Post-Pill PCOS: Reality Or Myth?

Polycystic ovarian syndrome (PCOS) is a hormonal condition that affects many women. It is characterized by an irregular menstrual cycle, cysts in the ovaries, and hyperandrogenism (high levels of androgen hormones).¹

One of the main treatments for this condition involves taking contraceptive pills. These can help improve many of the associated symptoms.

However, some women report developing symptoms that mimic those of PCOS after discontinuing contraception. If the individual didn’t have previously diagnosed PCOS, this condition is sometimes known as post-birth-control hormonal withdrawal syndrome. Some have falsely labeled it as “pill-induced PCOS.”

To better differentiate between PCOS and hormonal withdrawal syndrome, it’s important to understand the different causes, symptoms, clinical characteristics, and treatments.

What is PCOS?

An estimated 6–10% of women in the US have PCOS.²

Pointing out an exact cause for PCOS is impossible, as numerous environmental, genetic, and lifestyle factors interact together and contribute to the condition’s development.³ For example, PCOS is associated with insulin resistance, obesity, and genetic predisposition.

A family history of PCOS is common in those who develop the disorder. Lifestyle factors that may increase the risk of developing or worsening PCOS symptoms are poor diet, lack of exercise, smoking, and alcohol.

The main three presentations found in those diagnosed with the condition are the presence of cystic ovaries with ovulation irregularities and increased androgen levels. These issues can lead to several symptoms that may vary in severity from one person to another. Not everyone will experience all of the following symptoms:

• Irregular, light, or missed periods

• Infertility

• Weight gain

• Oily, acne-prone skin

• Tiredness or fatigue

• Thinning scalp hair

• Excess facial hair or body hair on the chest, stomach, or back (hirsutism)

• Skin tags on the neck or in the armpits

• Skin patches around the upper chest and neck area

Unfortunately, this condition extends beyond these symptoms. It doesn’t just affect the reproductive system — it can impact your cardiovascular, immune, metabolic, and psychological health, particularly if left untreated.⁴

Your first step should be to talk to your doctor if you have one or more of these symptoms. They can run tests to confirm a PCOS diagnosis or discover other underlying issues.

Can contraceptive pills cause PCOS?

In the US, 87% of women use contraception at some point. Contraceptive pills constitute 21% of all current contraceptive use.⁵

Oral contraceptive pills are divided into the progesterone-only pill (POP) and combined oral contraceptive pill (COC). The COC pill contains both progesterone and estrogen.

These pills primarily work by preventing ovulation, which stops a pregnancy from occurring. They achieve this by introducing higher levels of progesterone, which disrupts signals from the brain that stimulate ovulation.⁶ It also thickens the uterine mucosa, making it difficult for sperm to enter the uterus. Estrogen, on the other hand, controls menstrual bleeding.

Doctors typically prescribe the COC pill when treating PCOS symptoms, aside from infertility, as estrogen and progesterone together can:

• Prevent pregnancy

• Slow, heavy menstrual cycles

• Reduce cramps

• Reduce the number of ovarian cysts

• Control acne

• Reduce ​​hirsutism

The cause of PCOS is unknown and is likely the result of many combined factors. Some people who develop symptoms similar to PCOS symptoms after discontinuing oral contraceptive pills have suggested they cause PCOS. However, there is no scientific proof that birth control pills can cause someone to develop PCOS.

Numerous research studies have found that contraceptive pills effectively improve PCOS symptoms by regulating the menstrual cycle and reducing androgen production.⁷

Potential side effects of taking contraceptive pills

It’s common to experience side effects when taking oral contraceptives. Some may resolve with time or if you switch to a different type of contraceptive.

Speak to your doctor about any changes you notice that may be caused by the contraceptive pill. Inform your doctor if you experience any of the following:⁸

• Nausea

• Headache

• Cramping

• Increased vaginal discharge

• Tender breasts

• Decreased interest in sex

Oral contraceptive pills can also cause serious side effects, such as hypertension, myocardial infarction (heart attack), and stroke. However, these side effects are less common.

Some women may have a greater risk of developing these serious side effects than others. Consult with your doctor and discuss your medical history before starting oral contraceptives.

What are the symptoms of post-pill hormonal withdrawal syndrome?

Because contraceptive pills work by altering your body chemistry and disrupting your cycle, discontinuing them may lead to some hormonal changes. Your body will need some time to adjust to these changes, and you may notice new symptoms after you stop using the pill.

Not all women experience symptoms after discontinuation, while some experience more symptoms than others. Research has demonstrated that the development and severity of a person’s symptoms after discontinuing the pill are associated with their duration of use and how old they were when they started taking it.⁹ ¹⁰

Symptoms of post-pill hormonal withdrawal syndrome include the following:

• Bloating

• Abdominal cramp

• Joint pain

• Headaches

• Trouble sleeping

• Fatigue or low energy

• Pelvic pain

• Mood swings

• Depression

• Acne

• Heavy or lack of periods

• Weight changes

• Fertility issues

Unfortunately, no adequate studies have been conducted to confirm the exact mechanism behind hormone-withdrawal-associated symptoms or its prevalence.¹¹ Most symptoms ease within a few weeks to six months as the body regulates your hormones.

Additionally, in high-quality studies, contraceptives were not found to negatively affect the ability of females to conceive or significantly delay fertility after discontinuing them.¹² This is despite some experiencing a delay in becoming pregnant in the first few months of not taking the pill.

Getting a PCOS diagnosis after stopping the pill

If some of your symptoms persist after you stop taking the contraceptive pill, and you fit the criteria specific for PCOS, it could be hypothesized that pre-existing PCOS is causing these symptoms. The condition may not have been properly diagnosed before you started taking the pill, potentially in early adulthood.

The pill may have reduced your symptoms, meaning they never fully manifested. These symptoms may have started to appear or worsen when you stopped using oral contraception. Meanwhile, other hormonal changes were taking place.

How to deal with post-birth-control syndrome

Some doctors recommend certain lifestyle changes as a way to cope with post-birth-control hormonal withdrawal syndrome. These might include consuming a healthier diet and increasing your activity levels.¹³ ¹⁴

If none of these things helps reduce your symptoms, your doctor can perform tests to see what is going on and may prescribe medications that can help. However, these may target specific symptoms.

When to talk to your doctor

Most women who stop taking birth control pills can expect to regain their normal cycle within a few months.¹⁵ During this time, you may experience:¹⁶

• Irregular periods

• Weight fluctuations

• Increased cramping

• Increased acne

• Mood swings

If your symptoms don’t improve or are severe enough to affect your quality of life, please contact your doctor. They can prescribe medications to ease each symptom individually while ensuring there are no other underlying causes. They can also request blood and imaging tests to confirm whether your symptoms are due to hormonal withdrawal or previously undiagnosed PCOS.

The lowdown

There is no evidence that taking birth control pills causes PCOS. However, some individuals may have already had PCOS with masked symptoms as a result of early and continuous birth control use. Oral contraceptive pills are a commonly prescribed treatment for PCOS.

Your symptoms should go away within a few months of stopping the pill. However, it’s best to speak to your doctor if your symptoms are severe or have not resolved after a few months.