Can You Treat PCOS With Birth Control?

Polycystic ovarian syndrome (PCOS) is a condition that affects 8–13% of women in the US (according to the Rotterdam Criteria).¹

There is currently no cure for PCOS, but many women seek treatment to reduce their symptoms. Hormonal contraceptives may be used in some cases.

Before taking action, it’s a good idea to learn more about PCOS, its symptoms, and how treatment can affect you. Read on to learn more.

What is PCOS?

Polycystic ovarian syndrome is a disorder of the reproductive endocrine system. It often causes irregular menstrual bleeding, among other signs and symptoms.

Women with PCOS often have elevated androgen levels. Androgens are the hormones responsible for developing masculine traits. They can lead to hirsutism (excess hair growth) and male pattern baldness.

Fertility is commonly affected by PCOS. Your body creates many follicles each month, but only one will mature into an egg. If the egg doesn’t become fertilized, your body will usually get rid of it together with the uterine lining during your period.²

PCOS interrupts ovulation (the process where eggs are grown and released), although the exact mechanism is unknown. Pregnancy is not possible if you do not ovulate.³

In some people with PCOS, their follicles turn into cysts. These are tiny fluid-filled sacs.

Symptoms of PCOS

Cysts are not always present with PCOS. Diagnosis does not rely on them.

Instead, diagnosis is commonly based on the Rotterdam criteria. This is a set of diagnostic criteria for diagnosing PCOS. It includes the following three criteria:⁴

• Oligoovulation (irregular or infrequent periods) or anovulation (no ovulation)

• Hyperandrogenism (high androgen levels)

• Polycystic ovaries or multiple follicles seen via ultrasound

Two out of three criteria must be observed for a diagnosis.

Other symptoms of polycystic ovarian syndrome include, but are not limited to:

• Male pattern hair loss

• Irregular periods

• Acne

• Infertility

• Excess hair growth — typically occurs on the chin, upper lip, chest, back, upper arm, the center of your abdomen, thigh, and buttocks

How does birth control manage PCOS?

Although no curative treatment has been found for PCOS, hormonal birth control is the treatment of choice for those with hyperandrogenic symptoms that do not want to get pregnant. In many cases, women no longer experience symptoms when taking hormonal birth control.⁵

The hormones in birth control pills, such as the combined pill, can help if your body produces too much androgen. They can also help control your menstrual cycle and reduce acne and excess hair growth.⁶

Additionally, the combination pill or cyclic progestin can reduce your risk of developing endometrial and ovarian cancer.

The oral contraceptive pill is often used to ease PCOS symptoms for these reasons, but no one particular pill is recommended over others.⁷

Insulin resistance is another hallmark of PCOS. Some experts suggest that defects in insulin sensitivity may lead to compensatory hyperinsulinemia (high blood insulin levels).

Insulin resistance can become a serious health risk, so your doctor should monitor how your symptoms progress.

Can PCOS patients use birth control for weight loss?

Although oral contraceptives are not likely to help you lose weight, reducing excess body fat may help alleviate some of your symptoms. Weight loss of even as little as 5% can help restore ovulation and reduce hyperinsulinism. This brings androgen levels under control and eases symptoms.⁸ ⁹

Disadvantages of using hormonal birth control for PCOS treatment

Taking oral hormonal contraceptives won’t cure PCOS. Cyclic estrogen and progestin contraceptives may help manage PCOS symptoms, but they can only do so much. Your symptoms will likely return if you stop using them.

Using oral contraceptives increases your risk of developing venous thromboembolism — a condition that occurs when blood clots form in a vein.¹⁰

Older-style hormonal contraceptive pills are more androgenic, but they have less risk of causing blood clots. Newer pills are less androgenic but may increase the risk of blood clots.¹¹

Ultimately, the birth control pill should be used with caution in PCOS patients with increased risk factors for thromboembolism. Your doctor will consider that contraceptives with less risk of causing blood clots may be less effective against hyperandrogenism — although more research is needed.¹²

Can using birth control to treat PCOS cause infertility?

If you have trouble becoming pregnant after stopping birth control, it is not because of the medication. Long-term use of birth control does not compromise fertility. However, PCOS, age, lifestyle choices, and overall health can all impact your fertility.¹³

Can people with PCOS who are also using birth control become pregnant?

Whether you have PCOS or not, birth control prevents unwanted pregnancies. Discuss your desire to become pregnant with your doctor if you have PCOS and are also interested in learning about your choices for controlling your symptoms.

If you have PCOS and you are overweight, your doctor will recommend making lifestyle changes to lose weight. This is considered the primary treatment for infertility in PCOS. Your doctor may recommend medications like metformin and clomiphene as a second-line treatment option.

Which is the best birth control for PCOS?

If your menstrual cycle is irregular due to PCOS, the correct method of birth control may help regulate it. It can also help alleviate other androgen-related symptoms, including acne and excess hair growth.

You and your doctor should decide which kind of oral contraceptive would be best to help ease your PCOS symptoms.

The following are examples of hormonal contraceptive pills that may be used to treat PCOS:

• Ortho-Tri-Cyclen

• Yaz and Yasmin

• Diane

Levonorgestrel has been historically avoided in people with PCOS as it is androgenic, despite it being less likely to cause thromboembolism. While a 2018 meta-analysis concluded the drug is just as effective as other birth control medications, it still tends to be avoided.¹⁴ ¹⁵

On the other hand, some doctors still prefer to prescribe pills containing levonorgestrel or norethindrone (a contraceptive that has medium androgenicity) due to concerns about blood clots.

The lowdown

Managing your PCOS symptoms successfully may significantly enhance your quality of life. The most appropriate method of birth control may ease your discomfort while preventing unwanted pregnancies.

While birth control may help with symptoms, it won’t cure PCOS. Discuss medication and lifestyle changes with your doctor to give yourself the best chance of seeing the results you want.

Generally, oral contraceptives are more effective for symptoms related to high androgen levels than lifestyle changes. 

Despite its long history and widespread use, there are risks associated with using oral contraceptives. Understanding your medical background and reading up on potential adverse effects is crucial. For some women, the potential dangers of using birth control outweigh any potential benefits.

It’s vital to remember that although birth control can provide some relief, it does not address the fundamental cause of PCOS. Experts still don’t fully understand what causes the condition.

Speak to your doctor if you want to begin treating your PCOS but you don’t know what method is best. Your doctor may recommend a combination of treatment methods to provide the best results.