PCOS and Birth Control Pills -- A Good Idea?

If your doctor tells you that you have PCOS, they will probably also suggest putting you on the pill. But before you make that decision, it’s important to know more about how the pill works, the risks and problems with taking it, and alternatives you can consider.

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Prior to menopause, most women naturally produce estrogen and progesterone in a rhythmic fashion in order to regulate ovulation and menstruation. In women with PCOS, this natural hormonal rhythm is disturbed.

The Pill causes a monthly bleed in most women, which seems like a "normal" period. Although the shedding of the lining of the uterus is an important health benefit of birth control pills, women are not actually ovulating while taking them.  Therefore they are not experiencing all of the complex hormonal interactions that occur with a natural cycle. Continuation of this unnatural activity on a long-term basis could have unintended consequences.

How Do They Work?

In a nutshell, birth control pills (oral contraceptives) release hormones into your body to create a highly regular menstrual cycle without ovulation. They contain various combinations and strengths of the hormones estrogen and progestin. Since irregular periods are the most common symptom of PCOS, taking birth control is a way to force your body into a regular cycle. There are both advantages and disadvantages to this approach.

You may have heard that excessive levels of testosterone stimulates acne and facial/body hair growth, and impairs fertility. But did you know that there are two types of testosterone hormone? One is inactive. The other is biologically active. It is the "active" hormone that causes your symptoms.

Fortunately, there is a substance circulating in your body called "sex hormone binding globulin" or SHBG. SHBG binds to the active testosterone and makes it inactive. This means there is less 'free' testosterone circulating to certain tissues susceptible to testosterone stimulation, such as the hair follicle. That’s a fancy way of saying the pill may help control problems like acne and facial hair.

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 the hormones are 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:

  • Menstrual regulation 
  • Better bone density 
  • Contraception 
  • Possibly increased fertility 
  • Lower male hormone levels 
  • Less acne and hirsutism 
  • Decreased endometrial effects including endometriosis and hyperplasia 
  • Fewer risks of uterine and ovarian cancer 
  • Decreased menstrual pain and bleeding and PMS 
  • Fewer uterine fibroids 
  • Less risk of pelvic inflammatory disease and ectopic pregnancy 
  • Decreased risk of rheumatoid arthritis

Disadvantages of Birth Control Pills

Although there are positive reasons to use oral contraceptives in PCOS, there are some ways that it might make your symptoms worse. The pill also carries risks of its own. These two factors include:

  • Weight gain
  • Increased insulin resistance 
  • Worsening of glucose tolerance
  • Risk of stroke, especially in smokers over 35
  • Worsened gall bladder disease
  • Erratic spotting between periods
  • Headache
  • Nausea
  • Breast tenderness
  • Risk of certain kinds of cancer

There are some 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 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.

Nearly all birth control pills contain a synthetic hormone called ethinyl estradiol, which is structurally different from any of the estrogens you have in your body (estrone, estradiol, and estriol).

Synthetic hormone derivatives do not work the same in your body as your own hormones do. They can't work the same because they are structurally and biochemically different from your own hormones. Long-term consumption of synthetic derivatives may eventually result in unforeseen negative consequences for your health.

Birth Control Pills Do Not Heal PCOS

But the real disadvantage of relying on the birth control pill to regulate your cycle is that you lose touch with what’s really going on your body. PCOS is not just about the menstrual cycle, or about ovaries; it's a whole-body, whole-person condition affecting many systems.

Taking the pill only masks the symptoms; it does nothing to cure PCOS or prevent the deep systemic health problems that lurk beneath the surface.

If you are engaging in lifestyle changes like exercise and eating right, you may want to monitor your natural cycles – they will tell you when you are healing internally by becoming more regular all on their own. And you’ll be addressing the other PCOS symptoms at the same time!

Source: Mashchak, CA et al, Comparision of pharmacodynamic properties of various estrogen formulations, Am J Obstet Gynecol, 1982, 144(5):511-8

Lifestyle Nearly as Good as Birth Control Pills for PCOS

Your doctor may have prescribed birth control pills because they lower total testosterone and may increase sex hormone binding globulin (SHBG), which relieves symptoms. The ratio between total testosterone and SHBG is called the FAI (free androgen index). The lower the ratio, the better.

However, if you are not keen on the idea of taking birth control pills for the next ten or twenty or thirty years, there is good news in a medical study of adolescent PCOS women was just released by the University of Rochester Medical Center. The researchers found that lifestyle improvement, all by itself, will reduce the FAI by 59% vs. an 86% reduction in the FAI with birth control pills.

In other words, improvement of your lifestyle is almost as effective as taking birth control pills!

Moreover, the good results achieved with birth control pills also had a significant downside. The PCOS women on oral contraceptives had a whopping 39.7% increase in their C-reactive protein levels and a 14% increase in cholesterol. C-reactive protein is a marker for inflammation. In other words, oral contraceptives worsen chronic inflammation, which is a big problem for women with polycystic ovary syndrome. Chronic inflammation worsens insulin resistance, which is now thought by many to be the primary cause of polycystic ovarian syndrome.

In contrast, the University of Rochester study shows that an improved lifestyle achieves good results, plus there are NO side effects! So what do we mean by "lifestyle" anyway? It's how you live: eating a much healthier diet, getting more exercise, reducing stress, and living in a cleaner environment. You can find the essential elements of a healthy lifestyle in The Natural Diet Solution for PCOS and Infertility e-book.

Source: Hoeger K et al The Impact of Metformin, Oral Contraceptives and Lifestyle Modification, on Polycystic Ovary Syndrome in Obese Adolescent Women in Two Randomized, Placebo-Controlled Clinical Trials, J Clin Endocrinol Metab. 2008 Aug 26. [Epub ahead of print]

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