Birth Control Is Often the First Line of Defense for PCOS Symptoms
Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders, affecting between 6 percent and 12 percent of reproductive age women in the United States. Because the exact cause of PCOS is unknown, treating the condition can be a bit tricky.
One popular option for treating PCOS symptoms is hormonal birth control. While this is obviously not available for women looking to get pregnant, it can be a solid option for those who want some relief from their painful symptoms. Common symptoms of PCOS include excess facial and body hair (hirsutism), irregular or absent menstrual cycles, infertility, pelvic pain, and obesity or trouble losing weight.
The condition is characterized by abnormal amounts of androgens (male sex hormones). Weight, family history and insulin resistance are thought to potentially play a role in the development of the disorder.
While there is no cure for PCOS, and the condition doesn't go away on its own, there are a broad range of treatment options to alleviate symptoms. Here's what you need to know about using the pill to treat your PCOS.
How birth control helps
Oral contraceptives are often the first line of treatment for patients with PCOS who aren't looking to become pregnant in the near future. Kelly Culwell, M.D., an OB-GYN, (known as Dr. Lady Doctor), has prescribed birth control for patients with PCOS in her own practice.
Culwell clarified that while birth control isn't treating the core of PCOS—because there is no cure—the pills can treat the most concerning symptoms.
"Using birth control helps with one of the main symptoms of PCOS—infrequent menstrual periods," Culwell explained. "Birth control helps to regulate the menstrual cycle."
In other words, birth control pills make ovulation regular, by preventing ovulation at all. Having regular ovulation and shedding the uterine lining is important in protecting the uterus. This is because having irregular ovulation can increase the buildup of uterine tissue (endometrial hyperplasia). "Birth control pills stop the lining of the uterus from getting too thick," Culwell said.
Debra Shapiro, M.D., an OB-GYN and health coach, noted having a buildup of uterine tissue can increase the risk of uterine cancer.
Other PCOS symptoms that birth control pills can alleviate include acne and excessive hair growth. The pills work by reducing the level of androgens produced by the ovaries, reducing androgen activity. Since the excessive androgen levels are the culprit for the acne and excessive hair growth in PCOS, taking birth control pills can alleviate these symptoms.
The downside to the pill
Similar to most prescription medications, oral contraceptives, although effective at alleviating symptoms, are not without risks. Some smaller risks Culwell outlined include irregular bleeding or spotting, nausea and nerve changes. More serious risks include blood clots in the legs and lungs, heart problems and strokes.
Birth control pills can also increase cancer risk. While birth control pills decrease the risk of uterine cancer, according to Shapiro, the pills may elevate your risk for other types of cancers, such as cervical and breast cancers.
Culwell added the number of risk factors a woman has, when taking birth control, is important to consider. "Sometimes women with PCOS have multiple risk factors, such as high cholesterol and obesity, which increase their risk for side effects," she said.
Besides the risks listed above, some women may find it takes a long time to find the "right" birth control. Not everyone reacts the same to every medication, and birth control is no different. What works for one person won't necessarily work for someone else.
"People with PCOS are the same as everyone else," Culwell said. "Everyone reacts to hormones differently."
If you suffer from PCOS and birth control isn't a treatment option you want to pursue, don't worry, there are other options available. Gonadotropins, hormone medications given by injections, and ovulation-stimulating medications are alternative treatments to birth control pills. Your doctor may also recommend altering your diet or using the diabetes drug Metformin.
A change in diet
A healthy diet and physical activity are important when treating PCOS. Dietary factors, such as reducing carbohydrates, have been found to improve PCOS symptoms over time. Shapiro recommends, in combination with reducing carbohydrate intake, eating a more plant-based diet and decreasing advanced glycation end products (AGES) intake.
AGES are harmful compounds formed through glycation, a process that combines proteins or fats with sugars in the bloodstream. Foods exposed to high temperatures, such as fried foods, have a high amount of these compounds. Avoiding these foods can help with weight loss and managing PCOS symptoms.
Insulin resistance is hypothesized to play a potential role in PCOS, although the mechanism is unclear. Metformin works by improving insulin sensitivity and optimizing the use of glucose available to the body. In turn, this decreases glucose production in the body.
Metformin may be a good option for women with PCOS looking to conceive. The medication stimulates ovulation and makes menstruation regular, optimizing your fertility. Metformin may also lower the risk of miscarriage.
Long-term usage of Metformin can result in side effects such as vitamin B12 deficiency. Your doctor may recommend you take a B12 supplement to counteract the effects.
Whatever treatment method you choose, it's important to manage your expectations. While birth control pills are an effective treatment for PCOS symptoms, there is no one-size-fits-all treatment plan. Working with healthcare professionals can help you come up with the right plan for you.