, after stopping birth control pill, that sex hormone binding globulin level will fall, although it is temporary. And your free testosterone levels will rise because it is not bound to SHBG. And so what this means is you have more circulating testosterone that's able to create issues with the acne that you didn't previously notice on the pill. For more information on SHBG, go back and listen to episode number 1 24, where I break down what is sex hormone binding globulin and how it can make a huge difference even if your testosterone levels are normal. Another reason why we see changes with coming off of birth control is the reawakening of this ovarian and hypothalamus and pituitary axis. It can oftentimes take three to six months or sometimes longer to reestablish a regular ovulatory cycle, and in the meantime, inconsistent fluctuations of estrogen and progesterone can impact oil gland production. Inflammation and hair cycling. So we do always place emphasis on focusing to try and get ovulation back on track as quickly as possible if nothing else, to stabilize the rollercoaster that can happen with this estrogen and progesterone balancing. One of the very common reasons that we see hair shedding is an in fact called telogen effluvium. Now, this is not just specific to coming off birth control pill, and in fact, we oftentimes see this telogen effluvium when you have any significant changes from a hormone standpoint or stress. So things like stopping birth control pill postpartum after delivering a baby. Significant illnesses, surgery, stressful situations, being hospitalized, having a significant change in medications or lifestyle. Any of these things can cause your hair to go into this phase of telogen, which means it's a resting phase so your hair doesn't grow. And not only does it not grow, it can continue to shed for two to three months after that stressful situation. And so when we see that, that. Improves, it can be another two or four months after the stressful situation has resolved itself before we can see things start to rebuild. So when we have hair loss from any of these stressful situations, hormone changes, illness, stress related situations, we can see that hair regrowth can be a full six months or more after that initial stressor. In fact, in many women, it can take up to a full year before they start to notice baby fine hairs that are starting to fill in throughout their hair. Now, one thing that's really important to differentiate here. Is that Telogen. Effluvium is typically going to be at least the loss of 100 hairs or more per day. Now, obviously I don't expect you to sit and count how many hairs you're losing, but if you are pulling it out by the handful, likely this is telogen effluvium. One other very important point with this is that if you have specifically bald patches or bald spots, this is not telogen effluvium, and it's really important to get with your primary care doctor or a dermatologist to assess this further because a completely bald spot is very, very different than having diffuse shedding of the hairs of your head. Now, one other big reason why you can have symptoms after coming off birth control comes to the nutrient deficiencies that can be created when you're taking the birth control pill. So we know that it can interfere with the absorption of many vital nutrients, especially your B vitamins. But also we can see problems with iron deficiency. Low protein and insulin resistance. Now, those aren't necessarily specific to all women on birth control pill, but if you had previous symptoms that were not treated, that puts you on birth control in the first place, those things will often come back. And when we see any of those issues combined, that can amplify the changes we see with acne and hair loss and can further delay the normalization of consistent ovulation. Now finally, I just want to call out that when you have acne, ovulation dysfunction, hair loss, this can oftentimes mimic polycystic ovarian syndrome for a few months. So it's really important to differentiate, again with cycle timed testing and to watch the trends over the course of three to four months before you get a label, especially coming off birth control. One of the common things we see is that women that are on the birth control pill can oftentimes have multiple follicles that develop in their ovaries, but are never released because it's designed to help block ovulation in some situations. This can even have the appearance of polycystic ovaries, and so if you have an ultrasound with the appearance of polycystic ovaries while you're on birth control, and then you come off of birth control and you're not ovulating. Those two symptoms alone may lead some doctors to give you a diagnosis of PCOS, so just make sure you're working with somebody who's looking at the big picture, who's been able to evaluate your symptoms off of birth control appropriately, especially that ultrasound, so that you don't get an inappropriate PCOS diagnosis. So how do we evaluate correctly? And again, this all comes back to the right tests at the right time. So as we discussed with Allie's case, we focused on checking some labs right away. So looking specifically at any vitamin deficiencies, thyroid dysfunction, adrenal dysfunction, and starting to correct those pieces where and when we can. When it comes to looking for some of the other hormones that are going on, sex hormone binding globulin, testosterone levels, progesterone, estrogen. If you do an early lab draw with those, your results could mislead you. And so oftentimes, even if those are checked, when somebody is just coming off birth control, we'll say we're not gonna make any decisions until we've had a few months. Off of them because if we check them right away, we're going to see inappropriate hormone levels across the board. So best to wait at least two to three months before we do that hormone testing, especially if you're going to recommend treatment. Ideally, we do have our patients all start charting their cycles right away when stopping birth control pill to make sure that we understand when ovulation returns. We always are going to consider looking at, again, all of those vitamin levels that we mentioned, but again, focusing on what are the underlying reasons or causes that somebody may be having some troubles with ovulation dysfunction if ovulation is not returning. So again, for some women it can take three to six or even 12 months before we see a regular ovulation pattern, but during this time, we want to make sure there's no other causes of ovulation dysfunction. So we check for things like. Insulin resistance or somebody who might be over exercising or stressed out too much or not eating enough food. All of these things can impair the quality of ovulation. Now, sometimes we'll utilize ultrasound, but typically only if you've gone more than six months without a return of ovulation. Again, we don't necessarily diagnose PCOS right after coming off of birth control pill, but we certainly want to consider it if it's been a prolonged time before the return of ovulation. So in the meantime, while we're waiting for all of the hormones to settle and get everything else balanced, we're definitely focusing on getting your nutrients right. Restoring any of those vitamin deficiencies that were present, correcting any underlying thyroid dysfunction that's there, but what are some other things that you can do that actually help things out in the meantime? So let's start with things you can do for your skin. Ideally, we focus on just a gentle cleanser for your skin, making sure that you're using a moisturizer that's not going to clog your pores. Always making sure to use a daily mineral-based, uh, sunscreen, especially if you're going to have any outside time. At nighttime, we wanna add in a moisturizer for overnight while you're sleeping. Now, there are other things that you can utilize depending upon the sensitivity of your skin. I typically recommend, we want to avoid anything that has a harsh scrub to it. So anything that has. Any sort of grit to it or anything that can irritate the skin can be creating a lot more inflammation. Some people do find benefit from using over the counter benzoyl peroxide, and this is oftentimes found either in cleansers or toners or moisturizers. And usually we just say, apply a very thin layer if you're going to try the benzoyl peroxide. Some people find that this is a little bit too drying, so I always say, let's watch for that. If your skin is feeling more dry when you're using it, it may not be the best fit for you. I always like to give people the heads up as well, that benzoyl peroxide will stain your clothes and your towels, so make sure that you rinse it off really well if you're using it as a wash, if you're applying it as a lotion. Use a pillowcase that you don't care if it gets stained because it will get ruined after it goes through the wash. Another thing that's helpful in many individuals is over the counter adapalene gel. Uh, now many people know this as Retin A or retinol based products, and this can do a really nice job as well with helping to even skin tone. Now, the one caution I'll give with this is that retinols are not recommended to be used when you are trying to conceive or during pregnancy. So just be cautious of that if that's on your radar. Okay. So ways that we can help to support good hair growth. Unfortunately, with Telogen Effluvium, by the time it's happening, the stressors oftentimes have already been way in the past, but things in order to help improve or eliminate or decrease your chances of the hairs. Staying in that phase would include focusing on whatever we can do to manage stress and adequate sleep when we have excess stress, whether that's emotional or physical. It will definitely impact that telogen effluvium, and continue to further prolong the return of new hair growth. We also want to make sure that your iron stores are in great shape, especially if your ferritin levels are low. We want to restore iron stores and also always add in vitamin C for absorption. I'm actually gonna have another episode talking all about low iron in a couple of weeks, so if you struggle with iron absorption, stay tuned and we'll make sure to get you all the details you need about how to replete iron stores. Another strategy that you can utilize to help with hair growth is that many women do notice a change in improvement if they're using topical minoxidil. Now, this is an over the counter product. It's available in many different brand name shampoos, but that can help if you have significant shedding. Again, as I mentioned, unfortunately, oftentimes it just takes time for your body to recover, to get past those stressors, and it can be three to six months or more before your hair enters back into that stage of regrowth, and especially if you had prolonged stressors from, you know, recurrent illnesses or if you were hospitalized or had to have surgeries or ongoing emotional stressors, not sleeping well. It can take quite some time for that hair growth to return. And then finally, we always want to make sure that we are helping to support adequate ovulation. So we ideally, we are using bioidentical progesterone timed to your cycle initially, if it's taking a while for your cycles to come back online, or if you're not having a menstrual cycle. More frequently than every 60 days or so. We sometimes do utilize progesterone to help with a withdrawal bleed before ovulation returns. Otherwise, we're always continuing to monitor for those signs of ovulation and then time your progesterone to be taken after ovulation has happened so we can help an augment that ovulation curve if you are having a weak ovulation phase. So some of the common questions we get asked with this is, how long does this all last? So as I mentioned, the acne oftentimes will calm down, but it can take a good three or four months before the hormones are firing again and balancing out to do what they need to be doing. Hair shedding will. Stabilize over the course of typically five to six months if there was no other stressors. But again, it can take a good six to 12 months or more to find that your hair is growing back nice and thick as it previously was. Another question we get asked like Allie did is Do I have to go back on the pill? Or maybe I should just restart it. My skin was so much better, and our answer is emphatically no. Although being back on the pill can suppress some of these symptoms temporarily, it doesn't resolve the underlying causes. So whether that's nutrient deficiency, insulin resistance, stressors. Sleep ovulation dysfunction, we always are going to be focusing on a true solution for those underlying causes that created issues in the first place. So we support a true reset and we know it can be challenging to get through that, but we are here to support you every step of the way. What if you truly do have PCOS, your plan is actually quite similar. However, we focus a lot on what are the other components that may be playing a role in your ovulation dysfunction. So again, many women with PCOS have troubles with insulin resist. Or perhaps with weight stabilization or ovulation dysfunction. So again, we focus on getting things back on track in order to help ovulation get back to where it needs to be, and oftentimes, all of the other pieces will continue to balance alone. And then finally, can supplements alone, get me back on track after coming off of birth control. Now, I will say a caveat yes with this because if it is matched with a particular diagnosis, so for example, if I'm iron deficient. Can I take an iron supplement? Yes. If I have insulin resistance, can myo and acetol be helpful? Yes. But across the board, I would not advocate for just taking a whole bunch of supplements without knowing what it is that you're actually treating. And that's why it's. So important to work with somebody who is knowledgeable, who can help walk you through these pieces, but more importantly, to evaluate what exactly does your body need at a particular time. How do we address the unique situation that your body is going through to get things back on track? Imagine if your post pill turbulence could be a little bit more gentle. Your acne breakouts can fade, hair shutting can settle down, and your cycle can find its regular ovulatory cycles because you supported the transition off birth control rather than just fearing it. Over the course of a few months, your skin can be more calm, your hair can start to be more full, and your charts can start to show clear ovulation all to improve health and promote fertility.

Speaker 2: 19:59

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