PCOS & Birth Control

Hormonal birth control is often leveraged for more than just contraceptive purposes: it can artificially balance our hormones and help manage PCOS symptoms.

However, it can also artificially unbalance hormones, intensify PCOS symptoms, and catalyze or worsen this condition.

In this article today, we will be covering the following topics:

• Birth control basics: How does hormonal birth control work?
• Hormonal birth control as a PCOS treatment strategy: Why are hormonal contraceptives often prescribed to help with PCOS symptoms?
• Potential downsides of hormonal contraceptives: What are signs that a particular hormonal birth control method is not the right fit for me and my PCOS?
• Post-pill PCOS: Can hormonal birth control cause PCOS?  

Before we dive in, remember that Pollie is incredibly supportive of helping our members find whatever PCOS management strategy works for them, whether that be conventional treatments like pharmaceuticals or more holistic care. The intent of this article is to provide an unbiased view of how hormonal contraceptives work and interact - both positively and negatively - with PCOS.

Birth control basics

Hormonal birth control’s primary function is just as the name insinuates: to keep our bodies from getting pregnant. But how does it actually work?

In most simple terms, hormonal contraceptives prevents pregnancy from some combination of inhibiting ovulation, thickening our cervical mucus (which makes it harder for sperm to fertilize an egg), and thinning the uterine lining (which makes it harder for a fertilized egg to implant in the womb).

However, different hormonal contraception methods do this in different ways. There are a variety of methods described in the chart below:

Hormonal birth control for PCOS treatment

Hormonal contraceptives are a common treatment method for PCOS for those who are not trying to conceive and who are trying to regulate their cycles and improve dermatological symptoms such as acne, hair loss, and hirsutism. Many also find that hormonal birth control can improve mood and mental health issues such as anxiety and depression.

While hormonal birth control does not not fix PCOS - it just puts a “band aid” on symptoms - it can improve one’s quality of life greatly. If you have tried to manage your PCOS with lifestyle changes for a sustained amount of time (at least 6 - 12 months) without significant improvement, or if your routine and goals do not allow for specific dietary, exercise, and other lifestyle-based changes, discussing birth control with your provider may be a good option.  

Hormonal birth control can be beneficial for those who have symptoms of acne, oily skin, unfavorable hair growth or loss, and irregular cycles. Pills that use estrogen and progestin to decrease androgen production are favorable for PCOS in regulating periods. The pills are recognized for protecting the endometrium (uterine lining) against abnormal cell growth and help control testosterone. This androgen can lead to acne in female bodies (1).

Beyond a day-to-day level, hormonal birth control can also help reduce long-term PCOS health risks. Hormonal contraceptive methods that use estrogen and progestin to decrease androgen production are generally seen as more favorable when it comes to regulating cycles with PCOS. The pills are recognized for protecting the endometrium (uterine lining) against abnormal cell growth and help control testosterone. This can be vital for people with PCOS, as this population is at a 3x higher risk of estrogen-related cancers such as endometrial cancer.

If you are considering hormonal birth control as part of your PCOS treatment, make sure to vocalize your PCOS symptoms with your prescribing doctor to make sure the pill you start has the best chance of helping your cycles, symptom reduction, and risk prevention. It is important to remember that there are over 50 types of pills, and just because one type or method does not work for you does not mean there is not an option that would.

Potential downsides of hormonal birth control and PCOS

Hormonal birth control and PCOS is a highly-debated topic. While it is one of the most common conventional treatment methods, some people may find it worsens their symptoms - or even catalyzes their PCOS!

As mentioned, it is important to understand that hormonal birth control will not cure PCOS. It can only help control symptoms, and once a person discontinues a hormonal contraceptive method that may be helping to manage their PCOS, symptoms will generally return. This is particularly important for people who are hoping to start a family soon, as it can take people with PCOS longer to regulate ovulation after discontinuing birth control.

As discussed, different hormonal birth controls will work differently with hormones. This is why it is essential to make sure the method you choose is suitable for you, your symptoms, and your body. If there is a mismatch, unfavorable symptoms can develop.

While labs and trial and error are sometimes needed to find a hormonal contraceptive that helps with PCOS, there are some general cause-and-effect dynamics to be aware of. For example, birth control methods that are either lower in estrogen or progestin-only pills have been shown to cause hyperandrogenism as a side-effect, which will worsen acne and hair loss or growth (2).

Another downside to PCOS, like any medication, there are always risks such as blood clots. For many, these risks are not concerning. Still, because PCOS is commonly associated with clinical and metabolic co-morbidities, these potential risks could be more significant depending on the condition. For example, an individual who may smoke and has a history of cardiovascular problems may experience more side effects with a combination pill. A progestin-only pill could be the next best answer. However, with progestin-only birth control pills, there is still this risk for hyperandrogenism (2).

There is little research behind PCOS and birth control. This leads to the aforementioned lack of overall understanding of which pill is generally the most effective for PCOS. It may take a few tries to figure out which pill works best for your body and what will work for you may worsen symptoms for someone else. It will be mainly up to you and your doctor to decide what approach will be the most appropriate to address your needs, concerns and manage PCOS symptoms (3).

"Post-pill" PCOS: Is it real?

After going off hormonal birth control, individuals can experience a withdrawal effect causing androgen surges, referred to as pill-induced PCOS. These birth control types are referred to as having a "low androgen index" that can disrupt your hormones and put you in a state of PCOS. This is common in pills with drospirenone or cyproterone (Yasmin, Yaz, Brenda, or Diana). Other lower estrogen pills, like mentioned prior, have also shown to increase androgen levels as a side effect.

Post-pill PCOS, in many cases, is temporary and a diagnosis should always be re-evaluated 6-12 months after stopping hormonal contraceptives. Still, you will likely find that it takes longer than friends or family to regain your regular cycle after discontinuing the pill. That said, an upside to this is that symptoms will generally diminish or even entirely disappear with time. The scientific field has not fully recognized or researched post-pill PCOS. Holistic doctors have experience promoting natural healing for getting off hormonal birth control that causes pill-induced PCOS. Some methods include replacing depleted nutrients, balancing blood sugar, supporting your gut microbiome, and certain herbal supplements.

It is not uncommon to come off of the pill and experience adverse symptoms. Working with a naturopathic doctor, a nutritionist, or your OBGYN can help you better understand your body's needs.

Be sure to discuss any hormonal birth control use with your Pollie care team. Your nutritionist, health coach, and care coordinator can all help you weigh the pros and cons of different symptom management strategies and point you to additional resources if needed.

Sources

1. PCOS treatments. PCOS Awareness Association. Accessed June 6, 2021. https://www.pcosaa.org/pcos-treatments.
2. Villines Z. What are the best birth control pills for PCOS. Medical News Today. Published November 17, 2017. Accessed June 6, 2021. https://www.medicalnewstoday.com/articles/320055.  
3. Galan N. Using Birth control to treat PCOS. Very Well Health. Published January 19, 2020. Accessed June 6, 2021. https://www.verywellhealth.com/taking-the-pill-for-pcos-2616584.