Post-Pill PCOS: What is it and how do I treat it?

Post-Pill PCOS (Type 3)

Have you recently come off hormonal birth control (HBC) and noticed your PCOS symptoms for the first time? 


It’s common for certain types of birth control to trigger the symptoms of PCOS like acne, hair changes, and irregular cycles when you stop using them. 


The good news is these are usually temporary.


The key thing to understand about this root cause is that if you had the symptoms of PCOS before going on HBC, you don’t have true Post-Pill PCOS. 


Coming off birth control can trigger your existing symptoms to flare up, however it didn’t cause your PCOS. 


In this situation, we need to dig deeper and work out what was driving your PCOS before you took birth control.


It’s common to be prescribed HBC because of the symptoms of PCOS. 


This is because the synthetic hormones can help to reduce acne and unwanted hair growth while you take HBC. 


HBC can also make you feel like you’re having a regular bleed by shutting down your ovulation (jump back to chapter two for more on why the pill can’t regulate your period).


If you were given HBC to help you deal with the symptoms of PCOS, they went away while you took HBC, but returned after you stopped, you don’t have Post-Pill PCOS – you have a different root cause. 


HBC essentially masks the symptoms of PCOS by suppressing your natural hormone levels. 


See the other chapters in this section for more information on the other three types of PCOS to work out which one you have.

"If, however, you didn’t suffer from irregular cycles, severe acne or hair changes before you started HBC and are experiencing these for the first time – you likely have Post-Pill PCOS."

This PCOS type is caused by a withdrawal from the synthetic hormones in HBC. 


Some types of HBC are more likely to cause Post-Pill PCOS than others. 


The most common are birth control pills that contain drospirenone or cyproterone. Common brands of these pills include Yaz, Yasmin, Diane, and Brenda.


Unlike the other root causes of PCOS, this type is temporary and will likely resolve in 12 to 24 months. 


In the meantime, there is plenty we can do to suppress your body’s overproduction of androgens and encourage your cycle to become regular again. 


We’ll cover this in more detail in the next section.

How does HBC cause PCOS symptoms?

The reason certain types of HBC are so commonly prescribed for acne and hair growth is because they strongly suppress your body’s production of sebum (skin oil). 

One study showed that cyproterone acetate-ethinyl estradiol containing birth control pills (like that found in Diane and Diane-35) suppress sebum to a childhood range.57

Adults need more sebum than children, so your body reacts to this by ramping up its production of oil to create enough to keep your skin healthy. 

It essentially has to work harder to get over the threshold to make enough oil. 

After a few months or years of taking the pill, your body has become accustomed to making extra sebum.

Then, when you stop taking the pill, this increased oil production can persist for several months, but this time unopposed. 

This means that you have more sebum than ever before, and more acne and hair changes than ever before. 

This tends to peak around three to six months post-pill and then begin to subside. 

If you are in the first few months after coming off the pill and experiencing extreme symptoms – hang in there and know it will improve soon!

Another potential factor contributing to Post-Pill PCOS is HBC- induced insulin resistance. 

Several studies have shown that HBC can increase insulin production.58

As you now know, excess insulin triggers our ovaries to produce extra testosterone, causing the main symptoms of PCOS. 

This usually begins whilst you are taking HBC and can persist for several months after you stop, similar to sebum production. 

As you wait for this to resolve, following the insulin resistance protocols in the next section can be helpful in improving your symptoms.

Finally, emerging research suggests that HBC has a mild antibiotic effect on your gut bacteria.59 

Alterations in healthy gut bacteria can trigger the onset of PCOS symptoms by influencing insulin sensitivity and androgen production.60

SPOTLIGHT: Janice’s Post-Pill Journey

Janice joined one of my group programs after she had been on the pill since age 14. 


Her doctor had prescribed the pill to help her manage her mild teenage acne. 


It worked – her skin was clear and she didn’t have to worry about getting pregnant before she was ready.


She had recently gotten married and at 29, decided it was time to start trying to get pregnant. 


Without giving it too much thought, Janice stopped taking the pill. She had one bleed when she first stopped, and then...nothing. 


Months went by and she had no signs of a period returning. 


To make matters worse, the acne from her teenage years came back with a vengeance! 


She visited her doctor who diagnosed her with PCOS and told her if her cycle still hadn’t come back after six months, she would need fertility treatment.


Like so many other women, Janice had gone from spending most of her life terrified of falling pregnant, to being 110% ready to have a baby NOW. 


This desire was all-consuming and she came into the group program desperate for any advice to make her cycle return naturally.


I explained to Janice that it can take several months for your body to find “normal” again after being on the pill for so many years.


We put her on an androgen blocker to manage her acne and this cleared up within a few months. 


Meanwhile, we assessed her for nutrient deficiencies and corrected these. 


Janice had regular bloating and we discovered this was driven by low stomach acid, so we added some nutritional support to improve her digestion.


Right before the looming six-month mark, Janice had her first post-pill period. 


The very next month, Janice was pregnant naturally with a healthy baby boy.

Testing for Post-Pill PCOS

Unfortunately, there is no test that can conclusively confirm Post-Pill PCOS. 


This PCOS type is specifically related to when your symptoms started. 


If you’re not sure if you had PCOS symptoms before you went on birth control, go back through the other three types, and take the quizzes to rate your likelihood of having these root causes instead of Post-Pill. 


If you are confident you have Post-Pill PCOS, you can skip ahead to chapter 15 for the core treatment for this PCOS type.

Signs of Post-Pill PCOS

There is only one essential checkbox in this section. 


If you aren’t able to tick this box, you are dealing with a different root cause of PCOS.


Read on to discover if Inflammatory PCOS is your root cause.

Free 3 min Quiz 

PCOS? Which Type Do You Have?

Post-Pill PCOS Core Treatment

Hormonal birth control (HBC), like the pill, works by shutting down ovulation in order to prevent pregnancy. 


When you stop using HBC, most women find their cycles return within a few months without a fuss.


For a smaller portion of women however, this suppression of ovulation continues for months or even years. 


Alongside this, a temporary surge in androgen production is common, particularly with brands of birth control pills that contain drospirenone or cyproterone like Yaz, Yasmin, Diane, and Brenda. 


This is why post-pill acne is a common symptom.


While your body finds balance again after being on the pill, it’s common to be given a diagnosis of PCOS. 


Unlike the other three types of PCOS, this type is temporary. 


However, the symptoms can last for up to two years. 


In the meantime, following the core treatments below will help to reduce your symptoms and speed up your return to regular cycles.

Core Treatment #1: Stay Calm and Stick With It

For many women, one of the scariest parts about coming off birth control is the acne flare ups. If you’ve ever found yourself caught in the cycle of trying to come off the pill before, you’ll relate to Ashely’s story below.

SPOTLIGHT: Ashley’s journey with post-pill acne

Ashley and I worked together after she had been on and off the pill four times in the past two years. She was ready to be free of medication and find a natural way to avoid pregnancy. 


Each time, she would boldly stop taking the pill and tell herself, “This is it – this time I’m sticking with it”. 


Then three or four months later, her skin would be flaring up so badly that in sheer desperation for relief, she would end up back on the pill.


I explained to Ashley that post-pill acne flare ups usually peak around three to six months because of the unopposed sebum production and androgen surges from your ovaries (see chapter 9).


This is why so many women give up hope and end up back on the pill at the three- to six-month mark. 


If you can wait it out just a little longer, things will improve.


Before quitting the pill again, we started Ashley on Nourished Androgen Blocker, removed some triggering foods from her diet like cow’s dairy and processed sugar and worked on some underlying gut issues she had been dealing with. 


After two months on this protocol, Ashley felt confident to stop taking the pill once and for all, knowing she had a treatment plan in place. 


She had some mild symptoms in the first few months, but nothing she couldn’t handle. 


She has now been free of HBC for more than 12 months and no longer qualifies for a PCOS diagnosis because her skin is clear and cycles are regular.


If you are currently taking HBC and planning to come off, I suggest implementing the core treatments in this chapter for around two months before stopping HBC. 


If you can do this, you will have a much easier withdrawal process with minimal symptoms.


If you have already come off HBC and are experiencing symptoms, hang in there. 


Follow the core treatment principles in this chapter, especially taking an anti-androgen supplement for quick symptom relief .

Core Treatment #2: Take An Anti Androgen Supplement

One of the major reasons we experience increased acne and hair changes after coming off the pill and other HBC is due to a temporary surge in androgens. 

The fastest, most effective way to stop these symptoms is to block your body’s production of androgens. 

A herbal blend like Nourished Androgen Blocker is a great daily treatment to use while your body regulates its androgen production. 

Once your hormone levels go back to normal (usually around 12 to 24 months) you won’t need this treatment anymore to control your symptoms.

About The Author - Tamika Woods

Tamika Woods | PCOS Author | Nourished Natural Health
Tamika Woods, Clinical Nutritionist (B.HS; B.Ed), Bestselling Author

For a decade, Tamika battled chronic acne, irregular cycles, mood swings, hair loss, painful periods, severe digestive issues and Polycystic Ovary Syndrome (PCOS). You name it - she's been there!

Tam was finally able to clear her skin, regulate her cycle, be free of period pain and fall pregnant naturally with her daughter in 2020. It took Tam 10 years and tens of thousands of dollars in tertiary education to get the answers she needed to get better.

She didn’t want other women to suffer as long as she did which is why she has dedicated her life to helping women in the same position as she was.

Tam helps women interpret what their bodies are trying to communicate through frustrating symptoms, and then develop a step-by-step roadmap to find balance again. She's here to help you get on track!

Tamika Woods is the author of the Amazon best seller PCOS Repair Protocol. She holds a Bachelor of Health Science degree (Nutritional Medicine) as well as a Bachelor of Education, graduating with Honours in both.

She is a certified Fertility Awareness Method (FAM) Educator and a certified member of the Australian Natural Therapists Association (ANTA).

Related Products

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Hormone Healing Recipes

References used for this article

Stewart ME, Greenwood R, Cunliffe WJ, Strauss JS, Downing DT. Effect of cyproterone acetate-ethinyl estradiol treatment on the proportions of linoleic and sebaleic acids in various skin surface lipid classes. Arch Dermatol Res.
1986;278(6):481-485.

Cortés ME, Alfaro AA. The effects of hormonal contraceptives on glycemic regulation. Linacre Q. 2014;81(3):209-218.

Khalili H. Risk of Inflammatory Bowel Disease with Oral Contraceptives and Menopausal Hormone Therapy: Current Evidence and Future Directions.
Drug Saf. 2016;39(3):193-197.

 Jobira B, Frank DN, Pyle L, et al. Obese Adolescents With PCOS Have
Altered Biodiversity and Relative Abundance in Gastrointestinal Microbiota. J
Clin Endocrinol Metab. 2020;105(6):e2134-e2144.

Ulvestad M, Bjertness E, Dalgard F, Halvorsen JA. Acne and dairy products in adolescence: results from a Norwegian longitudinal study. J Eur Acad Derma-
tol Venereol. 2016;31(3):530-535.

Melnik BC. Diet in acne: further evidence for the role of nutrient signalling in
acne pathogenesis. Acta Derm Venereol. 2012;92(3):228-231.

Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci.2013;17(13):1804-1813.

Cervantes J, Eber AE, Perper M, Nascimento VM, Nouri K, Keri JE. The role
of zinc in the treatment of acne: A review of the literature. Dermatol Ther. 2017;31(1). doi:10.1111/dth.12576

Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis –
back to the future? Gut Pathog. 2011;3(1):1-1.

Takeyama M, Nagareda T, Takatsuka D, et al. Stimulatory effect of prolac-
tin on luteinizing hormone-induced testicular 5 alpha-reductase activity in hypophysectomized adult rats. Endocrinology. 1986;118(6):2268-2275.
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Core Treatment #3: Avoid Cow’s Dairy

Cow’s dairy (but not sheep and goat) contains a protein called A1 casein, which in some women causes significant inflammation. 

This occurs even if you don’t have gastrointestinal symptoms when you eat dairy (such as gas or diarrhea). 

Gut symptoms from dairy are more commonly related to the lactose content, rather than inflammation. 

A1 casein has been linked with several inflammatory conditions including acne.8

Unfortunately, there is no simple blood test to check if A1 casein is an issue for you. 

A common sign that you have an issue with A1 casein that I learned from Dr Lara Briden38 is a history of recurrent upper respiratory infections during childhood. 

This includes chronic tonsillitis, ear infections, or bronchitis when you were younger. 

Researchers suspect that the inflammation associated with A1 casein contributes to immune conditions as well as acne.

Consider removing all cow dairy products (including yogurt, cheese, ice cream, and milk) from your diet for a minimum of three months to observe the difference. 

The exception to this rule is butter and ghee – the fat content in these products is so high that very little protein is present. 

You can also enjoy all sheep and goat milk products like cheese and yogurt, along with the many plant-based options now on the market like coconut, oat, and almond milks. 

Sheep and goat milk contain predominantly A2 protein, so will not cause the inflammatory acne effect.

If you are still taking HBC and preparing to come off, I suggest removing cow’s dairy for two to three months before stopping the pill, and continuing for at least three months after coming off to minimize acne flare ups.

Core Treatment #4: Reduce High-Dose Fructose

Eating large amounts of a particular type of sugar called fructose has been shown to worsen acne.83 

High-dose fructose is found in table sugar (the kind that’s used to bake cookies and cakes and added to your coffee and tea) and high-fructose corn syrup (the kind that you’ll find in popular sodas). 

It is also found in some natural sweeteners that are often touted as being a “healthy alternative” like coconut sugar, agave, fruit juice, honey, dates, and dried fruit.

Fructose is present in whole fruit, however this doesn’t contribute to acne because the amount is much lower than the processed sugars above. 

Whole fruit also contains fiber and other nutrients which negate the effects of fructose. 

This type of sugar is low-dose fructose and is not a concern.

I’ve covered fructose and how to lower your sugar intake in depth in the Core Treatment for Insulin Resistance in chapter 13, if you’d like to dive deeper into this. 

For post-HBC acne, I recommend reducing dessert foods to once per week while your skin heals. 

If you struggle with sugar cravings, check out your bonus resource: Kick Your Sugar Cravings.

Core Treatment #5: Replenish Depleted Nutrients

The oral contraceptive pill has been shown to deplete your body of essential nutrients including zinc, magnesium, B-vitamins, and selenium.84 

Zinc and magnesium in particular are crucial for regular ovulation and hormone balance.

Zinc is an ideal treatment for coming off HBC because it kills bacteria in your skin that leads to acne, reduces sebum production, lowers androgens, improves hirsutism (facial hair), and nourishes your ovarian follicles to promote regular periods.85

I designed Nourished Period Repair + Regulate to replenish the vitamins and minerals lost whilst taking birth control. 

It includes vitamins B1, B3, B5, B6, and B12 along with a therapeutic dose of zinc and dong quai; a herb traditionally used to promote regular cycles and clear skin.

Supplementing a high quality multivitamin that is designed to support female hormones like Period Repair + Regulate for around six months is a great way to address the nutrient deficiencies that may be contributing to your Post-Pill PCOS symptoms.

Core Treatment #6: Support Your Gut Health

Research shows that the pill has a mild antibiotic effect on your gut microbiome.59 

We also know that 40% of women who take the pill have low stomach acid levels.86 

If you are dealing with gastrointestinal issues like bloating, alternating bowel patterns, heartburn, or indigestion, working on your gut health is important. 

Imbalanced gut bacteria can lead to gastrointestinal inflammation, further worsening acne and hormonal imbalances. 

Check out your bonus resource Beat The Bloat for my three-step protocol to healing gut issues.

Extra Considerations:

Do you have high prolactin on blood tests? 

Prolactin causes androgen excess symptoms like acne and hirsutism by upregulating the 5-alpha-reductase enzyme – causing more testosterone to be converted to its super potent cousin, DHT.87 

If you have elevated prolactin and normal LH on blood tests after coming off the pill, the herbal medicine Vitex can powerfully reduce prolactin and promote regular periods.

Important note: You should not take vitex if you have raised LH. 

Vitex can cause LH production to increase, which worsens the symptoms of PCOS when used in the wrong situations. 

If you are unsure, speak to your practitioner for more advice.

If you have raised LH, the best treatment for you is a herbal medicine like dong quai that supports the regulation of LH and FSH. 

You can find a therapeutic dose of dong quai in Nourished Period Repair + Regulate.

SUMMARY: Core Treatments for Post-Pill PCOS

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About The Author - Tamika Woods

Tamika Woods | PCOS Author | Nourished Natural Health
Tamika Woods, Clinical Nutritionist (B.HS; B.Ed), Bestselling Author

For a decade, Tamika battled chronic acne, irregular cycles, mood swings, hair loss, painful periods, severe digestive issues and Polycystic Ovary Syndrome (PCOS). You name it - she's been there!

Tam was finally able to clear her skin, regulate her cycle, be free of period pain and fall pregnant naturally with her daughter in 2020. It took Tam 10 years and tens of thousands of dollars in tertiary education to get the answers she needed to get better.

She didn’t want other women to suffer as long as she did which is why she has dedicated her life to helping women in the same position as she was.

Tam helps women interpret what their bodies are trying to communicate through frustrating symptoms, and then develop a step-by-step roadmap to find balance again. She's here to help you get on track!

Tamika Woods is the author of the Amazon best seller PCOS Repair Protocol. She holds a Bachelor of Health Science degree (Nutritional Medicine) as well as a Bachelor of Education, graduating with Honours in both.

She is a certified Fertility Awareness Method (FAM) Educator and a certified member of the Australian Natural Therapists Association (ANTA).

Related Products

Sale Off
Nourished Period + PMS Repair - Nourished Natural Health
$29.00$29.00
Sale Off
Nourished Hormone Detox + Digestion - Nourished Natural Health
$29.00$29.00

Hormone Healing Recipes

References used for this article

Stewart ME, Greenwood R, Cunliffe WJ, Strauss JS, Downing DT. Effect of cyproterone acetate-ethinyl estradiol treatment on the proportions of linoleic and sebaleic acids in various skin surface lipid classes. Arch Dermatol Res.
1986;278(6):481-485.

Cortés ME, Alfaro AA. The effects of hormonal contraceptives on glycemic regulation. Linacre Q. 2014;81(3):209-218.

Khalili H. Risk of Inflammatory Bowel Disease with Oral Contraceptives and Menopausal Hormone Therapy: Current Evidence and Future Directions.
Drug Saf. 2016;39(3):193-197.

 Jobira B, Frank DN, Pyle L, et al. Obese Adolescents With PCOS Have
Altered Biodiversity and Relative Abundance in Gastrointestinal Microbiota. J
Clin Endocrinol Metab. 2020;105(6):e2134-e2144.

Ulvestad M, Bjertness E, Dalgard F, Halvorsen JA. Acne and dairy products in adolescence: results from a Norwegian longitudinal study. J Eur Acad Derma-
tol Venereol. 2016;31(3):530-535.

Melnik BC. Diet in acne: further evidence for the role of nutrient signalling in
acne pathogenesis. Acta Derm Venereol. 2012;92(3):228-231.

Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci.2013;17(13):1804-1813.

Cervantes J, Eber AE, Perper M, Nascimento VM, Nouri K, Keri JE. The role
of zinc in the treatment of acne: A review of the literature. Dermatol Ther. 2017;31(1). doi:10.1111/dth.12576

Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis –
back to the future? Gut Pathog. 2011;3(1):1-1.

Takeyama M, Nagareda T, Takatsuka D, et al. Stimulatory effect of prolac-
tin on luteinizing hormone-induced testicular 5 alpha-reductase activity in hypophysectomized adult rats. Endocrinology. 1986;118(6):2268-2275.