Polycystic ovary syndrome (PCOS) and birth control

What is Polycystic ovary syndrome (PCOS)?

PCOS is a common condition among women of reproductive age, it’s estimated between 2 and 26 in every 100 women have the condition. It can affect periods, fertility, hormones and your physical appearance. 

Women who have the condition are likely to have irregular or long periods, high levels of androgens (‘male hormones’) causing excess facial and body hair, and polycystic ovaries. You have to have at least 2 of these separate symptoms to be diagnosed with the condition. 

Polycystic ovaries means the ovaries are bigger than usual and develop harmless fluid-filled sacs (follicles) surrounding the eggs. The follicles are underdeveloped sacs in which eggs develop. If you have PCOS, these sacs often can’t release an egg, meaning ovulation often doesn’t take place. 

What causes PCOS?

It’s not known what the exact cause of PCOS is, but it is thought that there might be certain factors that play a role. These include:

• High levels of insulin -  insulin is a hormone produced by the body to help the cells to to use sugar. If your cells develop a resistance to the way insulin works, your blood sugar levels can rise and your body produces even more insulin. These high levels of insulin can cause ‘male hormone’ (androgen) levels to also rise, this may cause problems with ovulation. 
• Hormonal imbalance - some women who have PCOS have been found to have an imbalance of testosterone, luteinising hormone, globulin or prolactin. These changes may start in the ovary itself, the brain or could be caused by the resistance to insulin discussed already. 
• Family history - in some cases PCOS is thought to be hereditary, those with a family history of PCOS are more likely to have the condition. 

What are the symptoms of PCOS?

Women who experience PCOS have varying symptoms.

Common symptoms of PCOS include:

• Irregular periods or no periods at all
• Problems conceiving
• Excess facial and body hair
• Hair loss on the head
• Weight gain
• Acne or oily skin

How to test for PCOS

Blood tests check for hormone imbalances which can indicate PCOS. However, you’d also need to have any of the common symptoms of PCOS. If you think you may have this condition speak to your GP. They may carry out a blood test. Our women’s hormone blood test can be done in your home, then simply post your test and wait for your results.  

How can PCOS be treated?

There is no known cure for PCOS, however there are certain changes you can make in your lifestyle that can greatly improve the condition. Overweight women often find that their symptoms of PCOS are worse, and in some cases the risk of having long-term health issues as a result of PCOS is higher. Losing weight can make a vast improvement on the condition. Even a 5% reduction in weight can make a real difference in the symptoms. Eating healthy balanced meals regularly and exercising at least 3 times a week will help you lose weight. 

There are also some medications, such as the contraceptive pill, that can help manage some of the symptoms of the condition.

Can birth control help with PCOS?

Some women with PCOS may be prescribed hormonal contraception to help regulate their hormonal imbalance and menstrual cycle. If you don’t want to avoid pregnancy you may be prescribed a 10 or 14 day course of progestogen to help regulate your menstrual cycle. 

Contraceptive options for PCOS

Combined pill

The combined pill contains both oestrogen and progestogen. This combination decreases the production of androgen ‘male hormones’. Regulating these hormones with the pill can help improve any abnormal bleeding, excess hair growth, oily skin and acne that may be caused by PCOS. 

Vaginal ring

The vaginal ring (NuvaRing) also contains a combination of oestrogen and progestogen and works in the same way as the combined contraceptive pill. Therefore the vaginal ring can also help relieve the symptoms of PCOS. 

Contraceptive patch

Like the vaginal ring, the contraceptive patch (Evra) contains oestrogen and progestogen and will also help relieve the symptoms of the PCOS. 

Progestogen-only pill

The progestogen-only pill (or mini-pill as it is sometimes known) may help regulate periods and may also help manage the symptoms of PCOS. As some women can’t use combined contraceptives (if you’re a smoker over 35 for example), the progestogen-only pill may be a good alternative. 

Does birth control help PCOS hair growth?

Combined contraceptives such as the combined pill, vaginal ring and the patch may help reduce excess hair growth on the face and body, often caused by PCOS. They also may help with hair loss on the head. 

What happens when you have PCOS and go off birth control?

Once you come off birth control you might find that your periods return to an irregular pattern, and some of the other symptoms of PCOS return. There is no change in fertility when taking the pill however, after coming off you might find it difficult to get pregnant, as this is a symptom of PCOS. 

If you’re considering contraception, you can visit our contraception clinic for guidance and advice. 

References
www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/symptoms/
www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/
www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
youngwomenshealth.org/pcos-all-guides/
www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/pi-pcos.pdf