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What is the best birth control for treating PCOS?

September 8, 2020 • read

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What is the best birth control for treating PCOS?

Choosing the right birth control is always a tricky decision. Everyone has a unique hormonal profile, and adding new hormones to the mix can cause some unexpected side-effects. For people who have polycystic ovary syndrome (PCOS), birth control should be approached carefully. Hormonal birth control can have some great benefits in terms of reducing PCOS symptoms, but not every type is suitable or safe for this condition.

People 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. They’re secreted in small amounts by the female reproductive system. A little bit of androgens is fine — too much can throw off normal ovulation. The “cysts” seen in many people with PCOS are actually immature ovarian follicles. Hormonal imbalance prevents these follicles from fully maturing into eggs. This can cause havoc with your menstrual cycle and even lead to infertility. 

If you have PCOS, the right birth control can help restore your menstrual cycle if it’s irregular. People with PCOS who go on hormonal birth control report their periods returning on a predictable monthly schedule. Oftentimes their periods get lighter and less painful, and androgen-driven symptoms like acne and excessive hair growth subside. 

Hormonal birth control can increase your quality of life if you struggle with PCOS symptoms. But, it’s worth noting that birth control is not a cure for PCOS. Rather, it’s more like a band-aid solution. Birth control may offer symptom relief, but the underlying causes of PCOS are still present. You should consult with your doctor on an ongoing basis to decide on medication and lifestyle adjustments. These will bring about more profound symptom relief, and help ensure good long term health. 

What are the types of birth control for PCOS?

Oral contraceptives

Known more commonly as “the pill,” oral contraceptives come in packs that align with the days in a month. You take one active pill everyday for 21 days. Then, you either take no pills for seven days, or take the sugar pills that are included in the 28 day packs. Your period occurs during the seven day rest from taking active pills. 

There are two types of pills you can take:

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

Combination pills are the most common option to help with PCOS symptoms. Some people can’t take estrogen without experiencing adverse reactions, so the progestin pill may be a better choice. This should be decided on a case-by-case basis. 

Skin patch

The skin patch contains both estrogen and progestin, and follows a schedule much like the pill. You wear a small patch on your upper arm for 21 days, and remove it for seven. The seven days when the patch is removed allows for your period to occur. 

If you want a hormonal birth control option that’s low maintenance, the patch is a great option. Some people have difficulty remembering to take their pill at the same time every day. With the patch, you only have to think about it once a week. The skin patch is a less common option for treating PCOS symptoms. 

Vaginal ring

The vaginal ring is a small, soft ring placed inside your vagina. It emits small doses of estrogen and progestin into your bloodstream. Like the other methods, you leave the ring in for 21 days and remove it for seven when it’s time for your period. It’s less-commonly prescribed to help PCOS symptoms than the birth control pill.

The vaginal ring is low-effort, invisible to everyone, and imperceptible in daily life if inserted correctly.  The downside to the ring is it can be accidentally pushed out of your body. This can sometimes happen during sex, or if the ring was not positioned correctly when first inserted. If your ring falls out, you don’t need to panic. Your contraception will continue if you re-insert the ring within three hours. 

Intrauterine device (IUD) and depo-provera (depo) shot

These are longer-lasting forms of birth control. While they’re popular, very low-maintenance options, they’re not suitable for people with PCOS. Both IUDs and 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 typically already concerns for people with the condition.

Advantages of hormonal birth control for treating PCOS 

Hormonal birth control methods carry some undeniable benefits for people with PCOS. These benefits include:

  • Regulated periods.
  • Reduction in menstrual bloating and cramps.
  • Reduction in acne.
  • Curbing excess body hair (hirsutism). 

Disadvantages of hormonal birth control for treating PCOS

There are a couple very important caveats to keep in mind with any type of hormonal birth control. First, both PCOS and hormonal contraceptives put you at a higher risk for blood clots. Your doctor may decide that going on birth control is too risky based on your current health and medical history. 

Secondly, progestin is a synthetic version of the hormone progesterone. Progesterone is present in all hormonal birth control forms to protect your uterus. Some progestins mimic androgens more than others, which could be bad news for PCOS. Since PCOS symptoms are largely associated with high levels of androgens, taking birth control with those types of progestins could worsen symptoms. Choose a birth control option with low-androgenic activity when first starting out to see how your body responds. 

Other side-effects of hormonal birth control include:

  • Headaches
  • Dizziness
  • Mood swings
  • Nausea
  • Sore breasts
  • Fatigue
  • Possible weight gain
  • Appetite changes

What birth control is best for PCOS?

No birth control is perfect. It takes trial and error to find a hormonal birth control option that interacts well with your body’s natural chemistry.

The “best” birth control for PCOS should be determined between you and your doctor. Oral combination pills are the most common option for reducing PCOS symptoms. But, that doesn’t mean they’re exactly right for you. 

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.

Can you get pregnant with PCOS and birth control?

Birth control has the same contraceptive effect for everyone, whether they have PCOS or not. Birth control will prevent pregnancy at high rates as long as it’s taken correctly, as advised by your doctor and by the packaging instructions. 

If you have PCOS and you’re looking to become pregnant while managing symptoms, talk to your doctor about other medication options. There are drugs that can help balance your hormones and increase ovulation and fertility.

Can birth control cause PCOS?

Hormonal birth control does not cause PCOS. PCOS usually develops shortly after puberty, around the time your first periods begin. But, since hormonal birth control does alter your natural hormone balance, some pills might result in side-effects similar to symptoms of PCOS. On the other hand, 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 you’ve ceased taking birth control in hopes of having a baby. 

The final word on birth control and PCOS

PCOS is a lifelong condition, so it’s no wonder that people 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 PCOS symptoms. Sounds like 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. Medication and lifestyle adjustments will be more effective long term. And, birth control can cause complications that might be too risky for you. Birth control isn’t a miracle cure, but it can be a helpful tool for attaining better quality of life with PCOS. 

Want to talk to an endocrinologist about your PCOS, and what birth control is best for you? You can speak to our endocrinologists from the comfort of your home. 

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