Using Birth Control to Treat PCOS

Hormonal contraceptives (birth control) are commonly used for the treatment of polycystic ovary syndrome (PCOS) symptoms, such as acne and unwanted hair. However, finding the one that is right for you (combined, which contains estrogen and progestin, or progestin-only) can be challenging, and there may be reasons why you are able to take one, but not the other—or none at all.

Birth control is not a cure for PCOS, but it can help treat and relieve some of the symptoms of PCOS. Birth control performs three main functions to treat PCOS:

• It protects the uterus by ensuring regular ovulation. Failure to regularly ovulate can increase the buildup of uterine tissue (called endometrial hyperplasia) which may increase the risk of uterine cancer. With a combined contraceptive, progestin works against estrogen to prevent hyperplasia.
• It helps reduce excessive male hormone (androgen) levels in the blood, particularly testosterone. By doing so, symptoms of acne, androgenic alopecia (male pattern baldness), and hirsutism (unwanted facial and body hair) can be alleviated.
• It protects against unwanted pregnancy in women whose ovulation cycles are often difficult to track.

Combined hormonal contraceptives contain both estrogen and progestin, and are considered the first-line treatment for women suffering irregular periods and androgens as a result of PCOS.

There are several options to choose from, including oral contraceptives (a.k.a. "the Pill"), a transdermal patch, and an intravaginal ring. Because there have been few quality studies comparing the use of one type of combined oral contraceptive versus another in treating PCOS, it is largely up to you and your doctor to decide which may be the most appropriate.

There are several different forms of the Pill, each with different actions and a different breakdown of ingredients. They can be classified as:

• Monophasic: Hormone levels remain consistent
• Biphasic: Which progestin increases halfway through the cycle
• Triphasic: Which three different doses of progestin and estrogen change approximately every seven days

Estrogen Levels in Birth Control Pills: Oral contraceptives can be further classified by the amount of estrogen contained in each pill. Low-dose formulations contain 20 micrograms (mcg) of estrogen alongside progestin. Regular-dose contraceptives contain 30 mcg to 35 mcg of estrogen, while high-dose formulations contain 50 mcg.

On the flip side, low or ultra-low estrogen is associated with a risk of breakthrough bleeding, which can cause some women to stop taking them.

Progestin Levels in Birth Control Pills: It is equally important to determine which type of progestin is being used in a combination pill. Some have a high androgenic activity that can aggravate acne or facial hair growth, undermining their usefulness in PCOS treatment.

Low-androgen combination pills include:

• Desogen (desogestrel/ethinyl estradiol)
• Nor-QD (norethindrone)
• Ortho Micronor (norethindrone)
• Ortho-Cept (desogestrel/ethinyl estradiol)
• Ortho-Cyclen (ethinyl estradiol/norgestimate)
• Ortho-Novum 7/7/7 (ethinyl estradiol/norethindrone)
• Ortho Tri-Cyclen (ethinyl estradiol/norgestimate)
• Ovcon-35 (ethinyl estradiol/norethindrone)
• Tri-Norinyl (ethinyl estradiol/norethindrone)

Because these pills may have other side effects, it is important to speak with your doctor about the risks and benefits before making a choice.

In cases where a woman is experiencing abnormal menstruation, but none of the androgenic symptoms of PCOS, the doctor may offer a progestin-only contraceptive as an alternative.

There are two main types that can prevent pregnancy and uterine hyperplasia without affecting testosterone levels:

• Continuous options such as the "minipill" or the Mirena or Paragard hormonal intrauterine device (IUD)
• Intermittent therapy by means of the oral drug Provera (medroxyprogesterone), which is taken for 12 to 14 consecutive days per month

Taking birth control to treat PCOS can be risky when combined with certain other conditions or lifestyle factors. Your doctor may not want to prescribe you birth control if any of these circumstances apply:

• You have diabetes
• You are a smoker over the age of 35
• You have hypertension (high blood pressure)
• You have had major surgery followed by a period of prolonged immobilization
• You have a history of heart disease
• You have had a stroke

Managing PCOS can be a tricky business, especially since it is linked to a number of other symptoms, including obesity and high glucose levels.

It may take time to find a hormonal solution but, if you remain committed to your treatment and candid in your interactions with your doctor, you will be more likely to find the therapy that is right for you.