Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team. Updated on January 4th, 2021
If you have irregular periods, acne, and excess body hair, you might have polycystic ovary syndrome (PCOS). This disorder affects 1 in 10 women of childbearing age that is more than the number of people who have breast cancer, rheumatoid arthritis, multiple sclerosis, and lupus, combined. That equates to millions of women living with PCOS and its associated side effects.
PCOS is a pressing reproductive health issue which is why Pandia Health views it as our responsibility to spread awareness about it and help those with uteri get the best treatment for this health issue.
PCOS is one of the most common yet misunderstood health problems for women. The good news is that symptoms related to PCOS such as irregular periods, acne, and infertility can be treated with birth control pills, the patch, or the ring . Many of the symptoms and their severities vary from woman to woman and because PCOS is a syndrome (a group of symptoms), there is no test that definitively diagnoses the condition.
What is PCOS?
PCOS is characterized by a hormonal imbalance involving androgens (male hormones), insulin (which metabolizes carbohydrates), and progesterone (the hormone involved in the menstrual cycle). Researchers haven’t been able to determine what causes PCOS, but they suspect that it may be a combination of genes and environment ; causes also likely vary between women.
Although there is no cure, doctors will often treat PCOS with birth control typically prescribing the pill, patch, ring, or the IUD with progesterone (this is less effective) to help women manage the symptoms. The symptoms can appear similar to other health conditions so PCOS often goes undiagnosed which leads to women getting the wrong treatment or none at all.
Note: not all women living with PCOS have cysts on their ovaries, unlike the name suggests!
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Symptoms & Side Effects of PCOS
PCOS symptoms can include the following:
- Irregular periods
- No periods
- Frequently missed periods (three or more skipped in a row)
- Very heavy periods
- Hairiness (Hirsutism)
- Excessive male-pattern hair growth on places like the face and chest
- Male-pattern baldness
- In some patients, instead of causing excessive hair-growth, people experience female-pattern hair loss and thinning out of the hair.
- Obesity or trouble losing weight
- 90% of women with PCOS are overweight or obese
- PCOS does not only target those with obesity, but preexisting obesity may worsen the symptoms of PCOS.
- Pelvic pain
- Pelvic pain is not a direct symptom of PCOS; however, PCOS may cause the development of ovarian cysts, which may then push against your pelvis and cause this pain
- Acne due to PCOS will usually develop in places where males usually grow facial hair, around the lower cheeks, jawline, and chin. This is because PCOS may lead to higher levels of testosterone as well as general inflammation.
- Acanthosis nigricans (dark patches of thick velvety skin)
- This is caused by increased insulin levels due to PCOS. These patches usually develop under the arms, at the back of the neck, and around the groin area.
- Directly related to irregular or abnormal periods, infertility and fertility problems, this is because PCOS may cause failure to ovulate, and therefore no egg is released from the ovaries for fertilization.
- Increased risk of diabetes, metabolic disorders, and cardiovascular disease. There is also an increased risk of endometrial cancer, however these risks can be mitigated by taking medication to regulate and increase the frequency of menstrual periods.
PCOS & Infertility
While those with PCOS often struggle with fertility , having PCOS doesn’t mean you can’t get pregnant; with PCOS, the eggs simply don’t leave the ovaries regularly. If there are no eggs, then you can’t get pregnant. However, if and when you want to get pregnant, the contraceptive pill, patch, or ring can actually help you by normalizing your hormone levels.
Immediately after you come off of the medication, your hormone levels will be the closest to normal. So, if you want to get pregnant, the best time to try is as soon as you stop taking birth control; if that doesn’t work, those with PCOS are often recommended to try in vitro fertilization (IVF).
How is PCOS Diagnosed?
Because PCOS symptoms, like irregular periods, can be related to many other conditions, it’s often difficult for women to get a diagnosis. There isn’t a single test to definitively diagnose PCOS, so your doctor will assess you based on your health history and a physical exam. In addition to understanding your menstrual cycles, your doctor will also want to know about your weight, acne, hair growth patterns, and your medical history (and your family’s) regarding periods, PCOS, and infertility.
Your doctor will also most likely order blood tests to check your hormones, thyroid, and other areas to help rule out other causes and to confirm the diagnosis of PCOS. Sometimes, doctors will also order an ultrasound to check your ovaries for cysts but this is usually unnecessary.
Does Birth Control Help with PCOS?
The birth control pill, patch, and ring can stop the uncontrolled growth of the endometrium by providing progesterone which will also treat some of the bothersome symptoms of PCOS. Because PCOS usually is linked to an increased level of testosterone, introducing birth control into the body helps balance out the high testosterone levels with more estrogen and progesterone. Most women who experience PCOS and then start to take the pill do not experience side effects from the birth control, but some experience mood changes, nausea, headaches, and weight gain/loss. Because each individual’s hormone levels and bodily reactions vary so much, it is impossible to tell with certainty how your body will react exactly to the introduction of birth control with PCOS.
Birth control pills, patch, or ring. Doctors prescribe these to deliver the hormones you need to treat PCOS. These work by:
- Returning your hormone levels to normal by turning off the typical mechanisms that occur in your ovaries.
- Decreasing the level of testosterone; testosterone levels are elevated in those who have PCOS. Birth control pills, patches, rings, hormonal IUDs, and the contraceptive implant can lower those levels.
- Decreasing cyst formation. Those with PCOS should consider skipping the bleeding week on birth control as this lowers the risk of escape ovulation, which refers to ovulation after the hormones in birth control are stopped, and cyst formation.
- Reducing acne. The lower your testosterone level, the less acne you’ll have.
How to Treat PCOS
If left untreated, PCOS can increase the risk for endometrial cancer . With PCOS, the ovary does not ovulate regularly, meaning eggs are not released as they should be. As a result, insufficient progesterone is produced, which causes the lining of the uterus (a.k.a. the endometrium) to grow uncontrollably.
Treatment options for PCOS: pill, ring, patch
Other treatment options include:
- Diet and exercise. The National Institute of Health recommends eating healthy and exercising regularly for women with PCOS. If you are overweight and you lose 10% of your current weight, the symptoms of PCOS will often improve or go away.
- Metformin. This medication works by decreasing the excess insulin that some women have with PCOS. This is particularly useful for women who are heavier and/or are pre-diabetic.
- Progesterone. If you don’t want to use the birth control pill, patch, ring, or take metformin, or your doctor finds that those options are unsafe for you, then you might be prescribed progesterone. You will likely take progesterone for five days every 3-4 months to cause a “withdrawal bleed” and “clean out” your uterus; without progesterone, your uterus will have unopposed estrogen stimulating the growth of the lining of the uterus which then puts you at risk for endometrial cancer.
Because PCOS is under-diagnosed, the first step is to make sure those who have PCOS get diagnosed. If you or your loved one experience any of the symptoms described above, meet with your doctor to see if PCOS is the culprit.
With the Affordable Care Act (ACA), birth control is covered at no cost with insurance, making it more accessible and affordable for all people with uteri. However, because birth control is widely seen as a pregnancy prevention method, women with PCOS are often affected when it comes to birth control funding cuts. We must raise awareness with our policymakers that birth control is a treatment option for women with PCOS!
In the meantime, if you or somebody you love needs to treat PCOS with birth control, we’ve got you covered. Learn how you can birth control delivered straight to your door for FREE with Pandia Health. As the ONLY women-led, women-founded, and doctor-led company in the birth control delivery space, we understand that birth control is critical for so much more than preventing pregnancy, and we’re here to support women with PCOS.
We make treatment easy by automatically refilling your medicine so you can #SkiptheTrip to the pharmacy and experience #PandiaPeaceofMind. If you don’t already have a birth control prescription, and you live in AZ, CA, CO, FL, GA, IL, MI, NV, NY, TX, TN, PA, WA, or WY, our expert doctors can set you up with a prescription through a telehealth appointment.
If you’d like to learn more about PCOS, check out this site which offers important PCOS medical information produced by Boston’s Children’s Hospital.
Disclaimer: The above information is for general informational purposes only and is NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.