PCOS & The Pill
I’ve had a lot of questions recently about PCOS & the pill. Women are wondering:
“Is this the best way to manage my PCOS?”
“Are there any harms to being on the pill with PCOS?”
“What will happen if/when I come off the pill?”
“Does the pill affect my future fertility?”
If you have ever been on hormonal birth control and have wondered about these things, you are definitely not alone!! So allow me to shed some light…
The Oral Contraceptive Pill (OCP)
The birth control pill (OCP) is a common first-line treatment given to women newly diagnosed with PCOS in an attempt to help regulate their menstrual cycle and treat bothersome symptoms, such as acne and menstrual cramps. This, along with very basic diet and exercise guidelines, are some of the most common treatment options that I see being offered for PCOS conventionally.
Is this the best we can do for PCOS?? In my clinical experience, it is not!
Now let me preface this by saying that choosing a method of contraception is a highly personalized decision that often is the result of many, many factors. And so despite what you may have read online about the evils of hormonal contraceptive, it can be, in some cases, the best choice!
But What about when it comes to PCOS?
Well, here’s what we need to consider:
〰️ The pill doesn’t actually “regulate” your cycle. Yes, cycles may become more regular and predictable due to the withdrawal bleed that occurs. BUT, OCP prevents follicular development and ovulation, meaning that the bleed you are experiencing is not the result of your natural cycling or hormonal balance.
〰️ The pill doesn’t address the underlying hormonal imbalances, inflammation, or metabolic disturbances that underpin PCOS. Think of it more like a “band-aid” type treatment that may improve symptoms, but does not resolve the root cause(s).
〰️ Because of the underlying hormonal imbalances, inflammatory processes, and metabolic disturbances, women with PCOS are at a higher risk of developing type II diabetes, cardiovascular disease, infertility, and more. And because OCP does not address these imbalances, the risk remains. OCP itself ALSO increases the risk of cardiovascular issues, such as blood clotting and heart attacks, which only adds to the patient’s risk profile.
〰️ OCP, over time, is known to deplete the body of crucial nutrients needed for proper metabolic function & hormonal balance.
〰️ Though OCP has not been found to have a lasting negative effect on fertility, it can take time for your body to begin cycling normally again upon discontinuation. This, along with the hormonal imbalances that present with PCOS, can make it difficult for couples to conceive.
Conclusion…..
So do I think that the pill is the best way to manage PCOS? The short answer is no.
In some severe cases, it may be considered as a short term fix to reduce the risk of developing endometrial hyperplasia (this is when the endometrial lining builds up inside your uterus due to lack of regular menstruation). However, I do not view the pill as a long-term solution for PCOS. In fact, being on the pill may increase your risk of developing further disease down the line - diabetes mellitus, cardiovascular disease, and so on. The sooner that we can directly address the underlying hormonal imbalances, inflammatory processes, and metabolic disturbances that underly the pathophysiology of PCOS, the better chance we have at preventing future disease and making a positive, lasting effect on your overall health, wellbeing, and quality of life.
My Approach to PCOS
My approach to treating PCOS is simple - address the underlying cause(s) & pathophysiology to create lasting, positive change. The three main areas that I focus on when treating PCOS include:
Hormonal imbalances
Underlying inflammation
Metabolic disturbances
I begin addressing these areas by strengthening and supporting the foundations of health - i.e. stress, sleep, diet, movement, and connection. I then utilize targeted nutraceuticals, botanical medicine, and/or acupuncture to bring the body back into balance.
For women who are seeking solutions for their PCOS, know that there are options, there are solutions, and there is another way. If you are wanting to begin your journey towards better health & healing, don’t hesitate to reach out!
Resources:
The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices - https://pubmed.ncbi.nlm.nih.gov/10561657/
Approach to the patient: contraception in women with polycystic ovary syndrome - https://pubmed.ncbi.nlm.nih.gov/25701301/
Oral contraceptives and changes in nutritional requirements - https://pubmed.ncbi.nlm.nih.gov/23852908/
Return of fertility after discontinuation of contraception: a systematic review and meta-analysis - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055351/