Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects 1 in 10 women of childbearing age. The endocrine system consists of glands that secrete and regulate hormones, such as testosterone and estrogen.
Women with PCOS have a hormonal imbalance that causes unusually high levels of male sex hormones. This imbalance changes the way the ovaries function and can cause them to develop many small cysts.
Women with PCOS may also not ovulate or do so infrequently. PCOS is a leading cause of infertility.
- Doctors do not yet have a cure for PCOS.
- A widely used treatment for PCOS is combination birth control.
- The symptoms of PCOS vary from woman-to-woman.
- Birth control pills help regulate a woman's menstrual period, making it more predictable.
What are the symptoms?
Hormonal birth control pills are safe but they may present some risks.
Some of the symptoms of PCOS include:
- weight gain and obesity
- insulin resistance causing diabetes symptoms
- mood changes, problems concentrating, and fatigue
- acne on the skin
- excess body hair, notably on the face
- thinning hair
- difficulty sleeping
- irregular periods due to delayed or no ovulation
- heavy or painful periods
Symptoms vary and may be mild or so severe that they disrupt a woman's life.
How birth control can affect PCOS
With treatment, the symptoms can be managed and may disappear.
Hormonal birth control is considered to be combination birth control when it contains two hormones. These hormones are usually estrogen, and a synthetic form of progesterone called progestin.
These combination pills can also regulate some hormonal imbalances, by increasing a woman's estrogen levels and decreasing the amount of testosterone her body produces.
Due to combination birth control pills containing two hormones that can adjust hormone issues, they are the preferred choice for many prescribing doctors.
However, not all women can safely take combination pills. Hormonal birth control pills are safe, but they do present some risks including:
- A greater risk of diabetes: This is a consideration for women with PCOS who are already at risk for diabetes.
- A risk of cardiovascular issues: Including dangerous blood clots in the legs. Women with PCOS who are obese may have an elevated risk. If they smoke, the risk rises.
- Weight gain: Some evidence suggests that birth control pills can cause weight gain, but other studies disagree. Women who are already obese may be reluctant to take birth control pills. Weight gain can make the symptoms of PCOS worse.
For some women, a pill known as the minipill may be a better choice. Minipills contain just one hormone, progestin. They are less likely to cause side effects than combination pills. However, when they do cause side effects, these can be the same.
Best birth control pills for PCOS
Combination birth control pills all work the same way. They prevent the ovaries from releasing an egg and so prevent pregnancy. They also thicken the mucus of the cervix. If the ovaries were to release an egg, this thickened mucus could prevent pregnancy.
The same hormones that prevent ovulation can also keep male hormone levels low and raise female hormone levels. Combination pills for PCOS include:
The hormones that prevent ovulation in combination birth control pills, may also raise female hormone levels.
- Ortho Tri-Cyclen
Some pills, such as Loestrin, have lower estrogen levels. These low estrogen levels can reduce the severity of some side effects but may also be less effective against symptoms of PCOS.
Someone with PCOS should talk to a doctor about the right amount of estrogen based on their symptoms and other risk factors.
Pills for painful periods
Women who get some relief from combination pills but who continue to experience painful or heavy periods may wish to switch to a pill that causes them to be less frequent.
The following pills can make a woman have less frequent periods:
Women who develop unpleasant side effects from taking a combination pill may wish to switch to a minipill. In some cases, doctors recommend that women try a minipill first.
Women who smoke, who have a history of cardiovascular problems, who are very overweight, or who are diabetic may have fewer side effects with a progestin-only pill.
Combination and progestin-only pills are highly effective at preventing pregnancy. At typical usage rates, which are the imperfect way most women use these pills, they are about 91 percent effective.
Non-pill options for PCOS
A non-pill alternative to birth control may be an intrauterine device (IUD).
Birth control pills are not for everyone, as some women find it inconvenient to take a pill every day. Non-pill combination options that blend progestin with estrogen tend to be the most effective. Progestin-only options may pose fewer risks and side effects.
The non-pill alternatives to birth control for PCOS include:
- Birth control injection: This injects the hormone progestin into a woman's body every three months. At typical usage rates, it is 94 percent effective at preventing pregnancy.
- Birth control patch: This is applied to the skin and releases both estrogen and progestin into the bloodstream. With typical usage, it is about 91 percent effective at preventing pregnancy. In women over 98 pounds, it may be less effective.
- Birth control ring: This is worn inside the vagina, where it releases progestin and estrogen. It is 91 percent effective with typical use.
- Birth control implant: This is a small rod that a doctor inserts under the skin. It releases progestin only and can prevent pregnancy for three years or longer. At typical usage, it is more than 99 percent effective.
- Intrauterine device (IUD): This device is inserted into the uterus by a doctor and releases the hormone progestin. It is more than 99 percent effective with typical use. Another IUD contains copper only and does not release hormones or help with symptoms of PCOS.
Non-hormonal birth control options, such as condoms, natural family planning, or diaphragms, will not help with symptoms of PCOS. Also, women who want to become pregnant must try another type of treatment.
Hormonal birth control can help with PCOS symptoms, but it is not the only option. Lifestyle changes, such as losing weight and exercising more, may help.
Some women also try supplements or special diets. Some other drugs, such as Metformin, may help when birth control does not work.
And for women trying to become pregnant, the medication Clomid can encourage the body to ovulate.
Women with PCOS should talk to their doctors about their symptoms, and their treatment aims to arrive at a comprehensive treatment strategy. A woman can ask a doctor to refer her to a specialist for further advice.
Birth control can be a part of a strategy for dealing with PCOS, but it does not have to be the only option.