Restore the Menstrual Cycle Post Contraceptives

Restore the Menstrual Cycle Post Contraceptives

3 September 2017 by Caitlin Armit

Contraceptives have certainly liberated women in many ways and almost all of us have used them in some form or another. For some women, when they stop using hormonal contraceptives their periods do not come back anywhere near as quickly as they thought they would. This can be a little scary because, whether or not you’re a fan of getting a period, it’s an indicator that your body is functioning as it should. Many of these patients are either seeking to have a baby or are approaching peri-menopause.

How do contraceptives prevent pregnancy?

Hormonal contraceptives prevent ovulation and therefore prevent you getting pregnant. They suppress hormones which initiate follicular development through a process called negative feedback inhibition. They also affect the thickening of cervical mucous which would normally assist the sperm in movement through the female reproductive tract as well as by reducing endometrial growth. Most contraceptives combine oestrogen and progesterone or use progesterone on its own.

What happens when you stop taking the OCP?

It takes only a couple of days for your body to eliminate these synthetic hormones regardless of how long you were using them for. Your body then starts to produce natural hormones to initiate your normal cycle. For most women it takes a few weeks to a few months for their menstrual cycle to re-start and become regular and even if your periods don’t return, it is possible that you can still be ovulating and can still become pregnant. If it takes longer than 6-12 months, it’s referred to as post-pill amenorrhea (amenorrhea is the medical term for absence of periods). It’s important to rule out the possibility of conditions such as polycystic ovarian syndrome (PCOS), hypo or hyper-thyroidism, or Cushing’s syndrome to name a few. Assuming you’re not pregnant, post-pill amenorrhea indicates a delay in the production of your natural hormones because of a communication issue with what’s called the HPG axis.

What’s the HPG axis?

The HPG axis is the Hypothalamic Pituitary Gonadal Axis – a system of communication between the hypothalamus, pituitary gland and the gonadal glands.

At the beginning of a menstrual cycle, the hypothalamus produces and releases gonadotrophin releasing hormone (GnRH). This hormone stimulates the anterior pituitary gland causing the secretion of two hormones: leutenising hormone (LH) and follicular stimulating hormone (FSH). Both of these hormones travel to the ovaries and both are peptide hormones which means that they cannot diffuse across the membrane of cells but their presence activates surface receptors on theca cells (found on the surface of follicles) and granulosa cells (found on the surface on oocytes).

Inside the ovary there is a follicle containing an oocyte – an immature ovum or egg cell. Each month, only some follicles mature and only the most mature one is ovulated around day 14 of your cycle. As these follicles are maturing, they are producing oestrogen. Oestrogen stimulates the growth and maturation of the follicle so that ovulation can take place and it also increases the growth of the endometrial lining.

At low concentrations, oestrogen has a negative feedback on the pituitary gland which inhibits the release of LH. The FSH is stimulated by low oestrogen levels and therefore FSH decreases as oestrogen rises. You can see on the diagram that in the first half of the cycle, FSH increases and then gradually decreases whereas there is a steady level of LH and then a surge just before ovulation. This means that around day 10 of your cycle, oestrogen levels are rising which creates a positive feedback to the pituitary gland to stimulate LH secretion.

At ovulation, the follicle releases the oocyte and then the dead follicle becomes called the corpus luteum. The corpus luteum inhibits GnRH and FSH and secretes three hormones – progesterone, oestrogen and inhibin. Progesterone is especially important because it causes endometrial growth – thickening the lining to prepare for conception and implantation. Towards the end of the second half of the cycle, these three hormones decrease as the corpus luteum degenerates. As these hormones decrease to a level where they cannot maintain the endometrium, GnRH increases and a new menstrual cycle begins.

So why haven’t your periods started yet?

Well if you’ve switched off a natural process for an extended period of time, it doesn’t just automatically switch back on without a hitch. For many women, there is some underlying pattern of subfertility – perhaps a thyroid issue, polycystic ovarian syndrome, perimenopause, premature ovarian failure, endometriosis, or adhesions in the cervix or uterus. These factors could have been asymptomatic or untested during the period of time that you were using hormonal contraceptives and it’s only now that you’ve stopped the hormonal contraceptive that you can see nature telling you that something’s not right. Both Western Medicine and Chinese Medicine use observations of the natural menstrual cycle as a diagnostic tool for assessing patient’s health so whilst there’s a time and a place for hormonal contraceptives, it does pose a problem in the sense that it’s taken away a natural diagnostic criteria and a natural bodily process all at once. In other absence of other medical conditions, it may just be taking a while longer than normal for this system to kick in again. It’s important that your diet and lifestyle are at their optimum state to make sure that you body is capable of having a period. This means being a healthy weight, having a nutritious diet, exercising appropriately and managing your mental and emotional health.

Does stress play a role?

It is also possible that stress is delaying the return of your periods. The hypothalamus and pituitary gland are also involved in another complex system called the Hypothalamic Pituitary Adrenal axis. The adrenal glands secrete cortisol, a major stress hormone, which in healthy individuals will rise rapidly after waking up, gradually declines during the day, rises again late afternoon and then decline into the evening and night. You have probably heard of the ‘fight’ or ‘flight’ phenomena where our body responds to stressful or life threatening situations with surges of cortisol and adrenaline in preparation to either fight the situation or flee from it. The craziness of modern lifestyle has us experiencing this fight or flight too regularly and intensely to the point where this natural response is no longer about ‘Do I fight this angry bear who’s about to kill me?’ and more about ‘How can I possibly be the ultimate mother, wife, daughter, friend, student and professional genius all at the same time and still look after myself?’

Stress Management is a skill and we’re all practicing it in our own way and in our own time. The HPA axis is incredibly important for your digestive health, fertility, mental health, immunity and more. It’s not something to be taken for granted so sometimes we need to take time for self-care and sometimes we need to make tough decisions and life changes to care for our health.

Can Chinese Medicine and Acupuncture help me?

This is a modern problem which did not exist thousands of years ago when Chinese Medicine was evolving but Chinese Medicine theory still has an understanding and explanation of the mechanisms behind this problem. The basic premise is that long term use of hormonal contraceptives which suppress natural systems in your body causes stagnation of qi and blood. The goal of Chinese Medicine is move qi and blood where it is stuck and this principle applies to a variety of health problems. In this instance, we utilise points which affect your endocrine system – brain (pituitary gland & hypothalamus), kidneys and adrenal glands, thyroid, and ovaries. Your GP or gynaecologist can guide you through the relevant testing for any underlying problems where necessary and these tests can inform our practice further.


Central Causes of Amenorrhea

The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress

Stress and Distress in Infertility among Women

Management of Post-Pill Amenorrhea

Infertility in polycystic ovary syndrome treated with acupuncture and clomiphene: a randomized controlled trial

Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial.

Acupuncture and women’s health: an overview of the role of acupuncture and its clinical management in women’s reproductive health

An evaluation of the effectiveness of acupuncture for the treatment of post-oral contraceptive menstrual irregularities and amenorrhea

Effectiveness of Acupuncture for Primary Ovarian Insufficiency: A Systematic Review and Meta-Analysis

Electroacupuncture Modulates Reproductive Hormone Levels in Patients with Primary Ovarian Insufficiency: Results from a Prospective Observational Study


Categories: Brisbane Acupuncture Blog | Women's Health Brisbane

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