Polycystic ovarian syndrome, PCOS, is a hormonal reproductive health disorder that can affect people’s menstrual cycles, weight, energy levels, and even their fertility. Not only can it be hard to treat, but it can also be difficult to diagnose in the first place.
People with PCOS are often prescribed hormonal birth control as a way to help manage symptoms and regulate periods, but does it actually help? What about people with PCOS who are hoping to conceive or who want other options? We’re here to help clear up the confusion.
What is PCOS?
Polycystic ovarian syndrome, PCOS, actually has more to do with your hormones than ovarian cysts. It occurs when the ovaries produce excessive amounts of androgens, creating an imbalance in reproductive hormones. And yes, you can have PCOS without having cysts on your ovaries, although if cysts are present they usually aren’t painful or concerning.
Some of the most common symptoms of PCOS include:
- Irregular or missed periods
- Unpredictable ovulation (anovulation)
- Abnormal hair growth
- Darkening of the skin (acanthosis nigricans)
- Thinning hair on the head
- Increased risk of endometrial cancer (Up to 3x higher)
Up to 15% of people assigned female at birth (AFAB) and cis women of reproductive age have PCOS. Despite it being so common, PCOS is widely misunderstood and difficult to treat.
Does Hormonal Birth Control Help PCOS?
One of the most common treatments for PCOS is taking a combined hormonal birth control pill containing both progestin and estrogen. It is usually the first line of defense for PCOS treatment thanks to the effect it has on your hormones.
The estrogen in these contraceptives helps to inhibit androgen in the body thanks to the creation of sex hormone-binding molecules that reduce levels of free testosterone. Progestogens in hormonal birth control also limit the effects of androgens.
Essentially, HBC helps to manage symptoms of PCOS by reducing the production of androgens and reducing testosterone levels. Studies found the use of HBC in people with PCOS can reduce free-testosterone levels by 61%.
These testosterone and androgen reducing effects can help to reduce symptoms like acne, excessive hair growth, and irregular periods, and may help decrease the risk of endometrial cancer. Most studies on the use of HBC for treating symptoms of PCOS were done using oral contraceptives, there is limited data available for other forms of HBC like the patch or injection.
Side Effects of Hormonal Birth Control for PCOS
While HBC can be helpful in helping manage symptoms of PCOS, it does come with potential side effects. One of the biggest being increasing the risk of metabolic disorders like increased blood pressure and abnormal cholesterol or triglyceride levels. This is one of the reasons it’s not recommended for people with hypertension.
HBC may have a negative effect on cholesterol and triglyceride levels. People without PCOS may have a more than 40% increase in triglyceride levels, while people with PCOS may have an up to 75% increase. High cholesterol and triglyceride levels can increase the risk of heart disease and stroke.
Other potential side effects of HBC for PCOS include:
- Breast tenderness
- Weight gain
- Changes in period heaviness or length
- Mood imbalances
Some of these potential side effects, like weight gain, may be able to be mitigated by combining other medications like metformin.
Another caveat with HBC as a PCOS treatment is that many of the clinical guideline recommendations for HBC use were made based on studies done on women that don’t even have PCOS.
The elephant in the room is that while HBC may help people manage symptoms of PCOS, it doesn’t treat the underlying cause. This problem becomes even more apparent for people who are hoping to conceive.
PCOS and Fertility
Although HBC can be helpful for some people with PCOS, it certainly doesn’t help people who are hoping to have a baby. If you are dealing with infertility, whether or not you have PCOS, we’re sorry. We understand how difficult this journey may be and we hope you’re getting all the support you need.
People with PCOS often aren’t diagnosed until they try to get pregnant, usually in their 20s or 30s. An estimated 70-80% of people diagnosed with PCOS experience infertility. PCOS plays a role in 80% of anovulatory infertility cases, meaning infertility due to a lack of ovulation.
New medications called clomiphene citrate treatment have been developed to help induce ovulation to help people conceive through intercourse. Other potential fertility treatments for people with PCOS include administering exogenous gonadotropins, which also help to induce ovulation. Both these treatments have a live birth rate of about 70%. Another option, ovarian drilling with laparoscopy has about a 50% success rate.
Other PCOS Treatments
Unfortunately, there is no known cure for PCOS, only tools to help manage symptoms and support infertility. There are other medications available besides HBC like anti androgen medications or clomiphene for people who are trying to get pregnant.
PCOS also increases your risk of developing health conditions like certain types of cancer, obesity, cardiovascular disease, type 2 diabetes, and hypertension (high blood pressure). This is why it’s important to take steps to help support your overall health.
Whether or not you choose to go on HBC for PCOS, we encourage you to make lifestyle changes like avoiding smoking and limiting alcohol consumption, regulating your blood sugar, eating a balanced diet with whole foods, managing stress levels, and getting regular low-intensity physical activity.
There is no perfect answer when it comes to PCOS treatment. While hormonal birth control may help you manage symptoms, it doesn’t get to the root cause of your symptoms and comes with potential side effects, not to mention it doesn’t help with fertility. We encourage you to talk to your healthcare provider if you’re curious about using HBC to help manage your PCOS.