For many women, the decision to stop taking birth control comes with the unintended and generally unforeseen consequence of skin issues like acne and rashes. The truth is, your hormones are taking an unexpected roller-coaster ride and your body is just trying to regain its balance.
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My friend Dr. Jolene Brighten knows a thing or two about this. She’s a functional medicine and naturopathic medical doctor and the founder of Rubis Health, a clinic specializing in women’s hormones. Recognized as a leading expert in post-birth control syndrome and the long term effects of hormonal contraceptives, Dr. Brighten helps her patients find a healthy balance between conventional and alternative medicine.
In this interview, Dr. Brighten and I look at the seldom discussed effect that birth control pills can have on your skin, whether you take them currently or have in the past. As always, talking with Dr. Brighten was so enlightening. She is full of information, that as a woman, I wish I had learned years and years ago.
If you haven't checked out her book yet — GET IT HERE! (I highly recommend it!)
Have you experienced unexpected effects when you stopped birth control, specifically that may be tied to your skin? Leave a comment!
In this episode:
- What “post-birth control syndrome” is and what the common symptoms are
- The effect that birth control can have on your body’s nutrients
- What happens to your hormones when you go off of birth control
- Tests you should ask your doctor for if you’re struggling with a hormonal issue after stopping birth control
Quotes:
“If you’re on hormonal birth control now and you’re like, this is my jam and I want to stay on it, let's talk about how to keep you safe. And if you’ve already come off you may be experiencing post-birth control syndrome.” [2:47]
“Your body has to detox, it has to get things out. But if you’re not getting things out through the channels of elimination, like urine and breathing and pooping, your skin becomes the place where your body pushes that out. It’s not betraying you. It’s trying to keep you super safe!” [5:44]
“I advocate that women get a full thyroid panel every single year as part of their yearly exam, sooner if you have symptoms.” [15:22]
Links:
Get Dr. Brighten’s free post-birth control syndrome diet ebook
Beyond the Pill by Dr. Jolene Brighten
Find Dr. Jolene Brighten online
Follow Dr. Brighten on Instagram | Facebook | Pinterest | YouTube
005: How Hormonal Birth Control May Be Contributing To Your Skin Condition w/ Dr. Jolene Brighten FULL TRANSCRIPT
Jennifer: Hi everyone and welcome back to the Healthy Skin Show. Today I've got a good friend with me. You are going to love this and this is the reason why I love people that are willing to speak truth about certain things that might be a little inconvenient and sometimes they also can be something that's hidden in your medical history that you don't even know is a problem. Today my friend, Dr Jolene Brighten is going to talk to you about why birth control pills can be an issue for you, whether you're on them now or you've been on them in the past. Okay, so this is, we straddle both sides of the party line here as far as birth control pills. The conversation's not meant to scare you at all. It's meant to educate and inform you so that you can make the best decision for yourself.
Jennifer: Well, Dr Jolene Brighten is a functional medicine naturopathic medical doctor and the founder of Rubus Health . Rubus Health, a women's medical, a women's medicine clinic that specializes in women's hormones. She is recognized as a leading expert in post birth control syndrome and the long term side effects associated with hormonal contraceptives.
Jennifer: Dr Brighten is the author of the new book called Beyond The Pill. She's a speaker and a regular contributor to several online publications including mind, body green and she is in medical advisor for one of the fastest data driven apps to offer women personalized birth control recommendations. Dr Jolene brighten my friend. Thank you for joining us.
Dr Brighten: Yeah, thanks for having me here.
Dr Brighten: You know we should let everybody know we talked for about an hour before we actually recorded.
Jennifer: We have like so many things to talk about today, but I want to talk about this one particular issue that I hear about a lot and I think as an adult, you know as an adult there is this issue where you're on birth control pills and then you go off of them because you either want to have a baby or you start like me getting concerned about the potential issues with stroke and what not and all of a sudden your skin becomes a complete monster and you end up with acne and rashes and all sorts of stuff. So again, this conversation is not meant to say whether what you should do, the conversation here is to educate and I think that's where we both stand on this very strongly. So if for somebody listening to this and going wait, there is a whole deal with birth control pills and there's a like post birth control pills syndrome. What is that?
Dr Brighten: Yeah. You know, and I really want to say I appreciate you frame this conversation, but like this is not meant to scare you. In fact, I think what is scary is not knowing. And so that's really part of my mission
Dr Brighten: Is like, you know, I want you to just to be informed at the end of the day, whatever you decide, I also want to make sure that I'm supporting you in that. So if you are on hormonal birth control now and then you're like, this is my jam, I want to stay on it. Let's talk about how to keep you safe. And if you've already come off, you may be experiencing post birth control syndrome, which is the collection of signs and symptoms that arise. Typically on average we see four to six months after women discontinue hormonal birth control. Of course it can be sooner, it can creep up and be a little bit later that you have the explosion of symptoms which can range from skin symptoms like you said, can also be digestive issues. We see reproductive issues as well and maybe your periods missing and it gets heavy and maybe it's very, very painful.
Dr Brighten: Maybe you're having anxiety or depression coming on. And so it really can be, you know, every system, presenting in its own way. Just depending on, and this is where we need a lot more research cause it really depends on you as a person. And I think this is such an important part of the conversation that, you know, I want to say women who are being counselled on hormonal birth control, it really should be on the individualized level. Like what do you eat, where do you live, what's your family history like? What are your genetics? Because that's how we understand what really works for each woman. So as part of post birth control syndrome, as you alluded to, acne, acne is one of the big reasons why we get on hormonal birth control to begin with. And sometimes your skin actually gets worse while you're on hormonal birth control or it's not until you come off that, you know, you have, and this is the thing ladies, you may never have had acne before starting birth control, but you may very well have acne when you come off. And it's the fun part about post-birth control acne is it doesn't tend to just hang out on your face. It's like back knee, neck, knee Chest knee.
Dr Brighten: I'm making up these terms, these horrible terms, they are now, or on your buttocks. I mean that's the other thing. Women will say, why am I breaking out on my butt now? And so there's something that I talk about, in my book Beyond The Pill called the androgen rebound. And that is that you come off of hormonal birth control and now all of a sudden that testosterone comes back and you've got oily skin. You might be losing your hair and you're having that acne. But it goes a little deeper that with that, because there's also nutrient depletions that are taking place as well. And so zinc as we know, is super, super important for the immune system and for our skin and for keeping testosterone in check. It is depleted by hormonal birth control. And with that in mind, this is why some women start, they, they start hormonal birth control just for contraceptive reasons. And then they start getting acne while they're on it.
Jennifer: And so with that said, so guys, listen to that, that is a big deal. You will deplete certain key nutrients. B vitamins are included in that magnesium. Some of these are very important for energy production, for gut health. It just expands.
Dr Brighten: Liver detox,
Jennifer: Liver detox. Yes.
Dr Brighten: That's the other thing we have to recognize is that hormonal birth control has to be processed through the liver. It's depleting nutrients that your liver needs to do its job and your body has to detox. It has to get things out. And we can definitely talk more about poop if you want to talk about that. But if you're not getting things out, like through the, what we call the emunctories, so the channels of elimination, like urine and breathing and pooping, your skin becomes the place where your body pushes that out. It's not betraying you, it's trying to keep you super safe.
Jennifer: And so here's the thing I want to ask you. So you said testosterone is increased when you come off, because I, and I know this cause we've talked about this before, but the listeners may not, that birth control pills actually shut down that communication between your brain and your ovaries. That's essentially what's happening. It's not like the ovaries keep like doing their jobs. Your brain is like, Oh, I don't need, I don't need you to do that anymore. And now we're expecting the ovaries what to just like turn back on and work. So then on top of it you mentioned about the liver and the liver is responsible for detoxifying or converting hormones. So the hormonal picture, what happens, like is it that when you go off birth control, all of a sudden your hormones are trying to like figure it out on their own, how to reset essentially?
Dr Brighten: Yeah. So we can definitely see that, you know, the younger you were put on it. So if like you started your period menarche and then you were put on hormonal birth control immediately, you didn't really have the time for the brain and ovarian communication to really mature and we are in need of so much research about this. And then the other thing, so what I want to say is that some women, that communication is hard to bring back online and for other women that testosterone comes right back. But there's another layer to this in which hormonal birth control is inflammatory. This can be measured with a C reactive protein. They've done research on this. They find that women on hormonal birth control had an elevated CRP. Now if you have inflammation, we can all agree that too much inflammation is a bad thing. I mean root cause of chronic disease here, but it's your adrenal glands job to bring down that inflammation.
Dr Brighten: And so they're secreting cortisol. Tricky thing is, is that hormonal birth control increases binding proteins while you're on it. So it's grabbing onto that cortisol, it's grabbing onto thyroid, just grabbing on to testosterone. It's grabbing onto estrogen. It's again, it's all about keeping you safe and there's also the impact, the layer of it causes intestinal hyperpermeability and it's cues the microbiome in way to which some studies have compared to hormonal birth control to antibiotics. But let's keep in mind, so antibiotics, we know at one round of Cipro could decimate your gut for a year. You've got to build that back up. But how long are you on Cipro for and on? Cipro for like decades and yet hormonal birth control is being compared to these antibiotics and we are, and I was on it for a decade. I really wish my doctor would have told me about that.
Dr Brighten: So with that in mind, microbiome skewed, we've got inflammation in the intestines, then you come off of hormonal birth control, cortisol binding comes down and the adrenal glands, they come in for the wind there and they're going to secrete D H E A as well. Now DHEA is a lovely anti-aging hormone, but it also can get converted to testosterone. And so we can see the testosterone coming from that angle as well. And then as we know if her gut is inflamed, our skin is never going to look right. I mean that's, that's definitely a piece of it as well. So I know I just kind of fire hosed a bunch of information there.
Jennifer: No, but it's important because you know, I deal with a lot of clients that have underlying gut issues that are triggering chronic skin rash issues, but acne to some degree also can have a very big hormonal part as can other skin issues. And so we assume that, Oh well it's no big deal. I'm just going to take some progesterone. I like, we act or minimize the importance of hormones and the complexity of those hormones and what they do. And I think that's often times a mistake. I caution people, I'm like, you got to find somebody that really understands this. So if someone is struggling with what is appearing to be a hormonal issue, right? They've come off of birth control or maybe that's five or 10 years in their rear view mirror. Even what would be some good tests to run to get a picture of the land, the hormonal landscape to make sure that hormones either aren't the problem or what the heck is going on ?
Dr Brighten: Yeah. So you know, this is such an important, and I'm right there with you that you know, when I wrote Beyond The Pill, the idea is I, you know, I'm giving women short term wins and outlining exactly what to do, but I'm also wanting to teach and provide them with the information of what to ask your doctor for in terms of lab testing. What, what is a go to the doctor right now, not to the natural pharmacy, like get to the doctor because of these symptoms. And so in the book I, you will see so many times I say do a Dutch test. I think that is one of the best tests that we have out there for understanding hormones. But if you're on hormonal birth control right now, do not bother testing your estrogen, your progesterone because they're shut down. And I've talked with doctors who are, they'll say like, I think this woman's in menopause because as she had no estrogen on and she had no progesterone on her lab testing and I, and then I'm like, well, is she on hormonal birth control?
Dr Brighten: Will, yeah, but shouldn't that like show up? And I'm like, okay. So one, it kinda is like she's a menopause in terms of the ovaries acquit, but it's also that, like you, we're not testing for those metabolites and we're not testing for those. Those tests are testing for estrogen and progesterone. You've got her on synthetic estrogen and synthetic progestin. Progestins made in a lab. Progesterone is made in your body, or there's bio-identical plant based, but there is no lab manufactured progesterone that's as good as your stuff. So let me just say that. So we found in mind, if you're on hormonal birth control, that's going to be shut down. The other thing you don't want to test if you're on it, you don't want to be looking at your FSH, your LH. So these are brain hormones, or your AMH, which is anti-mullerian hormone, which, some docs will run.
Dr Brighten: And it will look bad and it will, there's, I actually talk about this in my research that for my book, that the ovaries actually they look aged while women are on hormonal birth control and they, and the AMH will be off and it will look like you're in fertile and you're not gonna be able to have babies that generally changes when you come off of birth control, or at least it should. And if it's not, get with the doctor to support you. Now, if you've come off of hormonal birth control, you want to, you, it's usually good to give your body like a good three months of supporting it and then invest in the lab testing in terms of estrodiol. So let me actually break this down. So we, if you're gonna measure FSH, LH, and estradiol, that should be on day three of your menstrual cycle.
Dr Brighten: So the third day of bleeding that is when, the brain, the FSH should be saying, let's make some estrogen. Let's get an egg ready and your LH should not be higher than the FSH. There's the three to one ratio that we sometimes see. It's not ubiquitous, but it can indicate polycystic ovarian syndrome. So that's when you would want to look at that. Now, day 21 assuming that you ovulated seven days before. So basically you want to catch, you want to catch when you ovulate five to seven days later, that's when you want to do a progesterone test. And then if something that I typically recommend doing estradiol and progesterone at the same time so that you can see how much estrogen do you have relative to your progesterone. Now these, this is something that you can do. So the day three testing, serum testing, just get it done.
Dr Brighten: Blood drops. The day 21 you can do that serum. Dutch is a much better bet with that. And why like Dutch is because you not only see your estrogen that you see your estrogen metabolites, and I cannot stress enough how important that is because you may very well have low estrogen. So I've seen this many times. Women have estrogen dominance symptoms, so they have clotty heavy periods. Their breasts are swollen and tender. They're feeling moody and cranky and gaining weight, butt hip thighs. And what will happen is their lab will come back and it's like, Oh, your total estrogen is low, but your 16 hydroxy metabolite is through the roof. So the way you're processing it is making a super potent metabolite that stimulates these tissues. Now I don't if so to sex hormones we just talked about, you got to be checking your adrenals and your thyroid.
Dr Brighten: If you don't check your adrenals and thyroid, you stand zero chance at getting your sex hormones in alignment. So, and I talk about this in my book, you will find, we talk about liver, we talk about gut, we talk about adrenal and thyroid before we ever get to sex hormones because we only give all of those aren't right. Then the sex hormones. In my book, I actually say, and I know there's going to be like teenagers that I eye roll , at this when they read the book, but I say you know, your sex hormones is like when your mom said to you like if all your friends are jumping off a bridge, would you just jump off a bridge to yeah, that's what your sex hormones will do if the thyroid and adrenals and all that business is jumping off a bridge, forget it. Sex hormones right there with them.
Dr Brighten: So those are really foundational. So when we talk about that, why like Dutch as well for the and you can do a saliva testing as well. I think that's a great way to measure cortisol. But I like Dutch because the Dutch complete will give you cortisol versus cortisone. So you can see sometimes. So this is the other tricky thing. Sometimes your cortisol looks low and you're like, Oh, like cortisol is low, my adrenals are not working the way they should. And the brain's not communicating right. Oh, but cortisone is through the roof. Yeah. You're breaking it down and you're actually really stressed out within. So that's another thing that you can check with that. And then with thyroid , TSH free T four free T three reverse T three I think is a really good marker to get as well. TPO and thyroglobulin antibodies. And I actually advocate the women get a full thyroid panel every single year as part of their yearly exam sooner if you have symptoms. So that's kind of the rundown of all of those. I know that Dutch can feel pricey for some women it is. I've had patients say to me like, this is an expensive test. And then when they see that data, they're like, Whoa, yeah, I know all of this. So it's, I think it's worth the investment to do.
Jennifer: I actually agree with you. I spent the money on one of the, the full panels. I think I had to pee on a little tiny piece of paper for a month. A lot of work. It was a lot of work. But you know what, I got so much information out of that. And I think that's the one thing we, we don't, we don't realize how much more information we can gather out of some of these more like functional labs as opposed to just straight conventional labs and they do go hand in hand. I think oftentimes it's just looking at a problem from very different perspectives and all of that information can be very helpful and usable. So I would say like if this is an issue, save up, you know, like put aside some money every month or you know, for your birthday and be like, Hey, would love some, you know, 50 bucks for on a gift card or something like that and you buy yourself this test, the test is amazing.
Jennifer: It's really worth the money. And two, I just want to make sure that we mentioned, so your book is coming out when you mentioned it a bunch of times Beyond The Pill, which I am so excited for because it's such an amazing, I feel he gets like a Bible of all the information that as a woman, I wish I knew this whole time. It's like I'm living in the body of a woman, but I really don't fully understand how it works. And you go to the doctor's hoping that they're going to explain it to you and they don't, and you're constantly feeling like, I don't get what my body's doing, I really don't understand. And you just break that all down. So a, you gotta go get this book number one. So I am, I am absolutely fully in support of Beyond The Pill, but number two, you've got a really great opportunity for people up on your website. You've got this really great diet that you can share with people if they are having issues. Do you want to talk about that really quick?
Dr Brighten: Yeah ,so at drbrighton.com/pbcsdiet, let me explain, my name is tricky is Dr B, R I G H T, E N and then PBCS. That stands for post birth control syndrome diet. That is a, it's a freebie you can grab. It's got a meal plan. It's, it talks to you about the foods that you should eat if you're on hormonal birth control now or if you've ever been off of it, you're getting ready to transition off. And I walk women through, you know, how they should be eating. There's a little mindset practice in there. That mind body stuff is really important. And so that's something that you can go and grab. I appreciate you saying Beyond The Pill is a Bible. I wrote it as the book that I wished that I would have had. And I very much came from the angle of going beyond the pill in terms of there's life beyond the pill.
Dr Brighten: There is also a challenge in there for doctors to think beyond the pill before they prescribe and ask why and what's going on. And for women, there's, I actually have this chapter that I call it, it's like the Dakota ring chapter for the female body of what we all should have been taught in sex ed. But that was an Epic failure. I don't know about yours. Mine was not good. It really troubleshoots the common period problems that women have. And so in that way you can go beyond the pill with solutions. So we know you go to doctor anytime and get that pill prescribed. But I'd like to give women other resources to like manage painful periods and to understand what the, what their body's trying to tell them and all of that. So go grab the free guide. Go check out Beyond The Pill. And I would love to just keep supporting women and getting educated and feeling like at the end of the day, they made the best decision for themselves.
Jennifer: Awesome. Well, thank you so much for joining us, Dr Brighten. I deeply appreciate your time. I know you are busy, but I hope we can have you come back sometime, talk more about this. And I am so excited for this book to be like, I don't know, entering the world. You're birthing this beautiful Bible into the world to help all of us women be more educated and empowered. Ultimately, that's the goal. It's not to tell you what to do, it's to help give you the information to make the best decision for yourself. Thank you so much for joining us.
Dr Brighten: Thank you.
