Birth Control Pills to Treat PCOS

Treatment may reduce symptoms while preventing pregnancy

Customer giving prescription to pharmacist in pharmacy
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Hormonal contraceptives are commonly used to treat polycystic ovary syndrome (PCOS). They not only provide protection against unwanted pregnancy but help normalize menstruation and treat PCOS-related symptoms such as acne and excessive facial hair growth.

While the use of a hormonal contraceptive may seem an easy fix for PCOS, there may be formulations and approaches that are more appropriate to you as an individual.

Combined Hormonal Contraceptives

Combined hormonal contraceptives—containing both estrogen and progestin—are considered the first-line treatment for women suffering irregular periods and excessive male hormones (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. These forms of hormonal contraception perform three main functions to combat PCOS:

  • They protect a woman's uterus by ensuring regular ovulation. Failure to regularly ovulate can increase the buildup of uterine tissue (called endometrial hyperplasia) which may, in turn, increase the risk of uterine cancer. With a combined contraceptive, progestin works against estrogen to prevent hyperplasia.
  • They help reduce 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.
  • They protect again unwanted pregnancy in women whose ovulation cycles are often difficult to track.

Choosing the Right Pill for PCOS

Because there have been few quality studies comparing the use of one type of 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 in which hormone levels remain consistent
  • Biphasic in which progestin increases halfway through the cycle
  • Triphasic in which three different doses of progestin and estrogen change approximately every seven days

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.

It's important to note that even the lowest dose estrogen is effective in preventing pregnancy and may be less likely to cause side effects such as bloating, weight gain, and mood swings. By contrast, high dosages may increase the risk of irregular periods rather than reduce it.

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

Low-Dose Progestin Pills

It is equally important to determine which type of progestin is being used in a combination pill. Some have a high androgenic activity which can aggravate acne or facial hair growth, undermining their utility in PCOS treatment.

Low-androgen combination pills include:

  • Desogen
  • Nor-QD
  • Ortho Micronor
  • Ortho-Cept
  • Ortho-Cyclen
  • Ortho-Novum 7/7/7
  • Ortho Tri-Cyclen
  • Ovcon-35
  • Tri-Norinyl

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.

Progestin-Only Options

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. These include:

  • 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

A Word From Verywell

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.

Source:

Yildiz, B. "Approach to the Patient: Contraception in Women With Polycystic Ovary Syndrome." J Clin Endocrinol Metabol. 2015; 100(3): 794-802. DOI: 10.1210/jc.2014-3196.