Summary: I am about one-year post-Pill now and have been suffering severe acne from 6 months post-Pill until now, along with low progesterone. My endocrinologist thinks it has been too long since coming off the Pill for this to be a post-Pill androgen surge only - he thinks this is just the way I am and has diagnosed me with PCOS, but I don't think I have PCOS and I'm not ready to give up hope. What do you think?
I have been going around in circles for about a year since coming off the Pill February 2021 with my doctors, a naturopath, and a functional endocrinologist, and I'm hoping to maybe get some answers here as I love The Period Repair Manual and it's been so helpful!
I am a 26 now. I was originally put on the Pill around age 16 for stubborn acne (not cystic), only a few months into getting my first period (eyeroll). So unfortunately, I don't know what my periods were/are supposed to be like!
This cleared up my acne really well, but of course I had all the other side effects, and proceeded to jump around from the Pill, to Nexplanon (no periods, terrible acne and hirsutism), to Mirena (no periods, eventually acne and terrible depression and anxiety), and back to the Pill from 2013-2020.
In 2020 I tried to go off the Pill. I did get my period back within 2 months and had regular periods from then, even though I wasn't doing anything special to support my body. Sure enough, at 4 months post-Pill, I (predictably) started getting really bad acne, worse than it had ever been before. I got put on 50mg spironolactone, tolerated that poorly, and then went back on the Pill 7 months after getting off of it, until February 2021.
With knowledge from Dr Briden's book and others with supplements and an elimination diet, I gained about 10 pounds in the 6 months following going off the Pill, but didn't get acne initially. It wasn't until the 6 or 7 month mark that, sure enough, cysts began to appear on my cheeks and jaw. It got really, really bad at 8-10 months - enough that I've avoided leaving the house at all costs and wasted hundreds trying to find makeup to cover up my acne and marks left afterwards.
I confirmed at this point using BBT that I was ovulating, but my cycle varied slightly from 27-32 days. I had very low serum progesterone on day 21 of a 30 day cycle (2.6 ng/mL), slightly elevated free testosterone (2.9 pg/mL - but normal total T), and my LH was almost 2x my FSH on day 4 of my cycle at 7 months post-Pill, so my functional endocrinologist suggested I have PCOS and prescribed me a low carb/no sugar/anti-inflammatory diet. (Curiously, I have SHBG that is on the higher side at 83.5 nmol/L). This has definitely helped me to return to my normal baseline weight (I've always been very lean and never had trouble with weight gain before now). My TSH (2.95 mIU/L) and T3 (6 pmol/L) were slightly elevated; T4 was normal. No thyroid antibodies.
I confirmed with BBT every month since that I have ovulated, albeit with a shorter than optimal luteal phase of ~10 days. At that point, 9 months post-Pill, I was prescribed cyclical progesterone therapy for low progesterone, and I think it has helped a lot of my luteal phase symptoms like PMS and breast tenderness since, but I didn't notice any improvement in acne/androgen production.
I'm now nearing a year since coming off the Pill, and I think my acne is improving slightly. However, I still have troublesome cysts appearing every week, along with oilier skin. I don't know if my acne is improving because of the Epiduo I've been using for 3 months, the topical niacinamide I've added in, the lower carb diet, the saw palmetto/zinc/licorice/peony supplements, a combination of them all, or I'm finally coming off a post-Pill androgen surge. But, it's still bothersome, even though it's improving.
So, my main question is this: is it normal to have such a long post-Pill androgen surge for someone like me, who was on hormonal contraception for nearly a decade? If so, will it ever get better, or am I doomed to suffer from this for the foreseeable future?
My endocrinologist thinks it has been too long to just be post-Pill effects and this is just the way I am. He thinks I need spironolactone to control androgens or else I will always struggle with acne. However, I don't yet want to believe him. What do you think?
I don't think I have PCOS - there is no family history, I confirm with BBT every month that I'm ovulating (even before I was prescribed cyclical progesterone), and in 2020 when I came off the Pill, I regained regular periods despite no nutritional or lifestyle support. When not on hormonal contraception, I have always had regular and not particularly troublesome periods (not heavy, not painful). But clearly, I had/have low progesterone still, and have evidence of elevated androgens. My cycles are now pretty much always 30 days long, but even before, I don't think my cycles qualified as irregular, did they?
My bloodwork on day 4, 11 months post-Pill now looks like this:
- Total testosterone: 1.2 nmol/L
- Free testosterone: 3.173 pg/mL
- SHBG: 85.5 nmol/L
- FSH: 6.4 IU/L
- FAI: 1.4
- LH: 10.6 IU/L
- Estradiol: 103 pmol/L
- Prolactin: 561 mU/L (always comes back slightly elevated when I do self-testing kits, but I had this checked with my GP and it was normal when blood was taken intravenously)
- Vitamin D: 80 nmol/L
Thoughts? Insights? I'm stumped and not ready to give up hope, so I'd really appreciate any input!