PCOS and Birth Control Pills: Which One to Choose and Why?

Polycystic Ovary Syndrome (PCOS): Diagnosis, Treatment, and Contraception

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting 8-13% of women of reproductive age. However, many women remain undiagnosed. The contraceptive pill is still the most prescribed treatment at the time of diagnosis. The aim of our article is to provide recommendations on the use of contraceptive pills for women with Polycystic Ovary Syndrome (PCOS). These consensus guidelines can help you, in collaboration with your doctor, choose the right type of oral contraceptive pills that will relieve symptoms with the fewest possible side effects.

Diagnostic Examination for PCOS

Polycystic Ovary Syndrome (PCOS): Diagnosis, Treatment, and Contraception

The diagnosis of PCOS is based on a combination of clinical, biological, and ultrasound criteria. We have written a comprehensive article on PCOS diagnosis. The key tests include:

Hormonal Assessment: A full hormonal profile is essential to evaluate levels of hormones such as testosterone, LH (luteinizing hormone), FSH (follicle-stimulating hormone), and SHBG (sex hormone-binding globulin). Elevated androgens and a high LH/FSH ratio are common indicators of PCOS.
Pelvic Ultrasound: This exam visualizes the ovaries and can detect multiple cysts. Polycystic ovaries often appear larger with many small follicles around the edges.
Glucose and Insulin Levels: Given that women with PCOS have a higher risk of insulin resistance and type 2 diabetes, we often recommend these tests.

Treatments for PCOS

The treatment of PCOS aims to manage symptoms and prevent long-term complications. Options include:

Lifestyle Changes: A balanced diet and regular physical activity are crucial for managing weight and improving insulin sensitivity. Weight loss can help regulate menstrual cycles and reduce androgen levels.
Medications:

Metformin: Commonly used to improve insulin sensitivity and help regulate menstrual cycles.
Anti-androgens: Medications like spironolactone may be prescribed to reduce excess hair growth and acne.
Ovulation Inducers: For women wishing to conceive, medications like clomiphene can be used to induce ovulation.

Contraception and PCOS

Contraception plays a key role in managing PCOS by helping to regulate menstrual cycles and reduce androgen levels. While the contraceptive pill does not treat the root cause of PCOS, it alleviates symptoms and serves as an effective contraceptive method. Several options are available:

Combined Oral Contraceptives: Pills containing estrogen and progestins are often prescribed to regulate menstrual cycles and reduce hyperandrogenism. Pills like Jasmine, Minidril, Optilova, and Leeloo are commonly used. They can also help reduce acne and excess hair growth.
Progestin-Only Pills: For women who cannot take estrogen, progestin-only pills like Optimizette and Slinda can be an effective alternative. They are also useful in preventing endometrial hyperplasia.
Intrauterine Devices (IUDs): Hormonal IUDs, such as Mirena, release progestin and can help reduce menstrual bleeding and stabilize hormone levels.

Which Pill to Choose for PCOS?

PCOS is characterized by an excess of androgens (male hormones), leading to symptoms such as acne, hirsutism, and hair loss. Therefore, the most suitable pills to reduce these symptoms are those with low androgenic activity, without androgenic effects, and anti-androgenic properties. These types of pills belong to the 3rd and 4th generations, which are associated with higher vascular risks.

It is advised to avoid pills containing cyproterone acetate found in Diane 35, its generics, and Androcur. At high doses (≥ 25 mg/day), cyproterone acetate increases the risk of meningioma. Even though Diane 35 and its generics are low-dose, we prefer to delay their use and recommend them only for short periods. Discuss this with your gynecologist, midwife, or general practitioner.

For those with PCOS, we recommend pills based on drospirenone. These pills have anti-androgenic effects and help reduce symptoms such as acne, hirsutism, and androgenic alopecia. This type of progestin also has a mild diuretic effect, which helps limit water retention and weight gain. Examples of combined pills containing drospirenone include Angeliq, Belanette, Drospibel, Phizoe, Jasmine, Jasminelle, Slinda, and Yaz.

Other options include pills containing dienogest, norgestimate, and chlormadinone acetate:

Dienogest: Dienogest, Endovela, Misolfa, Oedien, Qlaira, Sawis (Anti-androgenic action).
Norgestimate: Femi, Naravela, Optikinzi, Triafemi, Trinara (Reduces testosterone levels).
Chlormadinone Acetate: Belara, Chlormadinone, Luteran (No androgenic effects).

Unfortunately, most of these pills are not covered by health insurance, as they belong to the 3rd and 4th generations of contraceptives.

Progestin Generations in Contraceptive Pills

Note that the generation of progestins determines the type of molecule used in contraceptive pills. Here is an overview of the different generations of progestins and the associated pills:

1st Generation: Norethisterone acetate, Lynestrenol.
Pills: Discontinued.
2nd Generation: Levonorgestrel.
Pills and generics: Adépal, Asterluna, Daily Gé, Leeloo, Lolistrel, Lovavulo, Ludéal Gé, Minidril, Naravela, Optidril, Optilova, Qiade, Seasonique, Triafemi, Trinordiol.
3rd Generation: Desogestrel, Gestodene, Norgestimate.
Pills and generics: Carlin, Desobel, Femi, Harmonet, Melodia, Mercilon, Minesse, Minulet, Perléane, Triafémi, Varnoline.
4th Generation: Chlormadinone, Nomegestrol, Dienogest, Drospirenone.
Pills and generics: Belanette, Belara, Diane 35, Drospibel, Drovelis, Espizene, Jasmine, Jasminelle, Misolfa, Qlaira, Oedien, Phizoe, Yaz, Zoely.

Medical Benefits of Contraceptive Pills

Regular and lighter periods: Oral contraceptives help artificially regulate the menstrual cycle so that periods occur about every 28 days or less often with extended cycles. They usually result in lighter periods, which is important to prevent excessive growth of the uterine lining (endometrium), which can lead to heavy bleeding or endometrial hyperplasia.
Reduction of unwanted hair growth: Oral contraceptives can reduce androgen levels and decrease excessive hair growth (hirsutism). It may take up to six months to notice a reduction.
Clearer skin: They can also improve acne, although it often takes several months to see results.
Fewer menstrual cramps: The pills can help reduce menstrual pain as well.

Possible Side Effects of Contraceptive Pills

Although most people experience no side effects, some possible side effects include:

Light bleeding: Especially during the first weeks of taking the pill or after missing a dose.
Nausea: Generally temporary, it often goes away after a few days. Taking the pill after a meal may help.
Headaches: Related to stress or lack of sleep, headaches may worsen or improve with the pill. A version with lower estrogen can be suggested if headaches persist.
Mood changes.
Breast tenderness or enlargement: The breasts may become tender or larger, but this usually stabilizes over time.
Weight changes: Some teens may gain or lose weight.
Blood clots: Although rare, a blood clot in the leg or lung is a serious side effect. Consult a healthcare professional immediately if you experience sudden leg pain or swelling, or shortness of breath and chest pain.
Increased blood sugar: The estrogen in combined pills can affect insulin resistance, potentially raising blood sugar levels. Progestins may also influence blood sugar depending on the type used.
Nutritional deficiencies: Contraceptive pills can sometimes lead to subtle deficiencies, particularly in vitamins B6, B12, B9 (folic acid), and vitamin C. This can cause fatigue, irritability, or anemia, making it important to take a multivitamin.

Our Naturopath’s Advice

When you have PCOS, the contraceptive pill may give the illusion of better managing your condition, but it doesn't actually treat it. It merely masks the symptoms. And that’s completely okay! Sometimes, the symptoms of PCOS become so overwhelming, both psychologically and physically, that the contraceptive pill can offer temporary relief, allowing you to regain your strength. However, when you stop the pill, all the symptoms will return.

It's important to note that women with PCOS are more likely to experience depression and anxiety. You can find a full article on this topic on our website. The contraceptive pill may also worsen these conditions.

In summary, PCOS is a complex endocrine disorder, and the pill alone may not always be enough to improve all the symptoms. Therefore, it is recommended to simultaneously make lifestyle changes, which will help ease the transition when stopping the pill.

Conclusion

PCOS is a complex condition requiring a multidisciplinary approach for diagnosis and treatment. With proper diagnostic exams, lifestyle modifications, medications, and suitable contraception options, women with PCOS can effectively manage their symptoms and improve their quality of life. If you are experiencing PCOS symptoms, it's essential to consult a healthcare professional for an accurate diagnosis and a personalized treatment plan.