PCOS and Birth Control Pills
Birth control pills (oral contraceptives) are typically various combinations and strengths of both estrogen and progestin. They are synthesized in a laboratory in order to make them more absorbable by the body and to manipulate the strengths of estrogen and progestin. Generally, the strength of the pill is measured by the amount of ethinyl estrogen (EE) that the formulation contains.
There are four categories by which birth control pills are described.
- Composition describes the ratio of estrogen to progestin and includes either combination or progestin only pills.
- Pattern of administration refers to the amount of hormone received in a daily dose and include monophasic and multiphasic regimens. Monophasic therapy is the receiving the same dose received daily while multiphasic refers to varying doses of hormone given throughout the cycle.
- Progestin type is the third category by which birth control pills are described. There are 1st, 2nd and 3rd generation progestins. The generation refers to the "age" of the progestin used. For example, first generation progestins are the original formulations by which the second and third generations are derived.
- The final parameter of oral contraceptive development is the amount of ethinyl estrogen (EE) a pill contains and is classified as "high" (>35mg EE, low" 30-35mg EE) and "mini" (30mg EE).
How Do They Work?
In the PCOS woman, birth control pills are used to prevent abnormal uterine bleeding and to help regulate the woman's cycle.
From a hormone perspective, birth control pills help to decrease the overall testosterone production from the ovaries.
Due to the body's perception of estrogen and progestin circulating in the system, the pituitary prevents the release of luteinizing hormone which in turn prevents the stimulation of the ovary to release testosterone. The more the body recognizes estrogen and progestin in the system the less it releases LH and therefore the decreased release of testosterone.
The estrogen in the oral contraceptive stimulates more sex-hormone-binding-globulin (SHBG) which in turn helps bind up excess testosterone in the blood stream. Therefore, there is less 'free' testosterone circulating to certain tissues susceptible to testosterone stimulation, such as the hair follicle.
Oral contraceptives are conveniently packaged in 28 day punch packs. In most cases, the pills have 21 days of hormones followed by 7 days of 'sugar' pills. During the latter seven days, as hormone is 'withdrawn' (or in this case, no longer given), your body perceives this as a drop in hormones and a period results. In some cases, like endometriosis, they are purposefully prescribed to give hormone continuously to actually suppress the menses altogether.
Advantages of Birth Control Pills
Ultimately, birth control pills mimic the hormonal cycle of pregnancy. As a result of this hormonal influence, using birth control pills has potential benefits for the PCOS patient, including:
- Increased menstrual regulation
- Increased bone density
- Possibly increased fertility
- Decreased androgen (male hormone) levels
- Decreased acne and hirsutism
- Decreased endometrial effects including endometriosis and hyperplasia
- Decreased risk of uterine and ovarian cancer
- Decreased menstrual pain and bleeding and PMS
- Decreased growth of uterine fibroids
- Decreased risk of pelvic inflammatory disease and ectopic pregnancy
- Decreased risk of rheumatoid arthritis
Disadvantages of Birth Control Pills
Although there are some positive reasons to use oral contraceptives in PCOS, some of the disadvantages may contribute to the worsening of the disease process, including weight gain, increased insulin resistance and worsening of glucose tolerance.
Other potential side effects include risk of stroke in smokers over 35, worsening of gall bladder disease, erratic spotting, headache, nausea and breast tenderness.
There are some absolute contraindications for the use of birth control pills. Woman with a history of blood clots, coronary artery disease, breast cancer, impaired liver function, undiagnosed vaginal bleeding and heavy smokers, especially over 35 should not use them. Although previously categorized as absolutely contraindicated in pregnancy, the FDA has since withdrawn the label. In fact, oral contraceptives are used frequently in fertility protocols and have been shown not to cause birth defects.
See Other Oral Contraceptive Articles Related to PCOS
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