The Case:  Jenny went on the pill as a teenager to regulate her irregular and heavy periods. After 20 years on the pill, she decided to start a family. Going off the pill led to fatigue, insomnia, hair loss, acne, and when her periods returned after 3 months, they were painful, heavy and irregular. Her symptoms led her to suspect hypothyroidism but her levels came back normal.   The Investigation The first thing I did when I started working with Jenny was to run a full thyroid panel. While her TSH was normal, as her doctor had said, her free hormones were off. I knew that there had to be a connection between Jenny’s long history with birth control pills, her menstrual issues, and her thyroid but was the thyroid causing the issue or did the pill create a thyroid problem? To discuss this further, I reached out to Emily Sadri. She’s a board-certified women’s health nurse practitioner and midwife who runs a functional medicine practice for women in Cleveland, Ohio. She specializes in abnormal bleeding, perimenopause, menopause, and fertility so I knew she would be a great resource for this episode.   How the Birth Control Pill Became So Popular Most people are familiar with the birth control pill and yet, most of the time this medication is prescribed it is not specifically for family planning as it was designed. Instead, women often turn to the birth control pill to help them deal with other issues. For example, it is common for young women to turn to the birth control pill to lessen heavy and/or painful periods. They may also start taking the pill to help them deal with acne or irregular bleeding. This will often happen soon after a woman starts her menses. Emily says this is a bit of an issue because a woman’s cycle takes time to find it’s rhythm and if a medication is used to regulate that early on, it may never find its own rhythm because the feedback loop between all of the hormones is interrupted.   How Menstruation Works To fully understand why this is an issue, we needed to go back for an anatomy lesson and reconsider what is going on in a girl’s body as she starts to cycle. The average age of onset of menses is around 11 years old. Prior to that, the young woman's pituitary gland and hypothalamus (in the brain) start to send out little signals to her ovaries. This feedback look is called HPO access or hypothalamic pituitary ovarian access. It's like the feedback loop. So, the hypothalamus talks to the anterior pituitary. The pituitary gland sends out hormones to stimulate the ovaries and release estrogen. That estrogen is released in little bursts over the years leading up to a young girl's first cycle and may still be firing irregularly during the first year or so of menstruation. The estrogen builds up in the uterine lining which starts to thicken the endometrium (lining of the uterus).  The hormones from the anterior pituitary stimulate the release of a follicle (aka an egg) from the ovary. That first follicle is released prior to the first bleed. The follicle has a lining around it called the corpus luteum which releases progesterone. The progesterone stabilizes that thickened endometrium. When that egg is not fertilized, the body picks up on that and then the endometrium sheds and that is when you get a menses. All of these hormones have to rise and fall in the cycle and find their rhythm in those first few years of menses. And remember, often at this time in a woman’s life, she is dealing with other things that can impact the release of these hormones including stress and/or not getting enough sleep.   How the Birth Control Pill Works The birth control pill interrupts the natural feedback loop by introducing hormones that weren’t called for or stimulated by the system. The pituitary hormones, the hypothalamus calibrating hormones, that normally communicate with the ovaries, sense the circulating estrogen and progesterone so there’s no stimulation required. This quiets the whole system and the body either stops pr