PCOS and birth control pill: Your questions answered

Key takeaways:

• Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects women of reproductive age.
• The cause of PCOS is not fully understood. Health experts believe a combination of genetic and environmental factors can cause it.
• Birth control pills cannot cause polycystic ovarian syndrome (PCOS). Instead, birth control pills are used to treat symptoms associated with PCOS.

Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects people with ovaries and often results from an excess secretion of the male hormone, testosterone.

PCOS isn't life-threatening but can significantly impact a person's daily living and fertility and can reduce quality of life. It typically presents with hormonal imbalance, enlarged ovaries, the presence of multiple cysts in the ovaries, excess body hair growth, and other symptoms related to reproductive health.

Do birth control pills cause PCOS?

Birth control pills do not cause polycystic ovary syndrome (PCOS). In contrast, doctors sometimes prescribe birth control pills as treatment for PCOS and its symptoms.

While it's unclear the exact cause of PCOS, research indicates that genetic and environmental factors may play important roles. Those at higher risk of developing the condition include adult females with a family history of PCOS,  type 2 diabetes, obesity, and those who live a sedentary lifestyle.

Hormonal birth control pills can help with PCOS-related issues, such as:

• Regulating periods
• Reducing acne
• Managing excess hair growth (hirsutism) by lowering androgen levels.

These pills contain hormones (usually a combination of synthetic estrogen and progestin or progestin only) that mimic the natural female hormones. When ingested, the pills can suppress ovulation (which is how they prevent pregnancy) as well as regulate menstrual cycle (and, by extension, help reduce some of the symptoms of PCOS).

What is post-pill PCOS? Is it a medical condition?

No, post-pill PCOS is not a medical condition. Post-pill PCOS is also known as pill-induced PCOS. This is a term used when a person develops the symptoms associated with polycystic ovary syndrome (PCOS) after they have stopped using hormonal birth control pills. 

Typically, birth control pills help regulate menstrual cycles and hormone levels. But, suddenly stopping the pills can cause hormonal fluctuations, which may cause varying symptoms in different people, including symptoms similar to PCOS.

Keep in mind that experiencing such symptoms after stopping your birth control pills doesn’t mean you have PCOS. Still, some people who have been on the pills may actually have had PCOS but may not know until they stop ingesting the pills. This may cause them to believe their PCOS was caused by the pills.

Can birth control help treat PCOS?

Hormonal birth controls are not a cure for PCOS but can be an option for managing the symptoms of PCOS.3

Here are ways birth control pills can help treat PCOS:

1. Reducing androgen levels: Some birth control pills have anti-androgenic effects, meaning they inhibit the effect of the male hormone. This can help reduce the symptoms associated with high androgen levels in those with PCOS, such as acne and excess facial or body hair.
2. Regulating menstrual cycles: Birth control pills can help with menstrual cycle regulation, making periods more predictable in those with PCOS.
3. Improving hormonal balance: While they typically do not address underlying hormone issues in people with PCOS, hormonal birth control pills may help by adding synthetic versions of some hormones needed at certain times in the menstrual cycle.
4. Decreasing the risk of ovarian cysts: Hormonal birth control pills can help suppress the development of ovarian cysts in some cases, although the pills may not eliminate them entirely.

Some people with PCOS may also benefit from other treatments and lifestyle changes, such as dietary changes, exercise, and weight management.5 

Which birth control is best for PCOS?

The choice of birth control for people with PCOS depends on each individual's specific symptoms, lifestyle, and reproductive goals.6 It's essential to consult with a doctor who is in the best position to tailor the treatment to your needs. 

Here are two common birth control options that your doctor may suggest for managing your PCOS:

1. Combination Birth Control Pill: This contains both estrogen and progestin and is often prescribed to regulate the menstrual cycle, reduce androgen levels (male hormones), and manage symptoms such as acne, and hirsutism (excess hair growth) associated with PCOS.
2. Progestin-Only Pill: Also called mini-pills, progestin-only pills contain only progestin and may be a better option for you if your body has a low tolerance for estrogen.

Other medications for managing PCOS

Here are other medications that doctors may be prescribe to help manage PCOS:

• Anti-Androgen Medications: Medications such as spironolactone and flutamide can help reduce symptoms related to excess androgen production, including acne and hirsutism (excessive hair growth).
• Metformin: This medication is a common diabetes medication that is also prescribed for treating insulin resistance. It can help regulate blood sugar levels in people with PCOS. It may also help with weight management and ovulation.
• Clomiphene and letrozole: Doctors typically prescribe Clomiphene citrate or letrozole to induce ovulation in people with PCOS who are trying to get pregnant. These medications cause the ovaries to release eggs during ovulation.
• Progesterone: Progesterone therapy, often in the form of oral medication or a hormonal intrauterine device (IUD), can be used to induce regular periods and manage abnormal uterine bleeding in people with PCOS.
• Gonadotropins: In cases where clomiphene or letrozole are not effective, doctors may use gonadotropin injections to stimulate ovulation.
• Weight Loss Medications: In cases where weight management is a primary concern, healthcare professionals may consider medications like orlistat or a bariatric surgery.

Additionally, some people with PCOS may require a combination of these medications to address their specific symptoms and fertility goals.

Does birth control pill cause weight gain in people with PCOS?

Weight gain is a concern for many people, including those with polycystic ovarian syndrome (PCOS). Some people may experience weight gain when on the pill, while others may not.

A study shows that some healthcare professionals and people who use birth control pills have observed an increase in body weight while managing certain PCOS symptoms. 

For people who gain weight, the increase in weight is often minimal and can often be managed with a healthy diet and regular exercise.

Can birth control pills delay period?

Yes, birth control pills can delay a period. Here's how it works:

• To delay your period while on a combination birth control pill, skip taking the inactive pill at the end of a 21-day pack and start a new pack immediately.
• Progestin-only pills, on the other hand, are daily pills, do not contain inactive pills, and do not offer reliable control of your period. This makes it difficult to delay your period while on them.

Some birth control pills are designed for extended cycle use, which means they are designed to reduce the frequency of periods to as little as four times a year. Examples include Lybrel and Seasonale.

Research shows there is little or no risk associated with delaying your period. However, some people may notice breakthrough bleeding (i.e., bleeding or spotting between periods).

It's important to note that not all birth control pills are suitable for period delay, and users should discuss the ideal birth control option with their healthcare team.

When to seek medical attention

It's important to see a doctor if you experience any of the symptoms commonly associated with PCOS, such as: 

• Acne
• Fatigue
• Weight gain
• Thinning of hair
• Infrequent or absent ovulation
• Prolonged menstrual cycles
• Increase hair growth on the face, chest, and back.

Seeing a doctor is particularly important if these symptoms occur simultaneously, persist, or interrupt your daily life.

Also, if you are using hormonal birth control pills, you should speak with a doctor if you notice something abnormal while taking the pills or when you stop taking them.

Early diagnosis and management of polycystic ovarian syndrome (PCOS) can help prevent long-term complications like infertility, diabetes, and heart disease.

Wrap up

PCOS is a hormonal disorder that occurs in women of reproductive age. Clinicians are not sure of the exact cause, but there is no scientific evidence that shows that birth control pills cause this condition.

Instead, hormonal birth control pills are used to manage the symptoms of PCOS by controlling hormonal levels, regulating periods, and treating acne and excessive hair growth.

If you suspect you have PCOS or are concerned about its development, consult with a doctor for a proper diagnosis and treatment.