Since PCOS is caused by a hormonal imbalance, it’s commonly managed through hormonal birth control. While this certainly isn’t the only option for treating symptoms of PCOS—and it’s important to talk to your doctor about the best option for you—it’s a popular method. But is it the right choice? To learn more about the effects of birth control on PCOS—and whether or not it should be used for treatment—we spoke to top OB/GYNs. Here’s what they had to say.
What is PCOS?
The exact underlying pathophysiology of PCOS is unknown. “What is known is that the condition is characterized by hormonal imbalance impacting normal ovarian function resulting in multiple ovarian cysts, menstrual irregularities, heavy or painful periods, weight gain, obesity, acne, excessive hair on the body, increased risk of diabetes, cardiac disease, hypertension, infertility, or ovarian cancer,” says Dr. Kecia Gaither, MD, MPH, FACOG, double board-certified in OB/GYN and Maternal Fetal Medicine, Director of Perinatal Services at NYC Health + Hospitals/Lincoln, explains. “These symptoms vary from woman to woman.” Dr. Alyssa Dweck, MD and board-certified OB/GYN, adds that PCOS results from a hormone imbalance that occurs due to lack of or irregular ovulation. “Instead of having a well-orchestrated elevation of estrogen (mid-cycle) and progesterone (day 21), levels are volatile and imbalance occurs.” Having high levels of testosterone is common for those with PCOS, too. “Testosterone is often elevated too and leads to the typical symptoms of acne and hirsutism (hair in typically male locations),” Dr. Dweck states. “Insulin resistance and glucose metabolism are often impaired, leading to increased risk of diabetes and obesity. Cycles are irregular and often with unmanageable bleeding habits. Those with PCOS also have a higher risk of uterine cancer.”
How Does Birth Control Help with PCOS?
Birth control regulates hormone levels, which helps with PCOS. As mentioned, when testosterone levels are too high, it can exacerbate the symptoms of PCOS—and birth control can help reduce excess levels of testosterone. “By doing so, the symptoms of such—hair thinning on the head (male pattern baldness), hirsutism (excessive body hair/facial hair), and acne, can be alleviated.”
The Most Effective Birth Control for PCOS
“While combined oral contraceptives and progestin-only oral contraceptives can be utilized, combined hormonal contraceptives are generally considered first-line treatment for women plagued by irregular periods and androgen excess,” Dr. Gaither explains. There are several birth control pill options to choose from:
Monophasic (hormone levels are constant)Biphasic (progestin dose increases about halfway through the cycle)Triphasic (estrogen and progesterone doses change about every 7 days)
“You can have low-dose estrogen pills (20 micrograms) or regular dose estrogen-containing pills (30 to 35 micrograms),” Dr. Gaither adds. Dr. Dweck agrees combination pills are the way to go. “Combination pills (estrogen and progesterone) are the typical first recommendation and work as mentioned above,” says Dr. Dweck. “There are some progesterone types that are less androgenic (fewer typically male-type side effects). These are very helpful for those suffering from acne and hair growth.” Irregular bleeding can be problematic, in which case progesterone-only pills are recommended. “The progesterone-only pill helps PCOS by keeping the uterine lining thin; irregular bleeding could be an issue. All pills, patches, and hormonal IUDs help protect/prevent the uterine lining from getting too thick,” Dr. Dweck explains.
Will Any Form of Hormonal Birth Control Help With PCOS Symptoms?
While we most commonly hear about oral contraceptives and IUDs, Dr. Gaither expands on less commonly prescribed birth control options, too, including:
Intravaginal ring: A small ring contains estrogen and progesterone. You leave it in for three weeks and remove it for one week.Transdermal patch: A small adhesive sticker that delivers hormonal contraception through the skin. Efficacy is limited by BMI. You keep it on for three weeks, off for one week.
It’s important to choose the right birth control based on your unique set of symptoms, so this is a decision you should make with your doctor. “Combination pills, the patch, and rings manage the most symptoms (irregular or dysfunctional bleeding habits, acne, facial hair growth, lower risk uterine cancer),” says Dr. Dweck. “Progesterone-only pills, implants, and hormonal IUDs may help lower the risk of heavy bleeding and uterine cancer.”
Asking Your Doctor the Right Questions
When speaking with your doctor about your PCOS treatment options, there are a few important things to consider. “Diet and exercise are the mainstay treatments for PCOS. Metformin (a diabetes medication) and spironolactone (lowers testosterone) may also be used alongside hormonal contraceptives to manage PCOS,” Dr. Dweck explains. “The severity of PCOS can vary from person to person, so birth control should be individualized,” adds Dr. Jodie Horton, MD and Chief Wellness Advisor for Love Wellness. “When choosing a birth control, it is important to consider the routine of delivery, ease of use, desire for future fertility, the effectiveness of birth control, medical conditions, and possible side effects. It’s important to discuss all your symptoms with your doctor to choose the right method for you. Often, this is a matter of trial and error.” Next, read about 10 expert-backed ways to lose weight with PCOS.
Sources
Penn Medicine: “5 Myths About Polycystic Ovary Syndrome (PCOS)”Kecia Gaither, MD, MPH, FACOG, double board-certified in OB/GYN and Maternal Fetal Medicine, Director of Perinatal Services at NYC Health + Hospitals/LincolnAlyssa Dweck, MD and OB/GYNDr. Jodie Horton, MD, and Chief Wellness Advisor for Love Wellness
