Lingering Problems After Stopping Pill

Question

Thank you for your site – it has been very helpful to read your Q&A section.
My question is, how exactly does “the pill” inhibit ovulation?

I am asking because I am still experiencing side effects from the Ortho Tri-Cyclen Lo even though I only took it for nine days and even though I took it over a year ago (13+ months, to be exact). I was 37 and 1/2 years old when I took the pill for the first time in my life. After a few days, I experienced severe depression and thoughts of despair, loss of “in love” feelings, and complete loss of sexual feeling. I went off the pill after nine days but to this day, my libido has never completely returned. It’s very hard for me to become aroused. For the last three months, I’ve also had terrible digestion problems and have not felt hungry since taking the pill (I used to have a great appetite). Not to mention that while on the pill I fell completely out of love with someone I was madly in love with. I haven’t felt in love since. My periods used to start heavy and the flow would taper off gradually, lasting for seven days. Now I spot (tiny pin spots of blood) for a day, then a day of nothing, then I start my period. It is heavy the first day, then on the second day the flow is super heavy with large clots, then on the third day, it almost disapears. It comes back the 4th or 5th day to a medium flow and lasts another three days. After the pill, I’ve had pain in my limbs, my migrains and PMS disapeared, and I no longer have breast tenderness or sleeplessness the night before. All the old warning signs that my period was about to start are gone.

I recently had blood work done on the 23rd day of my cycle. My DHEA-sulfate was 2170 ng/mL, estradiol was 242 pg/mL, progesterone was 19.4 ng/mL, SHBG was 115 nmol/L, free testosterone was 1.3 pg/mL, total testosterone was 20 ng/dL. (A saliva test I had done last month on the 19th was unable to detect any trace of progesterone from my samples.) My doctor doesn’t feel he can help me.

I don’t know what is wrong with me. I feel that if I understand HOW the pill suppresses ovulation, I would have a place to start in figuring out what happened to me last year. An ultrasound showed nothing wrong with my uterus, ovaries or anything else in there. I don’t know what to do. I feel I’ve lost a part of myself as a person and as a woman. Could you recommend any research for me to read?

Thank you so very much,

Becky

Answer

Last Updated: December 13, 2014
Dear Becky-

First, the pill acts in three ways: 1) slowing ovulation by stopping the messages coming from the brain center that induces ovulation at the ovary. 2) changing the mucus at the cervix to a thicker, “less fertile” type. 3) thinning the lining of the mucus so that implantation of a developing child is very difficult.

The birth control pills contain artificial hormones, meaning that they are not the human identical equivalent forms of estrogens and progesterone. Ortho-Tri-Cyclen Lo contains 0.025mg of ethinyl estradiol and 0.180 – 0.25 mg of norgestimate, making it one of the lowest dosage pills. It is doubtful that taking this product for just nine days would have had any lasting effects especially on such things as libido, mood, and appetite.

The good news is that you are continuing to have menstrual cycles. The change in premenstrual symptoms is not alarming and could be considered a nice change. The pain in the limbs does not seem to be associated with any vascular problem such as a blood clot, the most worrisome physical side effect of the pill. The ultrasound demonstrated that there is no fibroid tumor or ovarian cyst or tumor. So these things are good news.

The lab work is a little difficult to understand because while you were on “day 23”, it doesn’t tell me where you were in relation to ovulation. It just tells me how many days it had been since you had you last menstrual period. It roughly looks like you were producing adequate progesterone on that day if you were post-ovulatory. I would need to know more levels of progesterone and 17-B estradiol during a given cycle to better qualify the results. I am assuming that the doctor checked for infections, did your PAP exam, and checked any other pertinent tests such as thyroid functioning, blood sugars, etc.

I would recommend that you would contact a natural family planning teacher who would teach you how to chart your cycles. These charts provide a lot of information. First, you would have more confidence in the timing of your cycles. The teacher and any practitioner trained to read the charts could identify if you were ovulating with regularity. Next, any laboratory tests done would be done with more accuracy because the tests would be interpreted according to the fertility cycle—ovulation, mucus cycle, blood flow, etc. This is a better reflection of how your body is functioning.

You could find good information through a number of organizations such as Pope Paul VI Institute, One More Soul, & Billings Ovulation method. The CANFP web site has a running list or references for NFP teachers. The teacher may be able to recommend a physician who is trained in this area who will be able to help you.

Dr. Gretchen Marsh

Answered By:

Gretchen Marsh, D.O.
Dr. Marsh graduated from Western University of Health Sciences in 1987 in Pomona, CA and is board certified in Family Medicine by the American Osteopathic Board of Family Physicians. She has been certified as a NaProTechnology® Medical Consultant (NaPro) and Creighton model Fertility Care System (CrMS) teacher since 2001. She and her husband, Jon, have 5 sons and live in the Reno region, where she sees patients in person, in addition to her telehealth services offered via MyCatholicDoctor.com

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