Are birth control pills right for you?
If you have PCOS, it’s highly likely you were offered birth control pills to control your symptoms and “regulate” your period.
Gynecologists often prescribe combination estrogen-progestin birth control pills as first line treatment for women with PCOS – and for good reason. These medications can reduce some of your cosmetically troubling PCOS symptoms pretty quickly. After 3 to 4 months, excess body hair and acne improve, hair loss on your head slows down, heavy periods subside, and you won’t get a build up of tissue in your uterine lining from not having periods – all important issues to control.
How does the pill change hair and acne?
The current theory is that birth control pills increase a liver protein called SHBG (sex hormone binding globulin). SHBG binds to hormones floating around in your blood, such as estrogen, progesterone and testosterone. When testosterone is bound up, the overall amount of “free” or active testosterone goes down. This can:
- Lower the amount of oil on your skin by suppressing oil gland action.
- Get rid of excess testosterone that can damage hair follicles on your head, and cause unwanted hair growth elsewhere.
Does the pill regulate your menstrual cycle?
The short answer is NO. Combination birth control pills have 21 to 24 days of high-dose estrogen and progestin, followed by 4 to 7 days of placebo pills. When you take the placebo pills, you get a “withdrawal” bleed each month.
This bleeding is due to the withdrawal of the high dose hormones. This is not “regulating” your period naturally. A period by definition means that you have ovulated, which you don’t do on the birth control pill. With a natural cycle, if you don’t get pregnant after ovulation, then your uterine lining breaks down and you get a period.
Why does it matter if you bleed because hormones are artificially withdrawn versus when you ovulate and have a period?
Well, to begin with, an artificial period is just that – a “fake” bleed that isn’t due to fixing your hormones. A natural, “all on your own” period that happens after ovulation is a gauge of your overall health and hormonal balance. The “fake” period with the pill is not. So, if you are led to believe that your cycle is being “regulated,” it is not. This is a misconception. The minute you stop the pill, all of your PCOS symptoms will come back, since the underlying cause or causes weren’t addressed.
When is it best to consider using the pill for PCOS?
Aside from getting more rapid control of your PCOS symptoms or choosing oral contraception for pregnancy prevention, there are situations when the birth control pill is necessary. If you have irregular cycles with heavy periods, or if you are overweight AND have heavy periods, you could be at risk for precancerous changes in your uterine lining, a condition known as endometrial hyperplasia.
If these cells become “complex” or “atypical.” you may be at risk for uterine cancer. In this case, birth control pill use may be necessary to prevent these unhealthy changes. Your gynecologist can easily check to see if this is an issue for you based on ultrasound assessment of your lining and/or an in-office sampling of tissue called an “endometrial biopsy.”
Any other concerns regarding birth control pill use and PCOS?
70% of women with PCOS have insulin resistance as the underlying cause of their hormonal imbalance. Many of you with PCOS have additional drivers, such as imbalanced bacteria in your intestines, crazy stress hormone levels, or toxic exposures, to name a few.
Putting aside concerns that birth control pills mainly cover up your symptoms of PCOS without addressing why your hormones are out of balance, the pill tends to increase insulin resistance and create a “bad” cholesterol pattern. So if sugar, insulin or cholesterol issues are of concern, then proceed with caution. Be aware that the pill can make these conditions worse.
Also, be aware that birth control pills are drugs and can have side effects on your liver, and also may increase your risk of nutrient deficiencies.
What should you do?
As Functional Medicine practitioners who specialize in hormone health, we are always in favor of looking for why you have PCOS and then fixing those causes. But, if you need symptom relief quickly, or need effective contraception, and aren’t ready to do a deep dive into fixing your PCOS, the pill may be the right choice for you.
Just be aware that when you do go off the pill, unless you address the underlying causes of your PCOS, you will be back in the same boat or maybe worse off than when you started.
It is also possible to be on birth control pills AND start investigating the drivers behind your hormone imbalance. Using the pill while doing a Functional Medicine evaluation and treatment plan is an option! The only downside to this approach is the artificial hormones will cover up what is really happening. You won’t be able to measure the effects of the Functional Medicine approach. You also can’t measure your hormone levels while on birth control pills, as your body’s hormone production shuts down.
Which birth control pill should I use?
Everyone reacts to different birth control pills uniquely. What works for your best friend or your sister may not work for you.
If you have symptoms of androgen excess (like acne, hair growth on your body and hair loss on your head) then choose a birth control pill with a 4th generation progestin such as drosperinone, or a 3rd generation progestin like norgestimate. These hormones have very low testosterone-like activity and have the most potential for solving your androgen excess symptoms.
One concern with drosperinone is that it has slightly higher blood clotting tendency than other birth control pills. Although, ALL birth control pills can increase your risk of blood clots. The risks are about 2 to 4 per 10,000 women per year. You are low-risk if you are under 35, not a smoker, and don’t have any family history of blood clotting disorders.
If you are more concerned with heavy bleeding or risks for pre-cancer of the uterus, and DO have sugar and insulin imbalance, consider a progestin-coated IUD like Mirena or Skyla. These contain about a tenth of the hormone load of an oral birth control pill. They have little to no impact on your sugar and insulin levels. Plus, they effectively control abnormal thickening of your uterine lining and prevent heavy clotty periods.
Last words . . .
Speak with your doctor about which choices are right for you. Do consider learning how to get to the root causes of PCOS by checking out our PCOS SOLUTION program!