PCOS and the Pill

Should I take the pill for my PCOS?

Hi, This is Francesca from The PCOS Newsletter where we explore how our bodies work and the best way to manage it. Today we are answering a question a dear reader of the newsletter submitted a few weeks ago.

We have quite a few new subscribers this week, so I want give them a warm welcome 🤗 ! I am excited to have you on this journey. The PCOS Newsletter is not a regular superficial article about PCOS. We go into a lot of depth about our bodies and what it means to have PCOS. I hope you enjoy deepening your understanding about the complex and fascinating way our body works.

This week’s question

Should I take the pill for my PCOS?

The answer

Isn’t this a tricky question? The answer to this question depends a lot on personal circumstances but the best way to make a good decision is to be informed about what the pill does, how it works and the implications of it. Knowledge is power and without it, it’s a confusing world.

Even before we get into how the pill helps PCOS, it is important to establish that the main aim of the pill is to avoid pregnancy. The way it does that is by stoping ovulation. No egg, no baby 🐣.

As we’ve seen in the newsletter issue about irregular periods (see here if you have missed it) varying levels of hormones (FSH, LH, progesterone, oestrogen) communicate with each other to create ovulation and your period. The FSH and LH hormones are particularly high in the first part of the menstrual cycle (the follicular phase). They tell your ovaries to mature the follicle that will eventually release the egg and ovulate. In the second part of the cycle they come down and progesterone takes over. This whole cycle is just a communication game where hormones are used to tell organs what to do 📞.

When we take the pill we get the same hormonal message all the time, so this variation doesn’t happen. The pill works its magic by making the brain think that FSH and LH are not needed, so as a result ovulation is prevented. Responsible for this are the synthetic hormones in the pill which mimic oestrogen and progesterone. This is the case for the combined pill (such as Yasmin). There are also pills that mimic only progesterone but they work more or less the same way.

Because you are taking the same hormones every day it’s like a hormonal deja vu 😵‍💫 - as Dr. Sarah Hill describes it in her book How the Pill Changes Everything: Your Brain on Birth Control (highly recommended if you are super interested in the subject).

Interesting, but how does the pill work for PCOS?

Glad you ask ❤️. There are about three ways in which it acts on PCOS symptoms:

1. In the lack of ovulation, less FSH and LH get secreted from the hypothalamus. If you remember from the article on Irregular periods an imbalance between FSH and LH tell the ovaries to overproduce androgens. In the lack of high levels of FSH and LH, the ovaries produce less androgens (testosterone).

2. The oestrogen component of the pill has been shown to increase the synthesis of sex hormone-binding globulin (SHBG), subsequently reducing the free testosterone running around. We touched a bit on SHBG in the article about acne but in essence it’s a transporter for testosterone. When it doesn’t have a transporter, testosterone runs free causing trouble.

3. The hormones in the pill can also reduce the activity of the 5α reductase enzyme, which converts testosterone to dihydrotestosterone, the latter being a highly potent androgen.

In conclusion, the main way the pill acts on PCOS is by decreasing the levels of testosterone in the body ⏬. The use of contraceptive pill was associated with up to a 61% reduction of free testosterone levels. Less testosterone means less acne, less hirsutism, less insulin resistance and all in all a decrease in PCOS symptoms (voilà 🤗).

Does the pill cure PCOS?

This is where we need to pay attention to the details. As you can see above, the pill pretty much mimics your hormones and synthetically creates this environment where your natural rhythm of hormones is somehow regulated. The moment you take away the pill, your hormones will take back control of the situation.

The pill doesn’t solve the underlying problem but it’s a great way of managing PCOS symptoms, as long as you don’t want to have a baby. The issue for women with PCOS is that eventually, when or if, they want to have a baby they need their ovulation back. This means stopping the pill. If you are not ovulating naturally, infertility happens which is one of the saddest parts of PCOS.

The contraceptive pills comes with a whole array of side effect: from health concerns to behavioural changes. I won’t go into this at the moment (maybe a newsletter issues for the future). That being said it is a very good way of managing your symptoms and giving you a break from the tiring symptoms of PCOS.

Coming around to the original question, should I take the pill?

This is totally a personal decision and one that you may take with your gynaecologist. I believe the most important thing is to make a decision that is informed. The reason why I care so much about this point is because when I fist got offered it, I naively thought it will solve my problems and the disappointment I had once I realised it didn’t, hurt me a lot.

I am sure we will come back to this topic on our way to understanding our bodies and learning about PCOS, but for now I hope this helped break down how it works and what it does. As per usual if this post raised more questions or you have another question you’d like me to address, please comment, reply to this email or submit it here.

Wishing you a lovely Sunday and see you next week.

Francesca

¹ Sources

1. Briden, L. (2018). Period Repair Manual. Macmillan.

de Melo, A. S., Dos Reis, R. M., Ferriani, R. A., & Vieira, C. S. (2017). Hormonal contraception in women with polycystic ovary syndrome: choices, challenges, and noncontraceptive benefits. Open Access Journal of Contraception, 8, 13–23. https://doi.org/10.2147/OAJC.S85543

Hill, S. E. (2019). How the pill changes everything: Your brain on birth control. Orion Spring.

Disclaimer: We are all so unique in our own ways so this information is for education purposes only. Please further consult your healthcare provider about your health needs.