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Woman examining a package of birth control pills for PCOS.

May 25, 2022 • read

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What’s the best birth control for treating PCOS?

What is PCOS?

PCOS or polycystic ovary syndrome is a hormonal imbalance that affects your menstrual cycle. Women who have PCOS tend to have high levels of androgens, which are hormones that cause male characteristics like facial hair growth and deeper voice tenor. Androgens are secreted in small amounts by the female reproductive system, but too much can throw off normal ovulation.

Every month, your body generates a number of follicles, but usually only one of them makes it through the whole ovulatory process to become an egg. Typically, if that egg isn’t fertilized, your body expels it and the lining of your uterus through your monthly period.

With PCOS, hormonal imbalance prevents these follicles from fully maturing into eggs. This can mean that some of those follicles turn into small, fluid-filled sacs, or cysts instead. These cysts in turn produce androgen which can further affect your hormones and menstruation.

What are the symptoms of PCOS?

For many people experiencing polycystic ovary syndrome, symptoms will include:

  • Hirsutism — excess hair growth, specifically on the chin, upper lip, chest, back, abdomen, and buttocks.
  • Irregular periods that might be very light, very heavy, or infrequent.
  • Hair loss on your head
  • Acne
  • Mood changes
  • Infertility
  • Acanthosis nigricans — small patches of dark skin, especially underarms, breasts, and in the groin.
  • Skin tags — often in the same location as acanthosis nigricans
  • Excess weight, especially around your midsection.

Despite its name, not everyone with PCOS develops cysts. To be diagnosed, you must have two of its three markers — irregular periods, cysts on your ovaries, or higher androgen levels than normal.

How can birth control treat PCOS?

Oral contraception, like the combination pill, contains hormones which can stop your body from producing excess androgen. This helps to address the symptoms of PCOS, regulate your menstrual cycle, and reduce acne and excess hair growth.

On top of that, the combination pill decreases your risk of developing ovarian and endometrial cancer. These factors often make it a go-to for treating PCOS.

Can birth control cause PCOS?

Hormonal birth control doesn’t cause PCOS. But, since it does alter your natural hormone balance, side effects of some hormonal birth control pills can be similar to symptoms of PCOS.

Conversely, hormonal birth control can also mask PCOS symptoms. Many people who start taking birth control in adolescence realize they have PCOS later on in life, only when they’ve stopped taking birth control. This can be difficult news, especially if they’ve stopped taking it in hopes of having a baby.

Does birth control help with weight loss in PCOS?

Although evidence isn’t conclusive, many women report that the pill causes them to gain weight. Since those experiencing PCOS often already carry excess weight, pill-induced weight gain can be a concern. Despite this, birth control can still be a helpful tool when it comes to treating the condition.

While birth control isn’t likely to help with weight loss, losing weight can help to improve your symptoms. This makes regular exercise and eating a healthful diet an important part of managing your symptoms.

What are some non-pill options for PCOS?

While birth control pills can help to manage your PCOS symptoms, they aren’t for everyone. Luckily, there are a number of other treatments, ranging from lifestyle factors to medication.

Effective stress management, regular exercise, and a lower-carb, higher-protein diet are all crucial for effective and long-term management of the condition.

Since insulin resistance — or how your body processes sugars — is often a feature of PCOS, weight management is a crucial part of addressing the condition. To this end, the drug metformin can be a great alternative to birth control. It helps to address both insulin resistance and ovulation and can be prescribed alone or in conjunction with oral contraception.

PCOS and the morning-after pill

The morning-after pill is a form of emergency contraception made up of the hormone levonorgestrel. It can be used if you’ve had sex without a condom, if a condom breaks during sex, or if you miss two or more contraceptive pills. The morning-after pill is safe and effective if taken correctly. It may, however, cause some side effects and doesn’t protect against sexually transmitted infections (STIs).

In some users, the morning-after pill can trigger cramping and menstrual changes. It may cause your next period to be irregular — heavier or lighter than usual. It can also affect the timing of your next period, prompting it to arrive sooner or later than expected. While these symptoms may mimic those of PCOS, levonorgestrel doesn’t cause PCOS and its effects will wear off for your subsequent menstrual cycles.

What happens when you have PCOS and go off birth control?

Because hormonal birth control methods help to suppress the symptoms of PCOS, many women find that their symptoms reemerge when they go off birth control. Your period may become irregular again and you may find yourself experiencing other symptoms, such as acne.

Can birth control cause infertility with PCOS?

No. If you stop taking birth control and experience difficulty conceiving, it isn’t due to having taken birth control. No matter how long you’ve been on it, birth control doesn’t affect your ability to conceive. PCOS, however, can affect your ability to get pregnant, as can age, lifestyle, and overall health.

Can you get pregnant with PCOS and birth control?

Birth control is highly effective at preventing pregnancy whether you have PCOS or not.

If you have PCOS and want to get pregnant while still managing symptoms, talk to your healthcare provider about your options. Drugs such as clomiphene or metformin can help to balance your hormones and increase fertility. With lifestyle adjustments, medical intervention, or both, many women go on to have healthy pregnancies.

What’s the best birth control for treating PCOS?

Choosing the right birth control is always a tricky decision. It can take some time to find the right hormonal birth control for your body’s natural chemistry.

If you have PCOS, the right birth control can help restore your menstrual cycle if it’s irregular. It may also help make your periods lighter and less painful, and reduce androgen-driven symptoms like acne and excessive hair growth.

The “best” birth control for PCOS should be determined between you and your doctor. Oral combination pills are the most common option for reducing symptoms, but not every type is suitable or safe for this condition.

Our resident PCOS expert, endocrinologist Doctor Grossman, typically suggests a birth control pill with lower androgenic progestin. Some examples are:

Doctor Grossman also recommends that people with PCOS avoid norgestrel and levonorgestrel as birth control options. Their progestin components mimic androgens more pronouncedly.

Some research has highlighted that levonorgestrel brings the lowest risk of blood clots, however. Despite some risk of androgenic side effects, this may make it the better option for some women based on their risk factors. In this case, a pill like Seasonique, Alesse 28, or Aviane may be a better fit.

What are the types of birth control for PCOS?

Hormonal birth control is commonly prescribed for people with PCOS as it addresses a number of the disorder’s symptoms. The advantages of hormonal birth control for treating PCOS include regulating periods, reducing menstrual bloating and cramps, decreasing acne, and curbing excess body hair.

There are some disadvantages of hormonal birth control. First, both PCOS and hormonal contraceptives put you at a higher risk for blood clots. Depending on your current health and medical history, this can make going on birth control too risky.

And, since all hormonal birth control contains progestin and some progestins mimic androgens more than others, taking birth control with those types of progestins could worsen your symptoms. Choose a birth control option with low-androgenic activity when first starting out to see how your body responds.

If you and your healthcare provider decide that hormonal birth control is the right decision for you, here are some of the options to choose from.

Oral contraceptives

Known more commonly as “the pill,” oral contraceptives come in two types:

  • Combination — contains both estrogen and progestin
  • Progestin-only — contains only progestin

Combination pills are the most common option to help with PCOS symptoms. For those who experience adverse reactions to estrogen though, the progestin pill may be a better choice.

Skin patch

If you want a hormonal birth control option that’s low maintenance, the patch is a great option. Containing both estrogen and progestin, you wear it as a small patch on your upper arm for 21 days.

Vaginal ring

The vaginal ring is a small, soft ring you place inside your vagina for 21 days at a time. It emits small doses of estrogen and progestin that absorb both locally, and in smaller amounts into your bloodstream.

Intrauterine device (IUD) and Depo-Provera (Depo) shot

While these are popular, low-maintenance, and longer-lasting birth control options, they’re not always suitable for people with PCOS. Depo shots are associated with increased weight gain and inflammation more than other types of hormonal birth control. That’s bad news for PCOS, since weight gain and inflammation are already concerns for those with the condition.

While research doesn’t back up the same concerns around IUDs, they’re not right for everyone. Hormonal IUDs can help to treat irregular menstruation associated with PCOS. Copper IUDs, however, don’t contain hormones, which means they won’t affect your PCOS symptoms. As well, if you have an STI or a recent history of pelvic inflammatory disease, you’ll want to steer clear.

Do you have to stay on birth control with PCOS?

No. Hormonal birth control isn’t for everyone and it isn’t a cure for PCOS. While birth control may offer symptom relief, the underlying causes of PCOS are still present. Consulting with your healthcare provider about medication and lifestyle adjustments can produce a more profound symptom relief, and help ensure good long-term health.

A word to the wise though — while PCOS may make it more difficult to conceive, you can still get pregnant with the condition. This makes some form of birth control a must if you’re sexually active and don’t wish to become pregnant.

If you live in Ontario, take birth control, and don’t feel that it’s helping to manage your symptoms of PCOS, speaking to a gynecologist can help. They may be able to recommend other treatments or another form of birth control instead.

The final word on birth control and PCOS

PCOS is a lifelong condition and it’s normal to want relief from aggravating symptoms like irregular periods, stubborn acne, and excess hair growth. Finding the right birth control can both protect you from pregnancy and nix some of your symptoms — a double win, right?

It’s important to remember that while birth control offers some relief, it doesn’t treat the underlying cause of PCOS. If you’re looking to treat your PCOS but aren’t sure where to start, try speaking to an endocrinologist. An endocrinologist can help you determine which medications and lifestyle adjustments will be most effective for you long term.

Reach out to speak to an endocrinologist today, and take the first step towards a better quality of life with PCOS.

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