How to Prevent and Treat Post-Pill Acne

clear skinComing off birth control doesn’t have to be a nightmare for skin. Your skin might have been bad last time you tried to stop the pill but this time will be different. This time, you’ll know about post-pill acne and how to treat it.

What causes post-pill acne?

Certain types of hormonal birth control suppress sebum (skin oils) to “childhood levels,” which is a bit frightening when you think about it. Adults are supposed to have more sebum than children, so it’s an abnormal situation. Your skin responds by up-regulating sebum, and that up-regulation can persist for months even after you stop the pill (see the diagram).

post-pill acne mechanism
How coming off the pill causes acne.

Post-pill acne is the result of:

  • rebound sebum production as you withdraw from the sebum-suppressing drugs drospirenone (Yasmin) or cyproterone (Brenda or Diane),
  • a temporary surge in androgens (male hormones) as your ovaries kick back into action, and during which time you could be mistakenly diagnosed with PCOS. (Read Maybe It’s Not PCOS.)

The withdrawal process won’t last forever, but it could last up to a year or more. And post-pill acne usually peaks about six months off the pill—just when you were about to give up hope.

post-pill acne duration
Post-pill acne can take six or twelve months to improve.

Don’t give up hope! You’ll eventually get through this drug withdrawal process.

Natural treatment of post-pill acne

For best results, start treatment a couple of months before you stop the pill. That way, your skin will be less reactive, and better able to withdraw from the drugs.

  • Avoid normal A1 cow’s dairy because it spikes a hormone called IGF-1 and because it contains an inflammatory protein called A1 casein which can stimulate mast cells and histamine.  Avoid all normal dairy (yogurt, cheese, ice cream, milky coffees)  but you can have butter (which has almost no casein) and goat or sheep dairy (which have only A2 casein).
  • Reduce sugar because (like dairy) it spikes IGF-1. Sugar is the high-dose fructose you get from desserts, honey, fruit juice, and dried fruit, not the low-dose fructose you get from whole fruit. Read: Why I Ask Some Patients to Quit Sugar (and What I Mean By “Sugar”).
  • Take zinc. Zinc is the perfect medicine for post-pill acne because it reduces keratin, kills bacteria and reduces testosterone. Read 7 Ways Zinc Rescues Hormones and remember, you’ll probably need at least 30 mg of a good quality zinc such as a liquid.
  • Consider taking DIM (diindolylmethane), which is a phytonutrient from broccoli. DIM is a natural androgen-blocker and is one of the most popular natural treatments for acne.
  • Consider taking the herbal medicine berberine, which is antimicrobial, anti-inflammatory, and improves insulin sensitivity (thereby reducing the acne hormone IGF-1). Berberine also reduces androgens in women, which makes it a particularly good choice for PCOS. Berberine is not safe if you’re pregnant or breastfeeding, and should not be combined with some prescription medications. Speak to your clinician or pharmacist for more information about how to use berberine safely.
  • Support healthy stomach acid with gentian or betaine hydrochloride (HCL). Forty percent of acne-sufferers have low stomach acid.

How long till your skin improves?

Reducing histamine and inflammation can give a little improvement in the first few weeks. Real, lasting improvement will take at least six months.

What is your experience with post-pill acne?

270 thoughts on “How to Prevent and Treat Post-Pill Acne”

  1. I went off the pill at the end of October 2018. As you state here, my acne peaked at around 6 months after getting off pill, it’s calming down on my overall face but I have white spots along my jaw line starting at the height of my ears which I never had before – not even as a teenager when I had acne. I recently went to a women’s health clinic to see a doctor, hoping for help – in vain. She just said that this is my skin when it is without hormonal impacts via the pill, she didn’t even listen and didn’t even look properly. She prescribed a topical treatment which I started using now, if I don’t see a change within the next 3 months I will insist on being referred to a dermatologist. I tried skipping dairy for months, took zinc and don’t eat a sugary diet anyway and take care of a wholefood, mostly plant based diet.
    It upsets me that there are so many doctors out there who are so ignorant and don’t care about women’s health.
    I’m grateful that acne is the only issue I have since getting off the pill, my cycle came back on a regular base, I’m ovulating (using BBT and a tracking app) and everything is fine.
    Before getting off the pill I bought your book, The period repair manual and it was a tremendous help.
    Thank you so much for the work you are doing here.

  2. I was on yas for 7 years (took a break in between) and came off of it last year while I was living in a rural part of India. I have since moved to Delhi. I started taking birth control so long ago because of my acne. After coming off it, my acne flared up more than I’d ever had before, and was at its worst about 6-7 months after. My skin was…wow. Appalling. It was still bad until about 1 year had passed. After the 1 year, I returned to a regular period and my acne calmed down. I also cut down on sugar and dairy for about 7-8 months during that time, and took zinc, magnesium, a B-complex vitamin, and other supplements as you recommended in your book. I also started taking a strong allergy medication during that time, because of a high dust allergy, and got an air purifier for the Delhi pollution. I still get acne now, but nothing as terrible as before. The acne happens around the time I ovulate, which I track now using an app and thermometer. I went back to sweets again a few months ago, when I had to eat very differently because of a stomach ulcer. I was also feeling a lot of stress with my job at that time. After I took antibiotics and the ulcer cleared, I slowly went back to eating what I ate before, but I stuck to the desserts. It’s very hard to give it up for good. Also…it sort of feels like career success requires stress along the way. I of course don’t want ulcer-inducing jobs, and I am making a change, but it would be cool if my body could handle stress better. My husband doesn’t seem to face the consequences of stress the way I do. Your book and posts have helped me make sense of things though, and I am grateful for that. And I do feel a sense of relief about my cycle coming back to normal for the first time since 2010.

  3. Hi Lara-love your information. I’m 45 and have been struggling with hormonal acne for quite some time. I have normal, non painful menses. I went off the pill over 2 + years ago after being on it most of my adult life. I eat a very healthy diet, organic diet consisting of wild salmon/sardines, organic veggies and fruits, no dairy, no sugar, limit grains and drink 0-1 alcoholic drinks per week (vodka with kombucha!). I’ve been on DIM for almost 2 years and am still breaking out. I’ve added zinc and berberine per your recommendation. I take 400-500mg Mag Glycinate daily. I exercise daily-walking, running, weight lifting or barre class. I meditate every morning (seriously, haven’t missed one in two years) and do yoga. I break out mostly around my mouth (upper lip area) and sometimes on my chin. I use non comedogenic makeup, Alima Pure, fresh aloe, honey and rose water on my face. I’m at a loss as what I should do. I’m a professional and work face to face with people on a daily basis, so the acne is difficult for me. Any suggestions would be much appreciated!

  4. Had a stroke due to loestrin aug 2017. Acne started the following Feb or mb arch now here we are July 2019 still struggling,and crying. Its made me ugly and has taken my confidence . I only DC o dairy 1 a week and gluten on weekends limited. I take licorice root,zinc,and b vitamins. I’ve tried it a ll and nothing

  5. I would like to come off Yasmin. I have pcos (diagnoses by ultrasound not blood test which I know is wrong)but I don’t know which type of pcos I have. I have always had irregular periods and acne prior to Yasmin. I will be getting a blood test done so I can try and identify this I note from your book and above that you recommend DIM among other options. Should I not take anything and have my blood test done first so I can determine the type of pcos I have or should I just start taking DIM etc

  6. Great post! Thank you! At 24 I started breaking out worse after discontinuing the pill and switching to an IUD (I love it, btw). I had cystic acne along my jawline and on my neck, so I take Spironolactone 100 mg daily. I’m finally starting to see results. I’m on week 4 of being on Spiro, and while my skin isn’t completely clear, I definitely see a difference. 😀 I should also note I’m using Retin-A topically. If you’re curious I get Retin-A (Tretinoin) and Spironolactone online to save $. Just search on Google for this code “LOOK4SPIR” 👍 to find the reliable source, Sorry, I don’t remember the link. Good luck to all!

  7. Dr Lara,

    would you please let me know weather I can take zink, barberine and DIM along with the spirnolactone?

    I cut off Yasmine already, but still at least for 2 months my doctor advices to take spirnolactone. I`ve started it just after cutting the Yasmine. Then she told to try flutamid. but I want to try your approach before flutamid, as I know of its toxic effect on the liver.

  8. Hi Danielle, I am in the same situatuation as you are with the spirnolactone left. Still searching for the answer. Would you please let me know weather you found the answer? DIM and Zinс сan we take it along with the spirnolactone?

  9. Hii,,
    I’m currently in the midst of battling post pill acne, I was on the pill for over 10 years (cringe). I have always had known gut issues and acne since I was around 11 years old

    I am currently seeing a naturopath who has commenced me on a few supplements to support my gut, we haven’t yet tackled the hormone side of things. I was just doing some research into DIM, and the brand of supplements I am taking have I3C supplement, will this have the same effect as DIM or am I better of to get DIM?

    Can anyone suggest you suggest any particular brands of DIM, I am in Melbourne Australia.

    Thankyou

  10. Hi Emma!

    My pills were coated as well. They were definitely hard to cut!
    & If you only had acne because of the pill, you should be back to normal after the 6-10 month period post-pill. Try doing a liver detox to rid yourself of excess estrogen.

  11. Hi Juliette,

    Thank you so much for your post! So interesting so ready about your experience weaning off Diane-35. I was prescribed Diane -35 2.5 years ago after a spike in hormonal acne caused by coming off a milder pill (Levlen) 5 months prior. I’ve never really struggled with acne except for when I try to come off the pill, so I was hoping to wean myself off. I’m from Australia, and here our Diane-35 pills are coated which means they are difficult to cut. Did you have trouble cutting your pills or were your’s uncoated?
    I definitely think weaning off the pill is a great way to buffer a resurgence in hormonal acne.

  12. Hi Juliette,

    Thank you so much for your post! So interesting so ready about your experience weaning off Diane-35. I was prescribed Diane -35 2.5 years ago after a spike in hormonal acne caused by coming off a milder pill (Levlen) 5 months prior. I’ve never really struggled with acne except for when I try to come off the pill, so I was hoping to wean myself off. I’m from Australia, and here our Diane-35 pills are coated which means they are difficult to cut. Did you have trouble cutting your pills or were your’s uncoated?
    I definitely think weaning off the pill is a great way to buffer a resurgence in hormonal acne.

  13. Hi Claire, I have been through this with Diane. 8 months is the magic number. This is when your skin will start to clear up. I wouldn’t play around with too much during this time (except for cutting out dairy and sugar). Let your body heal, it will get there.
    Cheers

    • Hi Kay,

      Did you ever figure out what was causing your acne?

      I have a theory that my acne before taking Diane was related to gut issues, which I still suffer from today.
      I am trying Betaine-HCL as recommended by Lara, but I am having a hard time dosing it. I’ve followed the protocol to determine how many pills to take but I have a hard time being consistent with every meal! Especially since I already take so many supplements to begin with.

      I am on month 2 of quitting Diane and my skin is still great. But I am bracing myself for impact!

  14. Hi Lara,

    I’ve always had problematic skin. I had acne back when I was 16, along with irregular periods so the doctor prescribed Diane 35 to me. I had been on Diane for 4 years when I decided to come off it at the start of this year (January 2019). The first few months were fine, my skin was actually better than its ever been, but in the last month of so, my acne has blown up. It’s sore, red and covers my chin, jaw line and cheeks. I’ve been taking 30mg of zinc per day as well as Maca powder. I have just purchased DIM and berberine. Should I take these together or just trial one at a time?

    Also could DIM make my skin even worse?

    Thanks,

    Claire

  15. Hi Juliette,
    You probably won’t see this message but I was on Diane 35 for mild acne when I was 16. Im now 20 and decided to stop taking is as I thought my skin had cleared and I always felt anxious on it.
    I stopped taking the pill in January 2019, and it’s been 4 months. For the first 3 months off the pill my skin was the best it’s ever been… then all of a sudden in the last few months I’ve been getting ridiculous breakouts all over my cheeks and chin. I feel so embarrassed, acne is the worst. I think I am going to try DIM and see if it works of me.

    • Hi Claire,

      We’re in this together!
      I actually started Diane-35 at 20 years old. I never had acne as a teen and developed ‘adult acne’ out of the blue. 4 years later, my skin is nearly impeccable but I knew I couldn’t be on it forever. I would get anxiety from the thought of getting all my acne back once I quit. Strangely enough, that anxiety pushed me to take the plunge and rid myself of the pill. I actually weaned off the pill, which is not very well-known. I found out about it on an acne forum and found many women who’ve tried it with Diane-35 successfully. This pill is notoriously ‘addictive’ for your body. Look up “cyproterone acetate”, the synthetic progesterone that suppresses androgens, which is found in Diane-35. You can easily find information about how the dose must be reduced gradually when stopping this medication.
      I cut my pills over 3 months (3/4, 1/2, 1/4). I took my last pill in mid-April and had my last pill bleed during that time. Haven’t seen a period since then. Thankfully I have not seen any acne resurgence. I am taking a bunch of supplements, notably Berberine, and I have just ordered DIM. If you want to chat more, email me here [email protected]. (It’s my spam email so I don’t care about displaying it but if you send me an email I can email you from my real address). Much love XoX

  16. Thank you soooooo much for this article. It is heaven sent! It’s been the absolute worse time coming off my pill. I started the pill when I was about 16 I had perfectly regular periods starting from 13 but then I got severely bad acne, I turned to the pill and had a clear face for years!! When I started becoming more conscious about what I was eating and doing things au natural I read up on birth control and quit. Then I was getting acne and within 3 months I went back on. A year later it was constantly nagging at my conscious to stop and I have been off for a year now. My acne came back within 2 months of stopping and it’s been pretty bad ever since. I haven’t eaten dairy for almost 2 years now but I love fruit and honey so now I know to stop doing that (at least as often). I will also be taking zinc in a liquid form and a higher dosage then I do with the zinc pills now! Thank you so much for giving me hope and these tips! I hope to get to a clear face soon!

  17. Hi Laura, I’m currently on 100 mg spirnolactone and birth control pills for my acne. I want to go off the pill but am not ready just yet to stop the spirno. I’m very scared to do this but am ready to be off the pill. I don’t think I’m insulin resistant at all. Would u recommend the zinc and DIM while on spirno or just the zinc? Does it really work?! 😭

  18. Hi Dr!! I’m looking to buy DIM online, is there a brand you suggest? I’m always weary to buy supplements off amazon if there isn’t a specific brand in mind.
    Thanks!

  19. This helps but im confused doe itget better with a year or 6 monts cuz im on month 8 or 9 since the acne started and its still re as lly bad. Im.worried the pill xhanged my hormones forever and ill always deal with t
    his aweful acne

  20. Hi Dr. Briden,

    I’ve been dealing with pretty horrendous hair loss for the past ~3 years since discontinuing ocp. I was on a low androgen pill, but have had unrelenting high androgen symptoms ever since – I’ve done many of the things you recommend on this blog, including magnesium, zinc, no gluten/dairy/sugar/alcohol, attention to blood sugar balancing, as well as several rounds of other nutrition and supplement interventions as suggested by various naturopath doctors.

    I recently did the DUTCH test, which showed my sex hormones relatively balanced and within normal range – things go out of whack though in the subandrogen hormones/metabolites (high 5a-reductase, androsterone, and androstenedione). My androsterone is above range as 1793, compared to etiochanoldone which is more normal range at 929, which means that I slightly tilt to the 5a metabolite preference. This makes sense, given what I’ve been experiencing with the acne and hair loss the past three years, and despite my best efforts to convince doctors that something is off internally.

    I’m just wondering what else can possibly be done in trying to figure this out. Should I explore the insulin piece? I’m not overweight, I hardly eat any processed food gluten or sugar and the starchy carbs I eat are mainly sweet potatoes and the occasional white potato. But could I perhaps have an insulin issue? I eat very healthy and throughout the day to avoid crazy blood sugar fluctuations.

    My periods are all normal and regular, and so I just don’t know why this one androgen piece keeps plaguing me all these years later. Any additional thoughts you have would be appreciated.

    • Also, in response to these recent DUTCH results, my naturopath suggested the following. I’m not sure if these mean anything to you as some seem to be specific compound combinations, but if you have any thoughts or concerns please let me know!

      HMF Forte 1 cap AM
      DIM 1 cap AM and PM
      Femgen PMS Tablets 2 caps PM
      HMF Neuro 1 cap PM
      D-Mulsion 1000 5,000iu PM
      Taken away from meals:
      UNDA 1, 20, 243 5 drops 3x daily
      Rosmarinus Officinalis 50 drops AM and PM
      Ferrum phosphoricum 6x 2 tabs AM and PM
      Take before bed:
      Cal Mag Vanilla 1TBSP

  21. I personally quit consuming dairy and wheat and took supplements for about two months before actually quitting birth control pills. So glad i didn’t try to quit cold turkey. I am not rid of my acne, but I had it before I was on oral BC, so this isn’t a shocker, to be honest. The frustrating struggle continues. But I believe there would have been way worse of a rebound situation if I hadn’t done those things prior. I did it this way because I read somewhere among the comments below that getting into a treatment routine, say, three months in advance is what Dr. Briden recommended to someone else. Either that or I read it in her book, but I think it was here. Obv I quit a month earlier than I originally planned, but it was because I got overly lazy with taking my BC pills on time in my eagerness to quit them, to the point where it made more sense to stop then and there rather than play dosage catch-up. Hope this is helpful.

  22. I personally quit consuming dairy and wheat and took supplements for about two months before actually quitting birth control pills. So glad i didn’t try to quit cold turkey. I am not rid of my acne, but I had it before I was on oral BC, so this isn’t a shocker, to be honest. The frustrating struggle continues. But I believe there would have been way worse of a rebound situation if I hadn’t done those things prior. I did it this way because I read somewhere among the comments below that getting into a treatment routine, say, three months in advance is what Dr. Briden recommended to someone else. Either that or I read it in her book, but I think it was here. Obv I quit a month earlier than I originally planned, but it was because I got overly lazy with taking my BC pills on time in my eagerness to quit them, to the point where it made more sense to stop then and there rather than play dosage catch-up. Hope this is helpful.

  23. I am excited to take the plunge and quit hormonal birth control. But I am terrified of the acne I am most likely going to get. So I have gone ahead and purchased all of the supplements you have recommended. My only question is do you think it is better to quit the pill cold turkey or stay on it for a month or two to give the supplements a chance to work. Will the counterintuitive to take the supplements and the pill at the same time? Thank you for your help!

  24. I didn’t find you and your information as early as I would have liked! I have been off the pill, and I already had a diet lifestyle similar to the one you discuss in your books, will be refining more so! Also I am starting my regimen of supplements, It’s been so hard and so bashing to my confidence to live with this acne! I’m hoping to see results soon!

  25. Hi, so good to read an article like this. I was on Yasmin for 6 years and finally decided to come off it to regulate my hormones naturally. I have been off the pill over a year now and still have acne in on my jawline and neck.

    • Hey ! I have the same experience : I was on androcur and oromone (cyproterone) for 7 years. I stopped it last year in September and since then, I’ve been having a hard with cystic acne. I hope it will stop soon as it’s been almost a year since I’m pill-free ! Good luck !

  26. Hi Lara,

    I’m in need of some help/advice. I’d like this to say anonymous and not re posted.

    I was on and off the pill for 10 years. I came off nov last year as it has always made me feel very anxious.

    Since coming off ive had bad acne and I’ve tried lots of things with my naturopath. Like vitex, zinc, lactoferrin, gut pro and pre biotics and I got my hormone blood test too.

    I’m at the point where I want to go back on the pill purely to fix my acne on my face. However, I love your book and know you’re the guru with this. So thought I’d message in the hope you have an answer or one last path I should try before going to the doc.

    🤗🙌🏼 💫
    Thanks.

    • Hi Abby, apologies for my slow reply. Have you spoken to your naturopath about high-dose zinc, berberine and DIM? (the protocol I discuss here)

  27. Hi Lara,

    I really appreciate your blog and have come back to it many times since my own post-pill nightmare begin. I was on ortho tri lo for a little less than 2 years, but have spent almost three years now trying to undo the negative effects. The main ones were massive surge in androgens and oil both on my face and scalp–cystic acne, horrific hair loss, lots of sebum churning out my scalp. With time and diet overhaul, things have improved, but they still aren’t perfect–my skin is still constantly dotted with a least a few breakouts (mainly forehead temples and chin) and my hair is still greasy a lot of the time, in addition to constant shedding and noticeable thinning.

    I am gluten free dairy free alcohol free and only get sugar from the occasional fruit or dark chocolate. Exercise, good sleep, and have done rounds of zinc and magnesium every few months. These interventions (all thanks to your recommendations!) have helped a lot, but I still feel ‘off’ on so many levels.

    I am just wondering — can this type of norgestimate wreck permanent damage on hormone and androgen levels, or definitively alter your origina balance? I have been at this for so long, working so hard to improve things naturally, and I still haven’t fully returned to normal…..it’s like the pill was a light switch that just transformed me (for the worse) when I went off it. Nothing has been the same…..have you seen cases where things take 3+ years to rebalance?

    • Yes, I’ve definitely seen cases where it takes 3 years or longer to reestablish regular, normal, happy ovulation and cycles. But you were only on the pill for 2 years, so that should make it easier. What were your cycles like before the pill?

      • Hello Dr. Lara ,

        I am going through something similar. I had clear skin all my life. Took BC just for 15 days and 1 year and 7 months down the line still suffering from cystic acne. I have tried Zinc but it didn’t help a lot .Things like Flaxseed break me out. I am at my wit’s end now .I don’t indulge in sugar and dairy. Any suggestions on how to overcome this ?

        Thanks a lot.

      • Hi Lara,

        Well, the weird thing is that my cycles are the only thing that really seem to be back to normal (and they were quickly back to normal, for the most part) – sometimes it fluctuates 29-33 days and I’ve randomly missed two periods in the past two years, but otherwise they are monthly, normal flow and duration, and nearly pain-free.

        I was a late bloomer and didn’t get my period until almost 16. First two years I would skip periods for months on end, then I got an ovarian cyst at 19 and was put on a low dose pill (it wasn’t Ortho Tri, maybe Yaz but I don’t quite remember) for the next 3.5 years. Then I stopped for about a year and a half and my cycles were normal, skin was clear, no hair loss or major hormonal reactions to the discontinuation. Then I started ortho tri cyclen March of 2014 and continued to December 2015. All the issues have been since then with hair loss, sebum, and acne.

        I’m just confused – my cycles seem to point in the right direction, but I haven’t really seen stabilization in my main post-pill woes.

        I didn’t suffer from acne as a teenager, or when I was on my first contraceptive pill, or in the year that I was completely off it. Only with Ortho-tri. Any further thoughts you might have would be so appreciated, thanks for this blog.

  28. Hello Dr. Lara,

    Thank you for the informative post. You seem to be one of very few doctors who acknowledge and understand post-pill acne very well. I have been struggling with hormonal acne since more than 1.5 years. Before that, I had clear skin all my life (I just turned 29). I took BC pills for 15 days in Jan 2017 and since then I started getting acne, however, it started to worsen after 6 months when I started getting cystic acne. I am still battling with angry, inflamed acne. I had ultrasound and my left ovary is bigger than the right one but the Gyno has ruled out PCOS. BC has triggered this massive chain of acne.

    Nuts and flaxseeds break me out right away. I have tried various supplements; berberine quickened my heartbeat and Omega 3 fish oil gave me under the skin bumps on my forehead. Probiotic wasn’t a massive help either.I am now taking zinc and vitamin D, it is helping somewhat but I still get acne. I avoid dairy and sugar for the most part. I have become very depressed because of persistent acne and losing the will to carry out daily acitivities. Is there any way out? Can you suggest anything? I am running out of options to clear this pill-induced acne.

    Looking forward to hear your wisdom!

    Thank you

    • Hi! i was recently in your situation, tried everything recommended and ended up trying the DIM that was suggested in this article. It has helped and its been about a week. I read a lot about it in the reviews and everyone seems to rave about it. I’m excited if in one week i’ve seen results what the future holds.

      • Hello Erica,

        Thanks a lot for your suggestion! I have read mixed reviews about DIM on the internet. I will see if I can give it ago! I can’t how harmful BC pills are your for body, they have ruined my perfect skin and I could eat anything under the sun and not break out. This has made my diet so restricted. I can’t even eat fats because it shows up on my face. I don’t know if the damage done is reversible or not!

        Best of luck in your journey! 🙂 Hope it works out for you

  29. Hi Lara,

    From your experience, I’m wondering what percent of women (if any) don’t experience post pill acne? Is this something I should prep myself for and will absolutely experience? I just ordered your book- I’m 29 and have been on the pill for almost 4 years (to prevent pregnancy). I’m judging myself a bit because there are so many pros to going off the pill, but my wedding is in 9 months and after reading about post pill acne I’m terrified to have this happen around my wedding.

    Thanks,

    Zofia

  30. Hi Lara! I have been taking DIM for almost 4 years (after my 2nd child was born) with a self diagnosed estrogen dominance. It has helped me a lot. I break out and gain weight when taking Chaste Berry so I don’t take that anymore after trying it for PMS symptoms. I’m about to turn 40 and have been on DIM for so long that I am wondering if I should stop taking it because my skin is great, yet still having pretty significant PMS symptoms… or if this is the time approaching perimenopause that DIM would continue to be a benefit if I have symptoms of estrogen dominance that are definitely tapered down while taking 200 mg of DIM a day? thanks for any thoughts!

  31. Thank you Dr Lara for your response. Your posts are always so informative and I particularly think your posts on identifying the differences between the symptoms of excess estrogren, deficient estrogen and progesterone deficiency are very important. Many women believe that acne may be a symptom of excess estrogens. As you rightly clarify, it is progesterone deficiency that is likely to be the culprit for such a symptom.

    In relation to post-pill acne, a number of things may happen to the body:

    • Ethinylestradiol synthetic esrogen may disturb gut bacteria and impair healthy estrogen metabolism and detoxication- this could give rise to estrogen excess but no acne symptoms but rather breast tenderness, bloating and thyroid suppression and heavy periods- the periods are unlikely to be irregular in this situation. Likely other symptoms sadness and depression.
    • Because your progesterone has not been producing it can lead to critical progesterone deficiency and this by its nature means that 5-alpha reductase is not sufficiently inhibited which converts testosterone to DHT and creates acne, aggression and irritability. Also period are likely to be irregular, weight gain, low libido, britlle nails, cracked skin and infertility.
    • Glycine, B-vitamins, selenium, zinc, magnesium, Vitamin C are also tragically depleted too.

    A blood test should be done to ascertain the source of the trouble or the combination of the problems.

    Coming back to DIM, examine article is a work in progress and they have also misinterpreted some of the results on the studies. I have a problem with them at times because of the inconsistencies of their reporting. However, DIM in smaller quantities less than 100mg may assist in the situation of excess estrogen post pill but the result cannot be assured as there are issues with absorbability as well.

    Unfortunately, as a DHT blocker, the study used was limited to male prostate cells and it used a minimum of 300mg pure DIM dosaging to realise some benefit. Unfortunately, such dosaging is very likely to create estrogen excess and that is why women taking DIM at higher dosages over a long period of time may temporarily get relieved from acne but end up suppressing their thyroid and gaining weight amongst other issues. This is clearly evidenced from the string of comments on this post.

    I suggest the following protocol for post-pill acne:

    1- Restore gut bacteria- acacia gum or a good probiotic brand
    2- Do blood work at 19-21 days to determine estrogen/progesterone balance and which one is in excess or deficient and test your testosterone.
    3- Clean up diet and remove sugar entirely and eliminate cow dairy
    4- Replenish with Zinc, magnesium, glycine/l-glutamine, b-complex and vitamin c and selenium
    5- If estrogen is in excess- eventhough I don’t personally recommend it take low dosage DIM less than 100mg or better Calcium D-Glucarate, iodine, cook in ceramic and surgical grade stainless steel, eat, organic produce, no BPA etc.
    6- If progesterone is deficient, then in addition to the standard zinc, iodine and vitamins, also specifically vitamin D and natural progesterone.
    7- If testosterone is elevated, you may have PCOS if you display other symptoms along with progesterone deficiency or if you don’t display the other symptoms but just aggressive acne and mood swings, your body may be producing a lot of 5-alpha reductase or elevated prolactin- you can use Reishi Mushroom powder and Green Tea Extract to inhibit the actions of 5-alpha (particularly as premenstrual acne exacerbates). Or follow a comprehensive PCOS protocol that Dr Lara sets out.

    Again, I would not recommend DIM in excess of 100mg. And in general I personally would not use it anymore as a DHT blocker in large quantities. This comes from both personal experience with using DIM over a long of period of time and speaking to women about it. I am also a qualified nutritionist who has recently graduated and I would be delighted to link with you Dr Lara.

  32. With all due respect to you Lara, but the information you have provided regarding DIM is not the complete picture.

    In small amounts, i.e. less than 100mg, pure DIM, can both inhibit the aromatase enzyme (and prevent conversion of testosterone into estrogen) and it can act on more potent forms of estrogen and convert them into less potent forms; this conversion reduces the overall effects of estrogen in the body.

    However, taking too much DIM ie. more than 100mg of pure DIM at once, can actually induce the aromatase enzyme and act in the opposite manner and increase estrogen synthesis. This type of anti-androgen inhibition is not necessarily a good thing.
    The interaction between DIM and estrogen is complex. Sometimes it may block the effect of estrogen, while it may enhance estrogen activity in other circumstances. It may also have an anti-testosterone impact. The bottom line is that DIM may cause hormonal disturbances, reports NYU Langone Medical Center. DIM may lead to positive — or negative — effects on various types of hormone-sensitive cancers. For example, DIM has an anti-estrogenic effect, which may reduce the risk of developing thyroid cancer, according to a study in “Thyroid” in March 2011. But researchers were surprised to find that DIM stimulated the growth of certain breast cancer cells, according to their report in “BMC Cancer” in July 2014.
    Safe supplemental dosages have not been established; in fact, dosages of DIM may prove tricky to determine. The less than or greater than dosages of 100mg are highly speculative in themselves. The study in “BMC Cancer” reported that different concentrations of DIM may lead to different biological outcomes. Until more is known about the safety of diindolylmethane, children and pregnant or nursing women should not take DIM supplements.
    DIM has also been show in recent studies to be an endocrine disruptor.
    I have sighted the studies and useful links as follows:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5165135/

    https://supplementsinreview.com/testosterone/diindolylmethane-dim-testosterone/

    Endocrine Disruption 2016 Study:
    https://www.ncbi.nlm.nih.gov/pubmed/27092574

    Proliferation of Cancer Cells:
    https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-14-524

    There are some women on this string who have expressed concern with the impact of DIM on their thyroid. Other women I have spoken to have had no success on DIM and in general it has created lower level symptoms such as headaches, bloatedness.

    In higher quantities, it may deal with acne as it acts to inhibit both m-TOR pathway and stop conversion of testosterone to DHT. However, such dosages are untested and therefore unsafe and whilst fixing one component of hormonal imbalance, you can be creating long-term damage elsewhere. As in one study cited above, the gentleman developed thrombosis.

    I have decided never to recommend DIM.

    • Thanks for all that Serene. It’s interesting because I went through a similar process with Indole-3-Carbinol (I-3-C) ten or so years ago and finally decided it might not be safe so I stopped prescribing. As it stands, it still seems like the majority of evidence supports the idea that DIM is safe (as discussed in this literature review: https://examine.com/supplements/diindolylmethane/). But yes, DIM is a powerful hormone modifier, and so by definition, a hormone disruptor. More powerful than I had quite realised… For example, the Examine site states pretty clearly that it antagonizes (blocks) DHT at the receptor, which must be why it works so well for acne. And its effects on estrogen vary greatly depending on dose and also the estrogen state of the individual. Looking at the current research, I think it makes sense to stay at 100 mg or below.

    • And DIM is a milder hormone disruptor than drugs like spironolactone or drospirenone. So, if the choice is DIM or back onto a pill like Yasmin, then I would vote for the DIM. But yes, if women can manage post-pill acne with diet and zinc and digestive enzymes, then that’s a simpler strategy.

  33. Hi Lara,
    I am planning on coming off the pill (ortho tri cyclen) – I have one month left. I have already began taking zinc and want to start DIM. I was wondering the best time to start the DIM, right after I stop the pill or sooner? I want to try and prepare my body the best way I can! Let me know if you have any other suggestions

    Thanks

    • I really enjoy Lara’s blogs. But I note the following:

      1- Zinc is not a straight-forward supplement. In higher dosages more than 54mg a day it inhibits 5-alpha, but in lower dosages it boosts testosterone and even increases 5-alpha (which is enzyme which converts testosterone to DHT and causes acne. At moderate dosages it also acts as an aromatase inhibitor which stops testosterone being converted to estrogen therefore increasing free testosterone. This may or may not be a good thing for women who suffer from hormonal acne. If your testosterone is normal to moderately high, zinc at low dosages will not really do much for you. if you want zinc to assist then it needs to be taken at higher dosages. https://www.ncbi.nlm.nih.gov/pubmed/6200703 (I attach the study). Thorne Research offers high dosage zinc, 30mg per table 2 tablets a day: https://au.iherb.com/pr/Thorne-Research-Double-Strength-Zinc-Picolinate-30-mg-180-Vegetarian-Capsules/18460 Zinc dosaging has personally frustrated me as at low dosages, Zinc did nothing for me. However, one needs to be careful in continuing with Zinc over a long time at higher dosages of more than 100mg per day as it could compete with other nutritional profiles.

      2- DIM is also not a straight forward supplement. DIM, like Zinc, is mainly an aromatase inhibitor, ie it blocks conversion of testosterone to estrogen and free testosteone from SHGB. This may not be a really good thing in women with acne and who already have moderate to high testosterone levels. DIM may for some women be counter-intuitive especially if there don’t have any issues with excess estrogens to begin with. The reason why sometimes DIM works for women is that it also happens to decrease 5-alpha which converts testosterone to DHT, but with more free testosterone, that positive effect can be negated. Also after a while of using DIM its effects may wear off and it could decrease libido and create other issues. The enzymatic pathways of 5-alpha may also become resistant. It is worth a try but it is definitely not a long-term solution. It is important to note that most studies on DIM are for menopausal and peri-menopausal women that have observed higher estrogenic activity and the lowering of testosterone. DIM is a helpful testosterone booster for these women that are unlikely to exhibit moderate to severe acne. Not sure that is a good idea for PCOS women. hhttps://www.ncbi.nlm.nih.gov/pubmed/12665522 and https://www.encognitive.com/node/2510

      Dealing with Acne is such a difficult road. A frustrating and cruel one at best.

      Removing Dairy and sugars assists. I am now going to try Inositol combination treatment and hope that this will assist my hormonal acne which is clearly as a result of increased 5-alpha reductase conversion and insulin resistance issues. She’s hoping.

      • Dear Serene ,

        Thanks a lot for such an insightful post. I started having acne after coming off the pill. I have been trying to combat the problem. I have been thinking of Zinc and DIM but your post makes much sense. As far as inositol is concerned , I am taking a supplement by the name of Ichol plus, it contains Myo-Inositol. It has helped me a lot in reducing the large , angry and painful bumps on my face. However , I still get small inflamed acne particularly after consuming something sugary. So diet will have to be controlled. I am on the pursuit of finding a long term solution to this problem. Surely there has to be a solution. Millions of women are suffering from this. We can be in touch personally in you like to share insights.

        Wishing you complete and speedy recovery !

        • Hi Sara,

          I would love to connect.

          It is interesting that you have normal glucose and normal testosterone but higher LH to FSH. This is clearly contributing to what apppears to be PCOS symptoms, though it is not your classic insulin-resistant or even adrenal PCOS. Also if you had clear skin before the pill then in your case the pill has disturbed your balance.

          I have suffered from acne all my life. I also don’t also have high glucose or high testosterone. I was on Yaz for 13 years and it cleared my acne. When I got off my acne came back. Controlled it with good diet, some DIM which wore off and my body started to make more 5 Alpha, Saw Palmetto which wore off, high dosage Vitamin a which wrecked my period. Now I will try Inositol myo and dchiro forms along with Green tea and Reishi Mushrooms as 5alpha inhibitors.

          Coming back to you- I recommend Apple Cider Vinegar. Please see this study https://www.ncbi.nlm.nih.gov/m/pubmed/23666047/ Your issue is related to high LH. Apple cider has been shown to restore that. Let’s see if that gets it balanced. Also maybe adding D-Chiro Inositol could help. Will review the formula of the one you are taking. Let’s put our brains together.

          My email is [email protected]

          Let’s talk

          • hi Serene, thanks for your comments, and apologies if you didn’t see them appear straight away. WordPress keeps flagging your comments as spam. I think because of the links.

      • I’ve seen good results with lower dose zinc. And the amount used in the acne studies is 30 mg. It is anti-microbial and anti-androgen. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120804/

        Just to clarify re: DIM. At moderate dose, it upregulates aromatase, which means more conversion of androgens to estrogen which is a good thing. But I think its main action for acne is that it’s an androgen blocker. ie. it blocks androgens at the receptor, but to be fair, that has only been studied in men.

        • Thanks Dr Lara, in smaller quantities less than 100mg pure DIM, DIM acts as an aromatase inhibitor which means it stops conversion of androgens to estrogens. In higher quantities more than 100mg it does the opposite as you say. However, this has been shown in a number of studies to be problematic as DIM dosage is very specific to individuals and is a massive hormone disruptor. I generally recommend women not to take DIM. There are recent studies which have identified major concerns with dosaging.

          • I’m definitely interested to learn more about any safety issues with DIM. Can you please share the studies? Hopefully, WordPress lets you post the links. I’ll also check the spam folder, just in case.

          • Oh, I just found your comment with the studies in the WordPress spam folder. And I’ve approved it. I’ll have a look.

  34. Hi Lara…

    I’m desperate. I was on ortho tri cycles lo for 12 years and besides an occasional pimple, never really broke out. I’ve been off the pill for four months and the first couple were fine but a little over a month ago it all went down hill and my forehead exploded in acne. I am now using a sulfur wash, have a low sugar/ low dairy diet, increased my water intake, have switched shampoos, am taking vitamin d, magnesium, a probiotic, and still on spironalctone.. I’m very afraid to wean off of it but know i will have to if i want to get pregnant.

    I was looking into HUM daily nutrition cleanse supplement and murad skin clearing supplement… do you recommend these? I just want my face and life back and will do whatever it takes..

    Thanks so much

    • It’s hard to come off a progestin drug like norgestimate (the one in Ortho Tri-Cyclen) or spironolactone. Coming off them can cause the double whammy of a surge in skin oils and a surge in male hormones–a nightmare for skin. As I describe in the post, ZINC is one of the strongest treatments. And also avoiding all sugar like dates and smoothies and maple syrup.

      But even with perfect diet and supplements, you will likely still have to go through a withdrawal-phase of 3-6 months. (starting about 2 months off the pill or spiro).

      • Dear Dr. Lara ,

        I have shared my issues in the post below (by Sara) . I would highly appreciate if you could give me your input on this as well.

        Thanks a lot.

  35. Dear Lara,

    I have a burning question. I am 28 years old and for the first time in my life I took Yaz only for 15 days for contraception purposes. I had clear skin all my life and regular periods. After I stopped taking the pill, I started experiencing large cystic bumps on my face .

    11 months after, things have been going downhill and the acne is getting worse. I went to dermatologist for my acne and when antibiotics didn’t work , I got an ultrasound done and was told I might have PCOS. I have cut out diary and sugar. But my acne is persistent. I recently got my bloodwork done, glucose, testosterone all are fine EXCEPT LH:FSH ratio with LH being 3 times more than FSH. I have a 37 day cycle and I am getting my periods (had one 45+ cycle in between ).

    I have NO idea how to treat this acne and doctors only recommend further Birth Control which I know will only exacerbate the problem. I really really hope you can share some of your wisdom on my unique case (high LH and acne) as I have failed to get any guidance and I am freaking out.

    Thanks a lot . Really looking forward to your response. Your doing great work !

    Regards,

  36. Hi Lara,

    I am so thankful for all of your information. I have been researching and reading everything I can (including your book) and I’ve also had blood work done. I do not have PCOS (I have regular periods and seem to ovulate because my temp rises and also have cervical fluid), but I have HORRIBLE hirsutism and acne. Went off the pill almost 3 years ago and still dealing with it. I started zinc 3 months ago and magnesium 4 months ago. Still dealing with this. I also get premenstrual migraines.

    Hormones tested on Day 6 of cycle:
    Estradiol level: 61 pg/mL
    Estrogen: 84.1 pg/mL
    Estrone: 23.1 pg/mL
    Testo Fe/Child: 37 ng/dL
    Sex Hormone Binding Globulin: 158
    Testo Free LC-MC-MS: 2.0 pg/mL
    Vit D 25 Hydroxy: 33

    TSH normal and CBC normal.
    I got my progesterone tested at the wrong time so I am going back to test that, however if I am ovulating then I should have enough right?

    Im so confused as to why I am having hirsutism and acne when I don’t have any of the other problems like PCOS. Please help!! Should I take DIM when my estrogen level seems to be normal? Would that hurt me?

    Thank you,.
    Rebekah

    • Hello Rebekkah,

      I am going through extreme acne too post-pill despite having clear skin all my life. And the acne is the worst, cystic type. It’s been 1.5 years that I came off pill (and I took it for only 15 days in total). Have you found anything that worked for you? I have become extremely depressed because of this.

      Thank you and wishing you complete recovery from this!

      • I am still on my journey unfortunately. Still struggling with the SAME ISSUES and very depressed. However, I recently discovered that it all begins in the Gut. So I am working with a functional dietitian (Laura Schoenfeld.. you can google her)… and we are going to do a stool test (GI MAP) as well as a DUTCH plus test. Very expensive which is why I have put it off for 3 years, but I am finally at a breaking point. If you can afford to do all the testing and work with someone that knows what they are doing, then definitely do it before you spend 3 years in MISERY! So far, all the supplements and everything that people recommend has not worked for me. I’ve also been through a miscarriage recently, so somethings is definitely off. I also found out my thyroid is a little bit hypo- so I recommend getting that tested as well.

        • Hello Rebekah,

          I am really sorry to hear about your struggles. I really hope you can sort them out very soon. I am already 1.5 years into journey too and consulted a Naturopath but even it hasn’t helped. I had no issues whatsoever and this little pill has caused so many. Can I keep in touch with you? We can exchange email ids if you like to support each other.

          Thanks and wishing you best of luck!

          • I found out that I have leaky gut and parasites. So I am working to heal my gut. I also did the DUTCH test and discovered that I have very low estrogen in my luteal phase. I started Armour thyroid and my thyroid levels seem to be getting better, but time will tell. I am going to start on some herbal supplements to help boost my estrogen! Im so happy I got tested because all of my symptoms seem like I would be estrogen dominant, which is totally opposite of what I am. SO i definitely recommend getting tested!

  37. Hello! I’ve been off the pill (Yasmin) for 11 months now and during these month my skin has been bad and periods irregular between 21-35 day cycles. I always had irregular periods before going on the pill so i’m Not too concerned with that, but my skin is a nightmare. Everything I’ve read says it should start to improve after 12 months. This month, my 11th, it’s been the worse. Is this normal? Does it get worse before it gets better. I eat a clean diet and supplement with zinc and epo. Thanks for any reassurance you can give

    • It usually does start to turn the corner at the one year mark. The most important diet changes are to avoid cow’s dairy and concentrated fructose including all dessert-type things, fruit juice, dried fruit, smoothies, date balls, etc.

      • Dear Dr. Lara,

        I am 17 month post-pill. I took Yaz only for 15 days and the acne afterwards have been unstoppable. I can’t eat any fatty foods (even healthy fats such as avocado and nuts because they give me cystic acne). I have tried supplements Zinc. Gave Berberine a try but it gave me arrhythmia. I did not have acne prior to going on the pill. My only hormone out of balance is LH being 3 times higher than FSH. ANY suggestions? I am seeing a Naturopath but still struggling BIG TIME! Please note I do avoid sugar and dairy mostly.

        ANY help would be immensely appreciated.

        Thank you

        • Hey there Sarah!

          I had a Skyla IUD for right at a year and have had it out for a year now. About 6 months after removal my skin went crazy, it got better, then a few months after my skin turned into a nightmare. It’s terrible right now and has made me terribly depressed. I had perfectly clear skin except for your typical period pimple every once in a while before IUD. I wish I would have never gotten it inserted…

          I eat a plant based diet (no meat, dairy, eggs, animal products, etc.). I’ve been to 4 dermatologist and they’ve all recommended accutane or an antibiotic and that’s a road I don’t want to go down. 🙁 I have an appt with a gynecologist tomorrow to see if they can test my hormones and all that jazz to see what exactly is going on. I’ve tried multiple topical treatments but my skin is so sensitive it makes it worse. I purchased DIM and hoping that it will help, I’m also taking a vitamin D, zinc, omega 3, and starting taking a ginger supplement. Just wanted to say you’re not alone and I know how bad it sucks…

          Stay strong!

  38. Hi Lara,
    Thank you for all your knowledge. I’m about to get my IUD taken out, I currently do not eat dairy, sugar, gluten/grains or soy and am considering supplementing to avoid or help the acne I’m anticipating will come back. My question is what are your thoughts between DIM and Ca D Glucarate? Ca D Glucarate also helps detoxify excess estrogen, is DIM a better source? If so, what supplement companies do you suggest getting a good quality product from? Thank you for your help and all your work!

    • Do you have a reason to think you’ll develop acne?
      I would not expect post-IUD acne. Mirena IUD does not suppress androgens or skin oils. If anything, it can cause acne (because its drug levonorgestrel has a high androgen index).

  39. Hi Lara! I am so happy with this text. I am Brazilian. 6 months ago I stopped the pill and my acne is getting worse. The results of my recent tests show that I do not have PCOS, my glucose is OK, insulin OK, thyroid OK, and all the hormones are fine. My total cholesterol is high and vitamin C is very low! I read your text “7 ways of zinc rescues the hormones” and I would like to know if I can ingest “20-30 mg per day (or a higher short-term dose for acne), and I give in the form of citrate or picolinate taken directly after food. ” as you suggested.

  40. I’m on testoquench and I just started dim and a product called estrosmart and my skin is even worse. Does skin sometimes purge and get better? I should note I have high adrogens dht I did start reishi mushroom as well.

  41. Hi lara

    I hope you can answer my quick Q -i can’t seem to find reliable info anywhere.

    I started to take DIM for my acne and it seems to have improved it, but I began to have hypothyroid symptoms and on a blood test my TSH was elevated (antibodies normal). As DIM is made from cruciferous vegetables, can it be goitrogenic? Would you recommend it for your hypothyroid patients?

    I really don’t want to stop taking it but will if it is damaging my thyroid gland!

    Thank you 🙂
    Lauren

    • Hi Lauren and Lara, I would like a reply to this one too, I took DIM for acne and became Hypothyroid for the first time in my life – previously no issues with TSH. Since stopping DIM it has subsided to normal.

      • Hi Ash

        I’ve been doing a bit more reading and with DIM i actually have symptoms of higher estrogen and have read that excess estrogen can increase thyroid binding globulin (reducing active thyroid hormone in the blood). I wonder if this is the mechanism?

        I know its odd to have excess estrogen with DIM but it also clears my skin. I actually had a lot of the same symptoms when taking the pill Yasmin and now i wonder if it was affecting my thyroid function.

        Lara what do you think?

    • Hi Lauren,
      thanks for your question. I’m not aware that DIM affects thyroid, but one interesting thing is that a large dose of DIM can actually increase estrogen (and thereby suppress thyroid). I usually recommend about 100 – 200 mg in a split dose. Were you taking more than that?

      • Thanks for the reply!

        Ahh thats interesting. I was only taking 100mg a day, in one dose. I am very sensitive in general though and tend to have naturally low estrogen – could it just be my physiology that deals with DIM in that way?

        What is the mechanism for DIM increasing estrogen?

  42. Hi Lara

    I hope you can help with this quick Q – I can’t seem to find reliable info anywhere.

    I started taking DIM and it seems to have helped my skin hugely, but I started getting hypothyroid symptoms and my TSH is elevated on a blood test (antibodies normal). I am aware that DIM is from cruciferous vegetables, but can it have a goitrogenic effect on the thyroid? Would you use it with your hypothyroid patients?

    I don’t want to stop taking it but also don’t want to damage my thyroid gland.

    Thank you! 🙂
    Lauren

  43. Hi Lara!

    I’ve been reading your blog and the Period Repair Manual and I have a question that I haven’t seen answered yet…

    If I’m taking hormonal birth control pills and spironolactone now, would it be alright/advisable to quit the BC first, give my body time to adjust, and then wean off of the spironolactone?

    I’ve struggled with acne (which these prescriptions eliminated) so I’m anticipating that it might come back. My intent with stopping one med at a time is to minimize scarring. I’ve already started adding the supplements you recommend for acne so that I’m prepared! 😀

    Any feedback or ideas are much appreciated!

      • Good to hear – thanks for the insight Lara! I’ve seen that there are also natural alternatives to spironolactone (like L-Lysine). I’ll wean off with that supplement as support and see how it goes!

    • Glad to see this question asked because I was just now wondering the same thing 🙂 We’re in the same boat with the same navigational goals, Lyric! Thanks for you response, Lara.

  44. The Pil doesnt “supress sebum”- it simply increases the amount of sex hormone binding globulin which in turn means less free testosterone, less sebum and less acne. When you go off the pill, SHBG goes back to normal levels and more sebum is produced. Its simple biology. There is no post pill PCOS. Most women take the pill for decades and then suddenly stop and get all these PCOS symptos, so they conclude that its because thy have been taing the pill- ie post pill PCOS. In reality though, had they not been on the pill, these symptoms would gradually appear over a long time and would be simply described as peri-menopause- ie a decline is estrogen and all the relevant symptoms. Your articles are somewhat misleading.

    • It’s about more than just elevated SHBG. The progestins drospirenone and cyproterone are strongly anti-androgen and therefore anti-sebum. The reference that I provide states that cyproterone suppresses sebum to childhood levels. And many women experience a post-pill rebound surge in androgens that endocrinologist Dr. Jerilynn Prior says can be described as “adaptive anovulatory androgen excess.”

    • This is not true. Post-pill pcos absolutely does exist and I have experienced it. I had high androgen symptoms – acne, hirsutism – directly after coming off the pill. I was on it for less than a year – these symptoms would not have ‘developed over time’ as you say. I am only 23 years old, I have been tested and have no underlying issues with insulin so there is no other explanation for what I experienced post-pill. Lara’s articles have been extremely helpful to me.

  45. Hi Lara

    Why would soy isoflavones help acne? They shortened my cycle to 28 days and gave me painful breasts, PMS & tiredness – but my skin got better.

    Would DIM work in the same way?

    Thanks
    Lauren

    • DIM works for acne because it blocks androgen receptors. I’m not aware the soy isoflavones have the same effect (but they might)

  46. Dear Lara, i just read your book and bought the supplements that you recommend (i have to low progesterone, pms, period pain, irregular period), and though it is even only one cycle that i am taking the supplements and adjusted my diet, things already got better! I am overwhelmed! I want to thank you.

    I noticed that you recommend DIM only for fibroids/heavy periods/perimenopause.
    Do you think i could though benefit from DIM as well, i would like to try it out.
    Is it possible to take Vitex AND DIM? (besides the other supplements). Or is it a bad combination?

    Regards from Germany, Anni

  47. You say DIM blocks androgen but I thought it was to clear estrogen? I’m a little confused. Would love some clarification. Thanks 🙂

  48. Could rebound sebum production occurr after discontinuing spironolactone? I was on spiro for about ten years and when I stopped taking it six months ago, my skin has had continual acne break outs. Love your blog, btw. Thank you for sharing your knowledge and expertise!

    • Yes, absolutely. Spironolactone is basically the same drug as the drospirenone in Yasmin. Coming off those drugs causes rebound androgens and sebum and acne.

  49. Hi, I’ve found this site really helpful, thank you Lara! Wanted to share what helped me with post-pill acne. For my face I’m using regular drugstore cleansers with salicylic acid, tea tree oil (also from drugstore) and active coal mask (made by me of pills bought in the pharmacy by adding water or aloevera gel). Plus I use baby powder (with zink) instead of regular face powder for finishing my makeup. These really help a lot but you have to be very consistent and use the cleanser and tea tree oil once or twice a day, the coal mask in every 2-3 days at least. I also take Zink tablets. The hardest period as Lara said is around 6-8 months post-pill so it’s also a matter of time and patience. Because of the hormone inbalance I also have excess selbum on my scalp and that resulted in itchy rashes and fungal and bacterial infections there. This is a bit harder issue for me because I was washing my hair so often for a while that I became allergic to shampoos (I went to see 3 different dermatologist but nothing they gave e helped). Now I wash my hair with soda and vinegar (it very important to use both, if you skip vinegar you’ll ruin your hair!) and I use tea tree oil and baby powder there too. It helps, and diet helps too (sugar and dairy free, but for me sugar is the key). From my experience alcohol is a bed influence and stress too of course. I noticed that when I was on holiday I didn’t need to be so strict with my diet I guess because my stress levels were low. Beside all these I advise you to change your pillowcase much more often, if the acne or the scalp infection is really bad, daily (and your makeup brushes/pads too). It really helps. And fingers away of course! Clean your skin really gently even if it’s itching. I’m 8 months post-pill and my skin is almost flawless and keeps improving. Good luck!

      • No, actually I started taking supplement really late because I didn’t know anything about post-pill problems before I had them. But I’ve been already on a sugar-free diet since I stopped the pill the first time some years ago and I was diagnosed with insulin resistance. I wasn’t taking any medication for it was only the diet (tried metformin but made me really sick). Now I think insulin resistance was also just a post-pill thing, because they told me it will last for life and now my doctor says I don’t have it anymore. I’m still on the diet though just because it’s healthier. And now it’s also dairy-free when possible, but I hope I won’t have to do that forever – oatmilk is nice but I miss cheese and yoghurt so much 🙁

  50. I have read that DIM promotes free testosterone so taking it might increase the androgens levels, making acne worse for the women who have it because of increased levels of this hormone.
    What would you recommend for someone who was on anti androgen pill (for acne), which has worked clearing it, during the transition to off pill? Besides the no sugar, no dairy diet and zinc+magnesium supplements?
    I was put on the pill only for acne (i m on it for 7 years), i did not have any period problems before pill (not heavy or painful, also regulated), altough an ecography showed micropolicysts on my ovaries (doctor didn t mention anything about PCOS).
    Thanks in advance!

    • No, there’s not a lot of sugar in wine. I don’t see wine as a big problem for skin. But of course too much is not good health generally.

  51. I thought I would comment for anyone looking for some hope with their post-pill skin. I can FINALLY say that my skin is on track to being clear, but it took more like 8-10months rather than 3-6. I am so glad I didn’t go back on the pill though…my skin is better now than it ever has been, and I was on an anti-androgenic pill for years that was supposed to be great for reducing acne!

    A few tips for those interested: read Lara’s book and encourage healthy cycles, avoid dairy and sugar, go mineral with your make up, wash your pillow case every 2 days, use good skin care (I started cleansing with jojoba oil and toning with an acv/water mix – amazing! Stay away from the harsh anti-acne stuff sold at the chemist, it actually makes your skin worse) and be patient, waiting is the hardest part. I remember being at 7 months post pill with the oiliest skin and feeling like it would never improve…but it did! And my body did it all by itself 🙂

    Now I am just waiting for my hair to stop falling out. I am hopeful that it will, and I’ll get to share my positive experience with that too. Fingers crossed.

    Good luck ladies x

      • Hi Emily, unfortunately my hair continues to shed, and I am now 19 months post pill. It has improved, my scalp has filled in moderately, but it is not back to my version of normal by any stretch of the imagination. I think (hope) that hair will take longer, maybe 3-4 years to fully recover. The pill triggered chronic TE for me and a myriad of scalp issues, so it will take time for that regulate. The positive is that I didn’t go bald, and I saw improvements 3 months post pill. Everything is better for me off of those nasty faux hormones.

  52. Hi Lara I have recently come off the pill (3 weeks ago) after being on it for 2 years to control my acne. I also have PCOS and have been on a gluten free, sugar free and dairy free diet for 6 months and I take magnesium, zinc, B complex. I am 28, slim and healthy. I am using bio identical progesterone cream and so far my skin is still the same as it was when I was on the pill but it has only been 3 weeks so I guess it is too early to change. Will the progesterone cream help prevent the onslaught of what is to come? I have also been on metformin for 2 years and I hope this will help too. How long after stopping the pill will my skin start to get worse? It was terrible before I went on the pill but even when I was on the pill it was still quite bad and always very oily. My hair has started to fall out more than usual over the last 3 weeks. Please advise me on whether progesterone cream is OK for me as I am deficient. Also will progesterone cream make a difference even while on BC? I noticed a slight improvement.

    Thank you for all of the helpful advice on your website!

  53. Hi Laura! I love your site and your book! I started taking Berberine (Thorne Research – 500mg), twice a day (AM and PM). I am having however constipation for the last few days now and a bit of cramping when I visit the restroom. I was reading that this is a common side effect of berberine. Is it true? Do I need to cut back the dosage? I would be grateful if you could offer some advice. Thanks!

    • Definitely, take a break from it and then maybe try again at a lower dose. I usually ask patients to stop berberine for a couple of days per week and not take it for more than 8 weeks in a row.

  54. I’ve cut out dairy, wheat and sugar. My face is finally back. But I’ve noticed tingeling in my arms and that my stomach gets bloated. Also a backache. Could this be of a b12 deficiency? Cause all of these foods include b12. I also have low ferritin. Under the normal range.. my b12 serum last time was at 400nmol.

    • Hi Kara, I had the same problem. I think hormonal imbalance causes IBS syndromes (bloating/diarrhea/constipation) and sometimes gluten free diet makes it worse. Your bowels need fiber to keep moving. Things you can try: skip gluten free diet partly or entirely and see if dairy free alone works (it works for me with bio products for example) and/or take probiotics (the really help a lot with IBS) and/or eat more popcorn 🙂 One coffee in the morning also helped me, but you need to try what works for you! Good luck!

  55. Hi Lara!
    Do you have any advice or resources for acne during pregnancy? I went off the pill in January 2016 and had post-pill PCOS symptoms including acne. I wasn’t able to ovulate, but finally did with the help of my OBGYN and did get pregnant (a year after quitting the pill). But now my acne is even worse. I wondered if you had any advice for pregnancy acne because it’s really getting me down! I’m also terrified of the acne getting even worse post-delivery. Thanks.

  56. I Lara,
    I have taken saliva test for cortisol, dhea, estradiol and testosterone. This last one is quite high, but I remember you saying – or probably have read it in your book – that the best way to measure testosterone is blood. Can you please tell me why and also is it only testosterone that must be measured with blood test or do you think that the other hormons are best tested with saliva?

    Even if I am in menopause I have read your book and I think it is fantastic, I do think all young girl must read it, pity I did not have this opportunity I would have understood lots of thing, but even now I found lots of tips very interesting.

    It would be nice if you could have it translated (in Italian for instance) so many more people would have the opportunity to learn a lot from it and improve their health.

    Thank you!

    • Thanks for your comment and feedback.
      Salivary testosterone is not a reliable test because oral bacteria make testosterone.

    • It’s common for skin to flare at that time due to drop in estrogen. The solution is to correct the underlying problem with skin with treatments that I discuss here.

      • Hi Lara, so nice to see I’m not alone and there’s a way to understand what’s going on, thank you! I quitted the pill 8 months ago. I’m taking Zinc, Maca (I’m planning to try Vitex too) and fish oil and I’m on a sugar and dairy free diet. I went dairy free a few months ago and I went on a sugar free low carb diet when I was diagnosed with insulin resistance some years ago after I stopped the pill the first time. Back then I had no period for 6 months and my doctor said I also have elevated male and female hormone levels. Before I started taking the pill I had light and mostly regular periods, but I remember that I had to gain some weight to have my first period because I was underweight. In stressful times I tend to loose weight and even now at age 30 I’m on the lower end of healthy BMI (18). I try my best to reduce stress and gain weight but it’s not easy – I’m a working women on a strict diet. My acne is very bad, I have a lot of excess oil on my scalp and scalp acne too, but at least this time I have periods. What worries me is that gap between them are keep getting longer. In the last 8 months the gaps were like this: 23, 25, 29, 23 days (with an average 5 days of bleeding and very bad PMS the weeks before) and than nothing for 39 days and after that I had a 10 days of bleeding (but mostly light). Since then 36 day passed and I’m having pre-menstrual symptoms but no bleeding. I’m not pregnant. Do you have any idea what can be the reason? Is there something I’m still doing wrong?

        • This is solved, I think it happened because I started to take Maca powder – I didn’t have my period until I stopped taking it. But I’ve also started to eat more carbo. I still have long periods but other than that it’s normal.

  57. Hello I was on the pill for seven year I went off about nine months ago I have regular periods but I have very oily skin and acne my free testosterone is a little high what would you recomended ?

  58. Hi Lara, can I take berberine whilst taking peony and licorice? My skin is awful even though I came off the pill ten months ago and am also taking zinc and magnesium.
    So embarrassing having awful skin at nearly 30 years old. Getting desperate! x

    • Are you off dairy and sugar? The peak of post-Pill acne is usually about 6 months, so should start to improve soon. I give peony and licorice only when there are clear signs of PCOS.

      • Lara is it ok to take 1500 mg of licorice and 1500 mg of peony together at once in the morning? Unfortunatelly you don’t write about dosage in your book. I have no period for 5 months, elevated androgens and awful skin so probably it’s post pill PCOS and peony and licorice are the right treatment. I hope so…

        • I didn’t specify dose because it depends on the specific product and the concentration of the extract. Do you have a local herbalist you could consult?

          • Lara if I had had a herbalist I wouldn’t have written to you for almost a year. And it’s really not easy to contact you 🙂
            I’ve been taking peony and licorice for a month. There is still no period but my skin is better and I have excessive vaginal mucus – so something is happenig… I hope something good because I have used almost every dietary and supplement advice from your book and blog. My phycisian persuades me to come back to the pill or to take Duphaston (Lutein). But I think I’ll waite and give the last chance to peony and licorice. What do you think?

          • Excessive vaginal discharge can be a good sign. Especially if it is the fertile mucus I describe in my book.

          • Unfortunately it wasn’t fertile mucus. It looked like one but I tested my urine and I wasn’t ovulating. Anyway I give peony and licorice a try and waite for another two months (because you wrote that if it is supposed to work it will work within 3 or 4 months).

          • If it looked like fertile mucus (raw egg-white), then it’s from estrogen, and a good sign. It means your body is trying to ovulate, even if you did not get all the way to ovulation that time.

          • Lara, after 1,5 months of taking peony & licorice I got my period (I haven’t had one for 6 months). I was beyond happy. But now it’s been another 45 days and still no period. So are peony & licorice working for me or not? I’ve been taking them for 3 months and they probably helped me to get my period but now it’s gone again. Should I continue with this treatment? PS. Unfortunately acne is not getting any better (it did in the begining but the progression stopped).

    • Hi Lara, so increased vaginal CM is a good sign?

      I too have had periods that became irregular. I haven’t tried licorice or peony but started seeing an acupuncturist/herbalist. After my 3rd acupuncture treatment, I started having more vaginal mucus. Haven’t had this in months, so I’m hoping my hirmones are regulating. I see my acupuncturist in a few days ago will start taking herbs.

  59. Hi Lara,

    I am about to get married in 3 months and really want to stop taking pills as I have terrible side effects with the Zoely and can’t wait anymore. I understand the acne is the worst after 6 months, how is it usually after 3? Do you recommend some supplements for when I stop?

    Thank you!

  60. Hi Dr. Lara,

    I’m wondering if you know anything about pore size/enlargement due to being on birth control and/or going off. I never had visible pores, until about age 24 a few months after starting Ortho Tri Cyclen. The sudden appearance of pores on my nose and cheeks was a bit alarming, and I was told that it was probably just due to aging and sun damage. But it very much coincided with starting the pill. When I went off a little over a year ago, I also developed noticeable pores on my forehead and along my temples, probably due to a general increase in oil and acne I’ve been suffering from ever since.

    Do you think my pores will shrink to their pre-birth control size (ie invisible) once my body balances out a bit? Or once the skin has stretched due to oiliness/androgens, does it never shift back? Not sure if you have any knowledge of this–I know it’s more of a derm question. Just wondering because I noticed the enlargement and visibility as a direct result of starting and stopping BC.

    Thanks!

  61. Hi Lara ! Your blog is very helpful for us. Thank yoou so much. I´d like to ask you…if a woman has irregular cycle – 40-50 days, according to basal temperature they are anovulate..should be bio-identical cream used from 12th day of a cycle till 26th or ? Also hemoraghic cyst is present.. Progesteron in folicular phase was 1,6, during “ovulation” 2,42 and estrogen 132,2 and in “ovulation” time 162,3 and 23CD 285,8. Range for progestreon in folicular phase is 0,6-4,7 and ovulation phase 2,4-9,4, estrogen in folicular phase 98-571 and ovulation phase 177-1153. According to me, there is a lack of progesterone, am I right ?

    • do you mean, “according to basal body temperature, they are anovulatory cycles”? As in, you don’t see a temperature rise? Then you have no ovulation phase and no luteal phase. And so no, there’s no point in timing progesterone cream that way.
      You need to figure out why you’re not ovulating, and try to fix that. Do you have PCOS?

      • Yes, exactly, no temperature rise..temperature is still about 36,4-36,6..rise and fall…I have no PCOS, just hemoraghic cysts for a year…my gynecologist recommends surgery to remove cysts but I don´t agree. Is it possible to remove a hemoraghic cyst withou a surgery, some supplement or something ? She says, my hormonal panel is OK but I see a lack of progesterone..cause in luteal phase progesterone should be about 30 and more..I have 2,42…she says that I´m not ovulating PROBABLY because of a cyst that´s why she recommends a surgery. I´m 170 cm tall and have just 50 kg, probably underweight little bit cause of Hashimoto..and now I´m on AIP paleo diet for 5 months. My last bleeding lasted only 2 days, normally 5-6 days. Do you have any suugestions how to cure a cyst ? Do you thing progesterone is useless at this moment ?

  62. I have been a reader of your newsletter Dr Lara for at least 10 years and it has taught me so much about hormones and the effects of western medicine on our body. Knowledge which I forwarded to my practitioners and passed on to others to be aware of. Always being skeptical the doctor’s advice/treatment is not always the right or best option. Or even the only one.
    I think it’s wonderful that practitioners such as yourself who are aware of findings and have so much knowledge on treatments put it out there for people like myself who are always looking for safer and better options. Thank you.

  63. Hi Lara

    Is there a particular form/dose of berberine that you recommend? I’ve taken Oregon Grape Root for 8 weeks in the past but it didn’t seem to make much of a difference. Should I be able to see a difference after 8 weeks?

    Thank you
    Lauren

  64. I really enjoyed your book and I’m hoping you can help me with a problem. I was having a hard time conceiving despite having nothing wrong with me or my husband. I’ve always had regular periods (between 27-29 days). So I started charted and after charting for a while, I suspected I might have a slow rise/progesterone deficiency. My MD did not listen to me, so I found an online program (based off of traditional Chinese medicine) which claimed to helped women improve their cycles. I thought this would help me progesterone issue. I was on the program for almost 2 months and was taking daily tinctures of herbal supplements based on what was going on with my cycles. Some of the tinctures had peony and licorice. I noticed that my periods started to become highly erratic and irregular. Now my past several cycles have lasted 43 days, 49 days, etc. and I don’t think I’m ovulating (or I’m ovulating very late). It seems that I have “pill induced PCOS” even though I did not take birth control pills. I’m still trying to conceive a baby, but now my cycles are completely messed up. Peony and licorice did not work for me. What should I do? My periods have been messed up for over 3 months now and I feel lost.

  65. Have hope ladies! I’ve been off the pill for 9 months acne is back but did peak at 6 months. I got my period this week (the first real one in a loooonnggg time). Whilst I’ve still got acne I’m confident that with my period coming back it will get better. I see a Chinese herbalist, drink turmeric daily, take fish oil and a probiotic daily. The main thing is be patient and relax. I also get peels at a medi spa and have learnt some good makeup tricks from you tube.

  66. Hi Dr. Lara,

    My progesterone is pretty low (620), amongst some other deficiencies in B12, iron, and zinc. I suffered horrible acne three months after going off the pill, and it started to stabilize a bit, but I thought it was just from the expensive acne skincare line I started using.

    3 weeks ago, my naturopath put me on a supplement regimen to correct some of these imbalances. My acne has gotten noticeably worse all of a sudden–all over my chin and even in random places like on my cheeks. Is it normal for things to get worse before they get better, or is it more likely that my naturopath is making me do too many things at once and my body is once again overreacting to the sudden hormone shifts (even if it’s in my best interests)…..what do you think?

    I am scheduling a follow up with my naturopath, but would love your opinion as well. I’m supposed to be getting better, but instead just seem to be reverting to where I was in the 3-6 month mark after the Pill when the acne was horrible and I had still not started using the skincare line.

    Thanks!

      • I am taking Vitex, one pill a day between meals. However, I only take it at the beginning and end of my cycle. Day 12-25 I am taking a type of liquid tincture.

        • Hi Alyse

          Just wondering if your naturopath put you on B12 supplements as they are known to cause/flare acne – that might be the problem? (Also, iron can disturb your gut bacteria and cause dysbiosis, which in turn worsens acne, e.g. enabling the growth of candida.) Just thought this might help as I struggled with both these things!

      • Hi dr briden…Im torn about Vitex I have high dht androgens pcos. but I started a supplement called testoquench a year which has 200 mg of vitex in it but it cleared up my face but now my back has acne. I dont want to quit the vitex as i have regular periods and regularly ovulate but do you think its contributing?

        • Testoquench also has the herbal medicine peony which has a fairly strong anti-androgen effect.
          But it should be fine to take a break and see if you continue to ovulate regularly.

  67. Hi Lara,

    I have just been diagnosed with PCOS which was a relief seeing as I have struggled with some from of acne for 5 or so years now

    It has been getting increasing worse especially on my chin, mouth area and forehead.

    I have completely changed my diet- 3 months now am diary free, gluten free, low GI, alcohol free and now sugar free- except for some dry fruit on occasion.

    Previously I have been on the pill twice but stopped more than 2 years ago now.

    I have had my hormones tested my LH was 3.6 IUL and my FSH was 3.7 IUL, my prolactin was 430 and my testosterone was 1.7 (the highest for the normal range is 1.67). I have also done an insulin fasting test and it has come back that I have normal insulin levels.

    I am currently taking a probiotic and have noticed some small changes.

    I am just wondering what you would consider my next steps would be?

    Any advise would really be appreciated.

    Thanks,

    Ellie

    • As your testosterone is elevated, you would probably benefit from some of the treatments I discuss in my PCOS post, and Chapter 7 of my book.

      But also let me say that even a small amount of dried fruit is too much sugar for skin.

      • Lara why so small amount of sugar is too much sugar for skin? Especially when Ellie’s insulin is ok. I don’t understand it and I also have huge problem with acne (I am waiting for you to read my questionaire).

        • Sugar (concentrated fructose) is a problem for skin even when insulin sensitivity is normal. I don’t know the exact mechanism, but it’s fairly consistent clinically. Dried fruit, dates, fruit juice all cause acne.

      • Hi Lara, thanks for your advise! very helpful i will stay away from the dried fruit! are a couple of pieces of dark chocolate okay? or should I stay away from this too?

        • Hi Ellie- I was sort of relieved to discover I had PCOS recently after 6 years of skin issues. Seems like we have very similar symptoms… I am not insulin resistant and my testosterone is evaluated compared to my progesterone and estrogen (although testosterone still technically in normal range). I am not overweight, but get persistent acne around my mouth and sometimes between my eyebrows. I have been minimal sugar, wheat, white rice, dairy and alcohol since start of August. Send me an email or Facebook message if you’d like to share how you’re going with someone 🙂 there’s not so many people with PCOS trying to treat completely naturally and I need all the support I can get! I am refusing to get back on the pill, despite all the pressure 🙂

          • Hi Emily! Yes it would be really useful to get in contact with you- whats your email or Facebook? I am determined to not go on the pill too and am hoping that an- anti inflammatory diet and staying away from toxic products will help clear my skin naturally!

  68. Dear Lara, dear all,

    I would like to share my own experience with post-pill acne. I apologize for the long post but I have had years of post-pill experience now. 🙂

    I came off Diane 35 (anti-androgen pill) nearly 4 years ago, in January 2013 and frankly it has been a very traumatic experience. I want to stress that before taking birth control, I NEVER had any acne and hair issues.

    6 months after coming off the pill I had a sudden and terrible cystic acne breakout. It got worse every day for about 2 months. My blood tests showed no hormonal imbalances and yet my face and back were covered with huge painful cysts. I cried all the time and got really depressed.

    At the time I was taking a lot of supplements and I started a gluten-free, sugar-free and gluten-free diet (for about 2 and half months).

    But I only saw an improvement after I started drinking yarrow tea. Within a couple of weeks, the difference was already obvious. A miracle!

    After 3 months of treatment, I still had a lot of scars but my skin had almost completely stopped breaking out.
    I was also combining the tea with other supplements (e.g: vitamins).

    Unfortunately, my hair which had started falling out progressively started shedding in clumps. It was very distressful as I always had beautiful long curly hair… so I had my hair cut very short. This was also a difficult experience for me.

    6 months after I started the yarrow treatment (Spring 2014) I stopped it and switched to strawberry tree treatment (drops). I assume this was not meant for me since a couple of months later I had a new breakout. Although it was not as serious as the first one it was still pretty severe. I was very upset and hopeless as it lasted for a few months. I went back to yarrow tea and some time later I switched to yarrow drops because I found them more convenient.

    2 years after coming off birth control (2015), the acne was still there but not as bad. I mostly had cystic acne around ovulation and as PSM symptoms. My skin would get better for a few weeks and then I would break out again a little. In the summer 2015, my skin was not perfect but it looked normal.

    Unfortunately, my hair loss which had slowed down a little got worse in the fall 2015, so I stopped taking yarrow and tried maca for a couple of weeks. I then had a new acne breakout and stopped maca as I suspected this was the cause.

    I continued to have some breakouts from time to time until April 2016 (over 3 years after coming off birth control). Then, I just got fed up with everything: yarrow, vitamins, etc and stopped all the supplements (although I was taking just 2 or 3). I just wanted to live without depending on any medicine even if this was only natural medicine…

    The funny thing is that my skin actually got better on its own and more impressively, my hair got fuller and thicker within a few weeks. It seemed that my body was finally adjusting to hormonal changes on its own.

    In June 2016, my boyfriend and I decided to try to get pregnant and luckily it worked right away! 🙂 Unfortunately, while my skin continued to improve my hair started falling out in clumps again. This new hair shed was a real disaster for me. I did not find out I was pregnant until the 7th week of pregnancy because I had my period (they were obviously false periods) and because I could not even begin to think that hair loss could be caused by pregnancy. I was put on a sort of natural thyroid treatment (Thyroid Erfa) because my thyroid was slow but this did not stop the shed so I suspect the thyroid was really not the problem.

    My conclusions:

    – the birth control pill really messed up with my hormones. I feel like I got over-sensitive to my own hormones.

    – it may take years for the body to actually get over the hormonal problems induced by the pill/coming off the pill

    – there is no need to insist with supplements. At some point, it is better to let the body “breath” a little and do the job by itself.
    No one can explain to me why my hair has been falling out so much ever since I got pregnant… my hair loss was even worse during the first trimester and I wonder if this is not related to the high levels of progesterone… Since my hair got thicker in Spring after I stopped taking yarrow supplements which are progesterone-like, maybe I gave too much of these to my body and it is now overreacting to progesterone? Difficult to tell…

    – In my experience, doctors know nothing about hormones and most of the time, you are on your own. It is important to be very determined and to trust your gut. I refused all the treatments such as Acutane, antibiotics and minoxidil for the hair. And more importantly, I always refused to go back on the pill despite what doctors told me…

    • Hi there, not sure if you’ll see this message but I am on Diane 35 and have been for nearly 4 years. I’m currently planning to go off of it with the tips from Lara. I’m surprised you were prescribed this pill if you didn’t have acne in the first place, since it is a treatment for it, with contraception as a side-effect. I’m obviously terrified of what will ensue, as I had pretty bad cystic acne that started in my late teens, early 20s. I never had acne as a teenager and actually had really smooth clear skin until I turned 18-19. I went on Diane 35 at age 20 and I am now 24. I’m really hoping my hair doesn’t fall out but I would prefer it over the painful acne and back acne I had before the pill.

      Have you seen any positive changes lately?

  69. Hi Lara, I love love love the Period Repair Manual and am looking forward to your upcoming webinar 🙂
    Quick question, what are your thoughts on Saw Palmetto or L-Lysine where androgen sensitivity is concerned (acne and hair loss) or is DIM really the gold standard in supplements here? I am already taking zinc and am dairy/sugar/gluten free. Thank you!

    • I’ve never had much success with saw palmetto, but I know others recommend it.

      Keep in mind that the strongest anti-androgen is progesterone. Do you ovulate each month?

      • Hi Lara, thank you. I believe that I am ovulating – my periods are very regular and I have other signs. It is just that I am 6 months post-pill and losing hair by the handful and everything is oily – face, scalp, back. I was looking for a little supplemental help. But do you think I should wait it out longer?

        • 6 months is usually the worst part of Pill-withdrawal. I expect it will start to settle down, but of course it’s impossible for me to say without knowing all the details of your case.
          It wouldn’t hurt to try saw palmetto, if it has been recommended to you. And then please consider reporting back to the comments here, so others can learn from your experience.

        • Hi, I just saw a very good doctor that told me I should stop using all my beauty products – no moisture, only shampoo with no conditioner and no make up! I only wash my face with very gentle soap and that’s it. It should dry your skin. I tried and it really helped. Let me know how it works for you.

  70. Hi Lara – Thank you for writing the Period Repair Manual. This book has helped me so much! I wanted to ask you opinion on taking DIM along with Letrozole. I’m 37 and my husband and I are having a hard time getting pregnant. My gynecologist started me on 2.5 mg of Letrozole to see if this will help us conceive. I would like to continue taking DIM but not sure if I should take this with Letrozole. Do you have any insight on this? Thanks so much!

  71. Hi Dr. Briden,

    I am at the 12 month post-pill mark and still suffering from sebum overdrive. It started around month two after quitting the pill. My acne has improved, which I think is a combination of time and the strong acne skincare line I am using. The sebum churning out the back of my scalp has improved a bit as well, but is still a problem. I have a healthy diet, and while I still eat greek yogurt for protein and the occasional cheese on pizza, I don’t have a crazy high dairy intake.

    Sebum on my scalp has never been a problem until this past year. When I used Plan B and went off birth control in other instances, I did experience increased oil production and acne on my face….however scalp/hair was never an issue in either instance.

    I am desperate to control the stickiness! Please let me know if there is anything else I can do. Will more progrestorene help with this? I have had periods for all 12 months (maybe a little irregular on timing though) so I know I am getting natural progestorne.

    Thanks!

  72. Hi Lara,

    I have just been diagnosed with PCOS which was a relief seeing as I have struggled with some from of acne for 5 or so years now- I am now 21

    It has been getting increasing worse especially on my chin and around my eyebrow area.

    I have completely changed my diet- 3 months now am diary free, gluten free, low GI, alcohol free and now sugar free- except for some dry fruit on occasion.

    Previously I have been on the pill twice but stopped more than 2 years ago now.

    I have had my hormones tested my LH was 3.6 IUL and my FSH was 3.7 IUL, my prolactin was 430 and my testosterone was 1.7 (the highest for the normal range is 1.67). I am going back to the doctors soon for an insulin fasting test- as I’ve read your book and am trying to find out what the cause of my PCOS might be.

    I am currently taking an omega 3, myo-insitol, saw palmetto, berberine, a probiotic and turmeric. I have only started these recently and have noticed some small changes.

    I have had another recent appointment at the doctors and have been prescribed a topical retonoid and a corse of lymecycline antibiotics for 4 months.

    I am really stuck as what my next steps could be- any help would be appreciated- I haven’t started the antibiotics yet- what do you think of these for acne?

    Thankyou,

    Eleanor.

  73. Hi Dr. Lara,

    I’ve tried almost every natural source and still have a bad skin. I stopped birth control 6 months ago. I’ve done gluten free, dairy free, I’ve tried honey masks, aloe masks, I’ve tried saw palmetto (didn’t see any improvement), I take Zinc for 4 months now, I’ve been taking DIM for 2 months now, also Magnesium. I eat healthy and drink a lot of water, I avoid sugary foods.

    DIM worked well for the first three weeks and helped a lot with cystic acne, now it’s coming back. Do you think I should try barberine also?
    I’m really trying to avoid oral medication for acne but I can’t find a way to control this issue naturally.

    Thank you so much for all your posts, very helpful!!!

    • As I state in the post, post-pill acne PEAKS about 6 months off the Pill. So it should start to improve on its own. Do you have regular cycles to make progesterone? Because progesterone is anti-androgen and THE best hormone for skin.

  74. Hi Laura !

    I’ve been off the pill for a little over a year now. I was one of those women falsely diagnosed with PCOS a couple months off the pill. That got cleared up by a more serious OBGYN. However now, almost a year and a half out, I’m suffering from the worst most constant acne of my life. Under my chin, on my cheeks, on my forehead. I have no relief from it ever. My doctors are suggesting putting me back on the pill because of a hormonal imbalance causing acne, irregular periods (although now they’ve regulated) etc. I am so frustrated because I don’t want to go back on and yet I feel like I’m at the last straw with this whole pepperoni faced deal and would do anything to get some peace of mind and face.
    Sincerely,
    Gloria

  75. Hi Lara, I’ve read that DIM can increase testosterone, and therefore not recommended for women with PCOS. On Frances Herr’s blog, she comments “DIM is an aromatase inhibitor, which means it blocks the conversion of testosterone into DHT, and therefore lowering DHT androgen levels. However, we hope that the excess testosterone is then converted into healthy estrogens, but in some cases it doesn’t so the testosterone levels rise even higher. For this reason I never recommend DIM to women with high testosterone”. What’s your opinion?

    • First of all, it’s 5-alpha reductase (and not aromatase) that converts testosterone to DHT. Next, there’s no evidence that down-regulating 5-alpha reductase would “back up” into elevated testosterone. My experience is that DIM has a definite anti-androgen effect in women.

      • Thanks for your response Lara. I’ve recently started taking DIM again, as I previously had good results. Was a little worried that it may not be the best for PCOS, but this doesn’t seem to be the case. Thank you

  76. Hi Lara,
    I plan to stop taking the birth control pill in the new year. For the past 6 months, I have been on a gluten free, dairy free, no sugar “diet”, I am also taking zinc. My main concern is possibly dealing with acne when I come off the pill. Is there anything more I can be doing to prepare my body the best way possible to come off the pill, or is there any other suggestions you have to avoid dealing with skin issues post pill. I see your suggestion of vitex and or berberine, are these something you take beforehand, or if the skin starts to act up? Thanks!!

  77. Hi Lara,

    I am just wondering whether you can shed some light on my problem. I’m 26 years old and had been on diane 35 for 8 years. I stopped the pill 8 months ago and had the copper iud inserted shortly after. Since then I have had two normal periods (then nothing for a couple of months) and now I have been bleeding for nearly three months. I am also not eating sugar, dairy or gluten, and am taking magnesium, b complex vitamins and saw palmetto (hair loss). I took vitex for 6 months and just stopped now after I read on your blog that is actually not recommended for everyone.

    My GP did a pap smear and std check but everything seems normal. She wants me to take provera to stop the bleeding but I’m definitely not going to do that. Have you ever heard of anything like that?

    I hope you come to the North Island some time soon so I can attend one of your seminars. I’m so pleased to have found your website and knowing that you also live in New Zealand is an added bonus!

    Regards,

    Mariane.

    • Did your doctor do any hormone tests? Constant bleeding like that suggests you are not ovulating. Which has to be for a reason. Usually thyroid or PCOS.

      • Yes, I do have pcos, sorry I forgot to mention that. She did some hormonal tests but never told me the answer, so I supposed they were within a normal range for pcos. Do you think that giving it some time will help?
        Not to mention the acne and hair loss that are destroying my self esteem, but I’m starting to take zinc this week, and am considering taking estroblock which is a form of DIM. Hopefully those will help…

          • Thank you so much Dr. Lara for taking the time to reply to our comments. Please let the north islanders know if you ever come up!!!!!
            All the best

          • Dr Lara – would you mind just shedding some light on my recent blood test results. I have been trying to investigate whether I am the insulin resistant pcos type, however I have ground to a halt trying to interpret my most recent test. My fasting glucose was 4.2mmol/L and my fasting insulin was 39 pmol/L. Do those results point towards insulin resistance in your opinion?

            Your response would be very much appreciated.

  78. Hi Lara, I’ve been pretty much spot free during my teen and early 20s years, but suddenly developped acne from a few months ago. It typically starts 11-12 days after my first day of period and lasts approx a week. It calms down a couple of days before my ovulation day (i have very long cycle, usually 35 days). The spots are huge and locate on both side of my neck near jaw lines, not the type that you can pop. It’s quite progressive, from only 1-2 spots on one side a few months ago to more than 10 on both sides now…

    it errupts and clears and repeats every month, so i figure it’s hormone related? What do you think is the underlying reason here? Is there any dietry advice I could follow to reduce this type acne? I’ve been trying GF, DF diet for one and a half months so far.

    Thanks so much!

  79. Hi Dr. Lara,

    How long does the sebum rebound tend to last? I went off Ortho Tri over 10 months ago, and my scalp is still producing excess sebum like crazy. It’s toward the back of my scalp, and makes the hair there feels greasy and stringy. I think it is also contributing to hair thinning and loss across my head. I’m desperate, how much longer an it last before correcting on its own? Periods are normal, and all bloodwork comes up normal according to both my naturopath and general doctor.

    If the sebum eventually calms down, should my hair eventually go back to normal? Or has the inflammation/infection caused permanent damage to the original hair follicle? I am confused by what I read about telogen effluvium and alopecia……it seems like I could have either one, and I just want to know that I can get my hair back eventually I don’t care how long it takes.

    Have you ever seen success with biohormones for hair loss and sebum correction? Is this something I can ask my doctor for?

      • Hi Dr. Lara,

        Does the rebound last for a year after stopping the pill, or a year about the rebound appears for the first time? I am at the 12 month mark since stopping the Pill, but the rebound started noticeably about 10 months ago. It has subsided very very little….still struggling with acne and severe scalp sebum that is contributing to hair loss as well….

  80. Lara,

    How do you know when you’re taking too many supplements? Is 29 pills daily too many? I have PCOS and just the myo-inositol alone is 8 pills, my multivitamin is 6 pills, N-Acetyl-Cysteine 3 pills. I feel overwhelmed, stressed and broke. Please lend your advice as I feel I have been cornered to believe I need all of this stuff and without it I wont have resolution. I hope there is a better way.

    Long time reader, Sandy

  81. Hi Laura,
    It was great to read your article as this is my exact story which you have described above!! I went back onto Yasmin contraceptive pill about 6 months ago along with a stronger medication called sprionalactone which is an androgen suppresant. I have recently come off spironalactone incredibly slower guided by my doctor and am waiting 3 months or so to start coming off the pill as dont want to give my body too much withdrawal all at once!

    I have a question for you about the supplements you suggest including – would it be better for me to start taking them now while i am still on the pill so that as i come off there is support already there? Or are they things i should be taking once i have come off the pill?

    Thanks so much for your article I have found it incredibly inspiring and eye opening so thankyou

    I am currently studying naturopathy at ACNT in Sydney at the moment and it would be amazing to meet you if you had time when you are next in Sydney as this is an area that i would also love to specialise in.

    Thanks so much,
    Lily

    • Hi Lily, Yes, I often start the acne diet (dairy-free, sugar-free) and supplements (zinc) while a patient is still on the Pill.
      I offer a mentorship/case-study workshop for clinicians in Sydney. My next one is Sunday 27 November in the CBC. You’re welcome to join. I just sent you an invitation.

  82. Dr. Lara,
    Do you have suggestions as the best way to wean off of Progesterone Cream? I took it to regulate my periods, and have been taking it for almost a year now and am hoping I can start weaning off. I take it day 12-21 of my cycle. Should I lessen the amount I’m applying each day? Or lessen the total number of days I apply? i.e. 12-18 instead of 12-21….or would it be best to just try stopping it?

    Thanks!

      • Yes, I’ve been regularly getting my period for a year now with the aid of this bio identical progesterone (hopefully it’s a real period, I’m not sure if you would refer to it as bleeding like on the pill?) Thank you!!

        • But have you ben ovulating? you can tell by tracking cervical mucus and temperatures. A real period is defined as a “cycle in which ovulation occurred”.

      • Yes from what I can tell I am ovulating based on cervical mucus. If I am what would be the best way to proceed? Should I wean off the progesterone cream slowly? Thanks so much!

        • If you’re ovulating, then you should be making a fair amount of progesterone. Generally, progesterone can just be stopped anytime. It doesn’t need to be weaned down. But best to speak to your doctor.

        • Hi Dr.Laura Do you have any recomendation for me I went off the pill nine months ago I have acne and very oily skin. I have regular periods but my free testosterne is a little high and the derma only says take again the pill but I was suffering horribles migraines

          • you should be nearing the time when your skin will start to improve. My best recommendations are those I’ve listed here (sugar-free, dairy-free, zinc, etc)

  83. Dear Lara,

    Been reading through all your comments the last few days. Lost my place, but saw you said you don’t really prescribe multivitamins anymore? What is the reason for that? I need magnesium and zinc, but I thought I would deplete my calcium and copper if I took them alone.

    Ciao, Justine

  84. Hi, I’ve been taking DIM combined with Zinc and I’ve seen a huge improvement on the cystic acne. Although I noticed that my mucus production is much lower now that I’m taking DIM, i am also experiencing a considerable decrease on libido. Is this because of the DIM? Maybe because DIM is keeping me from producing enough estrogen?

    Thank you so much, your posts are always very helpful and interesting.

  85. I came off the pill after being on it for 20 years, with 25mg of aldactone for the last 7 of those years. My face slowly grew oilier and and my acne worse. It took me 8 months to get a period, and for the past year my cycles have been regular between 30-35 days in length. I thought the acne would clear up now that I’ve been cycling for a year and following all the dietary and supplement advice outlined in your Period Repair Manual and with the help of my own naturopath, but the acne has only grown worse with cysts cropping up on my cheeks and chin. I have always had some degree of acne (except for when taking the aldactone) – I don’t have excess androgens or testosterone, but my skin is very androgen sensitive. My periods are light and I have no cramping. I am ovulating based on temps, but I do start spotting a few days or so before I bleed. I do NOT struggle with weight, if anything I find it very hard to gain and have a fast metabolism. I am absolutely at my wits end as I feel I have exhausted every ‘natural’ remedy, giving each at least 3 months to see a difference. The acne is causing severe depression, anxiety and obsessive behavior. As this has always been a struggle except for when I was on the aldactone, I feel doomed. Is there any hope for a case like me?

    • CJ, I’m so sorry to hear you’re having a rough time.I am in a similar situation to you although my mood is ok.. I get mild anxiety but no real change since going odd the pill. It took me 10 months for my period to return post pill. Then when it did I started getting acne really bad. I am also slim and have light periods. What supplements have you tried? I have been taking magnesium, vitex, vit B complex and zinc for about 6 months with no real improvement. I’m about to add in Berberine.. and I’m wondering if I should also try DIM. I’m interested in insulin resistance and wondering how I can find out it I have it.

    • I am so sorry to hear about all your struggles. And I am also with you, suffering miserably with post-pill acne. And nothing is helping much. Did something help you out in the end?

      Thank you and wishing you all the best!

  86. Lara,

    In your book you say periods should be painless. Do you have any comments for women who get cramps in their lower back with their period? Mine are so dreadful. It burns and aches, feels swollen and bloated and like my lower belly does, but I can even feel the muscles spasming and tightening in my lower back. This is how I know my period is coming…back pain! What might be the cause of this?

    Ciao, Justine

      • Oh no. I thought some amount of pain was normal? I have considered Endometriosis in the past. I was 16 or 17 when I started having these extreme pain attacks that felt like an ice pick through my belly button really sharp, pulling severely tight down into my tail bone. I had to hunch forward and couldn’t sit up straight, because it would exacerbate the pain to an extreme level and I felt physician tied. I haven’t had an attack that severe probably since I was 19, but I have lingering sharp pains in my tailbone often. My doctor dismissed my push of Endometriosis, because she said since I was on birth control if it was Endo birth control would have made it better, so it must not have been Endo. My back cramps are not so severe I am diabled to the floor, but it makes me grump and very unhappy and very uncomfortable to move. Being productive with them is hard and an Ibuprofen is necessary in order to be productive.

        • Dear Lara,

          Is it true that Berberine causes liver cancer? I want to try it to see if it helps with my pain. Also, is it ok to take it with Inositol, Magnesium and Adaptogens like Rhodiola?

        • Yes, some period pain is acceptable, and not a sign of anything serious. But “pain like an ice pick” to the point that you could not sit up straight was not normal period pain. And no, birth control does not always make endometriosis better.

          All that said, it’s good that your pain has improved somewhat.

          The most effective treatments for period pain are: 1) dairy-free diet, and 2) zinc supplements. Those treatments can also help with endometriosis, but are usually not enough to fix endometriosis.

          Please consider those simple treatments before taking something like berberine. I’m not aware of any studies linking it liver cancer, but it is a strong medicine, and I don’t recommend taking it casually, or taking it for more than a couple of months at a time.

          • Would Curcumin be a good option for potential Endometriosis? I have GERDS, maybe ulcers, not sure if it will aggravate. Thank you. I saw burning was abnormal in your link. My cramps always burn and pinch.

  87. Well hello! Looks like this helps explain my connect the dot face currently. I have been having a rough 2 1/2 months. Let me start by saying that I was on Loestin for a year. Switched July 17th to Seasonique because we thought the “sugar pills” were the reason my hidrogenitis would flare up. Well 4 days later I had my first panic attack! I was on this new pill a total of 13 days then I had heart palpitations that lasted 3 days that led me to the ER. Chest Xrays, blood work and EKG in the hospital were all fine and they sent me on my way. NOTE I STOPPED THE PILL COMPLETELY JULY 30th. Made an appt to see my PCP. He said I had heightened anxiety. GREAT! I believed my hormones were out of wack as I was having dizzy spells, then my hair started to thin out (which still does), anxiety up the wazoo which I’m battling now with a therapist and then I asked for hormone workup. He sent me to a cardiologist for a 48 hour holter monitor and turns out my heart is normal. Ok that is good. Then he sent me to an endocrinologist that I do not like btw. She was very rude. Anyway we did the hormone workup and most everything was found in the normal range. Even did the morning cortisol after a dexomethasone tablet and that was ok… what we did see was my Free Testosterone is 6.5 and my DHEA before the dexamethasone was 323 and after the dexamethasone was 266. She believes I have PCOS. I have been fighting the anxiety which is at an all time high like I have NEVER in my life experienced. Dizzy, “electric shock” feelings, and general anxiousness about everything. I am an auditor and travel alot. I have always loved this. I developed a fear of driving. Which is now progressively getting better. Thank God. Next, I am anxious around crowds. Never was prior! Loved going to fests and meeting new people. I’m always thinking that I need a way out in case I start feeling “funny. The therapist I see is great. She believes the pill in fact did start all this when the PCP and endocrinologist don’t. I have slowly been getting better, but not where I want to be at all, but definitely closer. Seeing that I still seem to be shedding a lot of hair, and my acne is HORRID (and all around my mouth), I still think something with my hormones is not right. I asked… “since you put people on the pill for pcos and to help those with high testosterone, don’t you think that by me taking myself off increased my testosterone and could have heightened my anxiety?” The answer I received was No. I don’t believe this. I was always a “productive anxious” type, but never in my life have I been so anxious that I didn’t want to do things I’ve always loved. Any thoughts or suggestions would be appreciated as this has changed my happy life!

  88. Hi Lara,

    I tried going off of the pill after being on the pill for five years about two years ago to disastrous results. I developed cystic acne on my face, chest, and back, which led my doctors to prescribe spironolactone and then the strongest pill I have ever experienced. Once my acne had cleared and I had been on the new pill for almost a year, I decided to try again.

    In the first three months, I took Vitex, zinc, DIM, and selenium in order to try and rebuild my cycle from the ground up. I enjoyed relatively acne-free skin for about three months. I am now in my fifth month post-pill, and am experiencing a flare up of cystic acne on my chin and jawline and increased acne on my chest and back. I have restarted the Vitex (which I had stopped at the three month mark) and have added goldenseal to my regimen. I generally eat a low-glycemic diet and limit my dairy intake to yogurt and kefir.

    Are these acne flare-ups within the year post-pill common? Or do I need to reconsider my supplement and diet choices?

    Thanks!

    • Skin flaring about 3 months off the Pill is a very common experience. It might worsen until the 6 month mark, and then should improve as long as you have the right support.
      A couple of comments: 1) yoghurt is probably too much dairy, and 2) Vitex can sometimes be a problem for skin. Did you see my Vitex post?

  89. Dear Lara,

    May you please recommend a natural alternative(s) for Bacterial Vaginosis and Vaginal Yeast? Orally and/or vaginally?

    Secondly, I found this suppository from Aviva Romm. I want to use it, but essential oil bottles say not to use in mucous membranes…if it were you, would you give it a go?

    https://avivaromm.com/vaginal-infection-remedy

    If you can help in anyway, please, I beg you. Thank you so much.

    Ciao

    • With my own patients, I usually prescribe a probiotic with the strains Lactobacillus rhamnosus, GR-1™ and Lactobacillus reuteri, RC-14. (I also discuss this in Chapter 10 of my book). An example product is Jarrow Femdophilus

  90. Hi! You say in the article that zinc reduces testosterone..
    I am taking zinc since I quitted the pill, but my testosterone levels were very low (lower than normal) when I did my last blood exam.. Is this zinc maybe being prejudicial to my testosterone levels?
    Thank you

  91. I have been off the pill for 6 months and have never in my life experienced oily skin like this! I typically have very dry skin so it has been a huge adjustment. I had no idea this was caused by the pill because the other times i had been off the pill I didn’t have this experience. My skin finally seems to have turned a corner with acne and the oil isn’t quite as bad but my hair is also very greasy at the end of the day and I have been having to wash it daily. Thank you for posting about this!

  92. Hi Lara and Readers,
    Thank you so much for your invaluable resources here and through your book Lara. It was a huge help for me when I went off the pill. After taking Beyaz for 7 years, which completely cleared up my skin, I decided to go off of it for health reasons and to live a more natural life. I was not prepared for the incredibly difficult year that followed. No period for 14 months and the worst acne I’d ever experienced in my life. I wish I would have done 2 things differently : found your site sooner and gone to a naturopathic doctor sooner. I kept thinking I could figure it out on my own, but no. It took 3 doctors until I finally found one that really knew what he was doing – so anyone going through the same thing please don’t give up! There is a light at the end of the tunnel. Now, thanks to progesterone cream my periods are regular and thanks to many of the supplements suggested here my skin is much better.

    I still struggle with the occasional breakouts and wish my skin could be as beautiful as it was when I took BC, but I’m confident I’m doing the right thing for my body. If anyone has any additional insight into how to turn that final corner let me know! I currently take progesterone cream, zinc, DIM, Burdock Root (for berberine) and Lactoferrin.

    Thanks Lara for all that you do!

    • Hi Sam, your story is very similar to mine, except I have yet to find a doctor who doesn’t want to prescribe me Roaccuate or talk me into going back on the pill! It’s very frustrating.

      Can I ask you what doses you take of the supplements you mentioned? I’m trying to figure out my daily intake.
      Thank you
      Jo 🙂

  93. Hi Lara

    I was originally prescribed the pill for acne, I was on it for 10 years and boy did it do the trick. I came off it 2 years ago when I began studying nutrition.

    After coming off it my periods were relatively normal for a few months then in May 2015 I didn’t get my period for 81 days. Since then it fluctuated between 30-45 day cycles. My last two have been 29/30 days. I do not suffer from cramps, PMS or any symptoms really besides for a bit of digest upset.

    My diet for the past two years has been low in sugar, dairy, processed, high GI and meat. I have also severely reduced and tried to avoid alcohol to let my liver just do its thing. I have been supplementing with 60mg zinc, vitamin C and since reducing my meat consumption activated B’s with selenium.

    My skin just does not seem to be improving, I feel like the self conscious teenager I once was. I mainly get it on my cheeks and seem to have poor wound healing as the redness lingers.

    I felt awful about my skin last week so I looked into my diet and the only thing I found I was consuming in excess was almond and ABC butter on pure 100% cacao. I am talking JARS of the stuff. So since last Friday I have decided to cut that out completely and see how I go.

    Any advice would be great, even a good recommendation of a practitioner in Sydney (east) who could guide me and maybe help me investigate further.

    After all my suffering this area of nutrition really interests me and perhaps could be an area I go into once I graduate.

    Thanks
    Robyn

    • Actually, I practice in Sydney. I might have some availabilities in November. See the bottom right of this site for contact details for my assistant Lisa.

  94. Dear Lara & all,

    First, let me say a huge thank you, Lara, for your fantastic blogs, social media presence and book – they have been an invaluable resource for me.

    Second, I wanted to share my post-pill story which features both acne and amenorrhea.

    Just as Lara says in her post and book, I quit the pill, having spent over 10 years on it, but having wanted to come off it from, well, at least 2 years in. But fear of my acne returning prevented me from doing it. So last year I finally gave it a go. I stopped taking the pill and … absolutely nothing happened. Neither ovulation/period nor acne. Three months in I started to get some acne and from then on it got steadily worse, until at the 10 or 11 month mark, having visited my GP plus a specialist gynaecologist, I went back on the pill (having never had a period during those months).

    This time, I was better prepared. I wanted to share my story, as I was so worried about amenorrhea and acne when coming off the pill and I think my story is a good example of what is achievable for someone with moderately bad acne (as well as amenorrhea). I now have regular periods and my skin is by no means perfect, but I don’t have “acne”.

    A month before coming off the pill, I did the following: (a) dairy-free diet; (b) low-sugar diet – but not super strict; (c) supplementing with zinc; (d) supplementing with magnesium; and (e) supplementing with an iron and B-vits supplement. When I came off the pill I continued with all of the above plus on day one I started taking DIM. My period returned and has been regular (29-32 day cycles) and while I have a few more spots than I did when on the pill, it’s nothing like the real acne I used to have. I have been off the pill for just over 5 months now.

    I’m also trying, not super successfully, to do some meditation and deep breathing on occasion – I think this probably helps, too.

    One more thing I wanted to add was that at the time I came off the pill last year, I was a “healthy” weight according to BMI, but in the lowest healthy BMI bracket. At the time I thought nothing of it, but later I have started to think that maybe even a “low healthy” is too low for some people (e.g. me) to get their period back. There’s now a couple more kilograms of me. I thought that might be worthwhile sharing, as that was something I thought about but ruled out on the basis that while low, my BMI was technically “healthy”.

    Good luck everyone with your post-pill journeys!

    • Great question. It seems like a good idea, but the problem is that staying on birth control (even intermittently dosed) will potentially prevent ovulation and the making of much-need estrogen and progesterone.

  95. Lara, I genuinely love your stuff and I have the Period Repair Manual from i book store!

    I have read the endo chapter as well as your YouTube video – all super helpful and keen to try some things out but wanted to ask a question that is actually related to endo – thought it was more likely you’d see it here rather than old articles.

    Realise it is super hard to diagnose just with symptoms and I have felt like I am on a wild goose chase.. In short, since Jan, had acute pelvic pain (now gone), had shooting pains in groin and inner thigh (now relatively infrequent) and internal stabbing pains and occasional pain on right side (ovary like), burning urination after IC and quite frequent sciatica in right arm.. Periods relatively ok a 28 one month, 30/31 the next but there’s a sort of pattern. Have cramps and the stabbing pain on first day and then heaviness/ cramps throughout but not debilitating or enough to merit having to take PainKillers to endure. I’ve had he Trans V ultrasound, comprehensive STI tests, pelvic exam, AMH tests and all fine but I am wondering whether to push for a Larosc with my Dr. I do eventually really want kids and I would rather know the state of my reproductive system now when I am still quite young. Do you recommend or is it too invasive… I know that often they can’t pick anything up because it is so microscopic? Would you recommend the blood tests as a marker? What would you advise? Feel like I am banging my head against the wal!!
    Thanks so much for taking the time to read. X X X

    • At this stage, we don’t yet have a reliable blood test for endometriosis. I truly hope (and expect) to see one in the near future.
      Did your doctor recommend surgery? If the pain is bearable, most doctors advise to wait until you start trying for pregnancy. Because you might conceive easily without surgery, and because surgery itself can cause scarring.)

      I’ve had many patients in your situation, and we usually take the approach of applying natural treatment “as if” it is endometriosis. We use the diet changes and treatments that I describe in my last endometriosis post → Endometriosis: 5 natural treatments that really work. And I look to see a result in 3-4 months. Say at least 50% reduction in all the pains including the stabbing and shooting pains.

  96. I struggled for 2 entire years after coming off the combined pill that I had been taking for 20 years .
    I had severe acne , hair loss , and excruciating ovulation pains to the point than I could barely walk or sit for 10 days of every month
    I tried dietary change and various other supplements to no avail .

    For the past 3 months I have been taking a wild yam supplement.
    I have my life back at last ?

  97. [No Subject]
    Me to laraSent
    Dear Lara,

    I have quite the predicament, please help. I was recently prescribed Flagyl for Vaginal Bacterial infection. I was supposed to take it twice a day for 7 days, but stopped at day 4 due to side effects. My doctor will offer me nothing else, she said I need to find a way to take it, but I threw up twice after my last dose and had extreme GERDS going into my ears through the whole duration as well as I started to get burning sharp pains in my limbs. I just cannot take the Flagyl this time! My body doesn’t want it and I can feel the harm it is doing! I have had vaginal yeast infections every month that are hard to treat for around 8 years now. In between I often get bacterial infections as well and end up taking Flagyl. I can’t do this anymore! Underlying health conditions are Adrenal PCOS, Hypothyroid and GERDS. Not currently taking anything. What can I do to clear up this Bacterial infection and the yeast infection I know will follow? I understand long term there is an overgrowth in my gut and currently probiotics seem to make the infections worse. I assume, because they aggravate the bad bugs and I need to rid them first. I guess what I am saying is I need accute relief and long term relief and most of the herbs like Curcumin and Oregano Oil say not to take with GERDS! So frustrated! Would taking a product like DGL Plus by Pure Encapsulations with Slippery Elm, Marshmallow, Licorice help? I am so very scared and I have been damaging my body with these antibiotics and antifungals for far too long. This is unacceptable. Please, help!

    Ciao, Justine

    • Please try inserting a garlic clove into the vagina. Remove the outer casing of the clove, place a few holes in the garlic or cut off the ends and insert. You could also try threading a thin string through for easier removal. Leave in for 24 hours and then replace with a new one. You can do this for up to a week. This has worked for many women who yo-yo between yeast and vaginosis. Good luck!

      • Thank you so much, Sadie!!!! I am so afraid the Garlic will burn or irritate and cause bleeding, but I think I will try the Boric Acid!!! You are a blessing!!!! I could just cry!!!!! Thank you sooooo much!!!!

          • Was reading about boric acid being poisonous and people dying from using it plus afraid it will burn, have a lot of inflammation. Wonder if Garlic tablets orally will knock it out?

  98. Hi Lara,
    I have been off the pill for over a year (after being on it for 16 years) and my skin is actually drier now, especially on my face and particularly in the morning. I also get some blackheads and pimples on my back and chest, which is something I didn’t really have whilst on the pill. Why is this? I’m off sugar and periods are regular (between 28 and 33 days).
    Thanks,
    Claire

      • Thanks for your reply, Lara. I’m not sure. I was on Levlen ED for the first 6 or so years and then Diane/Juliet/Brenda after that (2000- May 2015). I think I got ‘adrenal fatigue’ about a year ago after a slow build up. I suppose that hit kind of 6 months after going off the pill, so could be related to that, but there had also been a big build up of stress over a few years. I say adrenal fatigue because a naturopath I was seeing thought there was probably an adrenal problem based on my symptoms (return of chronic insomnia, chronic thirst, lots of water and needing to urinate a lot, bleeding gums, high stress, puffy eyes). These symptoms have improved a lot, but my skin is still quite dry so I thought it might be more of a post-pill thing. Any ideas?

        • Skin can change in lots of ways coming off the Pill. Something else to consider is the Pill depletes the body of zinc, and zinc deficiency can cause dry, flaky skin.

  99. Hi Lara,
    I went off the pill in January and in April I started to do all of those things you recommend (you wrote about it in other posts). My skin was better for a while, but now is as bad as it was (acne on my chin, neck, back, chest). Also I’m still sheding. But the worst thing is that my period, which has been regular for 6 months, now isn’t (I waited 47 days for the last one). Is it possible that diet and suplements, which are suppose to treat acne, are bad for period? Please help me, because I have no idea what else could I do apart from taking pills again…

      • No, I don’t avoid carbs. I avoid dairy, sugar, wheat, meat and processed food. I was 17 when I started taking pills – and it was beacuse of acne. And I really don’t remember if my periods were regular… Probably not, but I’m not sure.

        • You’ll want to talk to your doctor about possible blood tests to investigate why your periods are not coming regularly. For example, to test for PCOS and other conditions.
          Supplements such as zinc shouldn’t have caused a problem, but if you’ve been on them for some months, then it would be good to take a break. (Vitex can sometimes cause irregular periods)

  100. hi Lara, first of all, you have an avid follower from Turkey (me 🙂 ). I am thankful for this blog as it helped me on my journey to get rid of bcp for good. it gace me courage and the support i needed. your blog has a very positive tone which makes you believe that you wont get stuck with acne for the rest of your life. The first time I wanted stop taking the pills was in 2013. but when i stopped pimples came back with a vengeance. they popped up in places where i never ever had acne before. then i got back on it just after in two short months. this means that i wasn’t successful in saying no to the pills due to the fear of being ugly. such a stupid reason. i am 26 now and i finally stopped taking the pill in april. it got awful, i had pimple in my hairline, on my throat, at my jaw, on my back and on my chest & sometimes boobs. i was secreting so much excess oil that my cellphone would get oily in a matter of seconds that i have started talking. i have tried taking control with primrose evening pills. they did not work one bit. but zinc was amazing at the beginning. then that stopped working as well. then i started to use homemade masks it did not work either, my acne actually got worse. i started to pick my axne evenmore due to stress of not being able to get rid of them. then i went to a dermatologist. she prescribed me with several topical creams and tonics. i tried not to get frustrated but i am a working person and it is hard to put shitloads of makeup every morning and try to cover yourself up. the creams dis nor work. then the doc adjusted my creams and switched up to more hardcore topicals and facial scrubs and masks. it got so much better. but just to avoid a new acne spread, she prescribed me roaccutane twice a week( mind you that i had a roaccutane experience twice or times before) but the interesting thing was my skin was already getting better without me taking the hardcore roac. pills. i am not even using them right now. my skin and hair are getting better. the solution for me was: drinking loads of water, isotrexin, sebium global gel, acne gun tonic, neutragena grapefruit scrub, bioderms facial cleanser and a clay&mint mask by dcl. my hair is not falling of but i may be due to mw using minoxidil once a month. 🙂 anyways girls out there, just have some patience (i know its hard to ask but it always gets better)

  101. Hi Lara!

    Is pcos reversible?

    Also , I just had a baby and my hormones are out of whack (5 months postpartum and NOT breastfeeding). My skin was bad in pregnancy and still bad now… do you have recommendations for balancing hormones after pregnancy?

    • Vitex was the best solution for me. Its an amazing herb.

      If you have pcos though I believe lara suggests peony and licorice as vitex will raise lh levels which will make pcos worse.

      Search for her post on pcos. I recall the post mentioning Berberine, magnesium, lip something acid (lol) inositol etc

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