Using Birth Control to Treat PCOS

Hormonal contraceptives are commonly used in the treatment of polycystic ovary syndrome (PCOS). While their birth control effect is helpful if you do not wish to become pregnant, these medications can also help correct out-of-balance hormone levels that contribute to PCOS symptoms such as acne and unwanted hair growth.

However, finding the one that works best for you can be challenging. There may also be reasons why you are able to take one medication but not another—or none at all.

This article explains how birth control can help relieve symptoms of PCOS and why combined hormonal contraceptives that contain estrogen and progestin are often the go-to choice.

How Birth Control Helps PCOS

PCOS is an imbalance of reproductive hormones that can make getting pregnant difficult. Often, it causes a menstrual cycle to be irregular, meaning that a period may be late, stay longer than usual, or not come at all.

This is where hormonal birth control comes into play. While it's not a cure for PCOS, it can help treat some of the symptoms and keep some of the potential consequences in check.

Birth control performs three primary functions to treat PCOS:

• 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 reduced or prevented.
• 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 (the overgrowth of cells).
  
• It protects against unwanted pregnancy in people whose ovulation cycles are often difficult to track.

Combined Hormonal Contraceptives

Combined hormonal contraceptives contain both estrogen and progestin and are considered the first-line treatment for people who have irregular periods or androgen levels as a result of PCOS.

There are several options to choose from, including oral contraceptives ("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 for PCOS, it's largely up to you and your healthcare provider to decide which may be the most appropriate.

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

• Monophasic: Hormone levels remain consistent.
• Biphasic: Progestin increases halfway through the cycle.
• Triphasic: Three different doses of progestin and estrogen change about 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.
• High-dose formulations contain 50 mcg.

Low or ultra-low estrogen is associated with a risk of breakthrough bleeding, which can prompt some women to stop taking them.

Progestin Levels in Birth Control Pills

It's 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, speak to your healthcare provider about the risks and benefits of each one.

Progestin-Only Options

If you are experiencing abnormal menstruation, but none of the androgenic symptoms of PCOS, a healthcare provider 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 (progestin-only) "mini-pill" or the Mirena or Paragard hormonal intrauterine device (IUD)
• Intermittent therapy: Provera (medroxyprogesterone), which is taken for 12 to 14 consecutive days per month

Who Shouldn't Use Birth Control for PCOS

Taking birth control to treat PCOS can be risky if you have certain other conditions or lifestyle factors.

Your healthcare provider may not want to prescribe birth control to you 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

If you still desire a means of preventing pregnancy, talk to your practitioner about non-hormonal birth control options.

Summary

PCOS is an imbalance of reproductive hormones that can lead to an unpredictable (or absent) menstrual cycle and unwanted symptoms, like facial hair growth.

Hormonal birth control can help regulate a cycle while also blocking unwanted pregnancy and reducing androgen (male hormone) levels, which may improve your PCOS symptoms.

Hormonal contraceptives that contain both estrogen and progestin are go-to choices, but progestin-only options exist too. Talk to your doctor to see if either of these options may be right for you.

A Word From Verywell

It's common for women to try several types of birth control pills before they find the one that suits them best and/or results in the fewest side effects. Try to be patient as you undergo this process of elimination. It's time well spent.