The Pill and PCOS: Is it the only treatment option?

Why the Pill Is Not Your Only Treatment Option for a PCOS Diagnosis

Woman holding birth control pills, mid section. Credit: PhotoAlto/Ale Ventura / Getty Images

Polycystic Ovary Syndrome (PCOS) can be a complicated and confusing condition to live with. If you are not comfortable pursuing a line of treatment or medication for PCOS that is recommended to you by your doctor, you should never feel like you don't have a choice in the matter. You always have the right to refuse treatment or get a second opinion before deciding what you want to do.

Understanding Your Doctor's Point of View

Since the birth control pill has been shown to improve symptoms of PCOS without many side-effects, your doctor may recommend it to you as a treatment option early on in your patient doctor relationship.

Before you outright refuse to take the pill understand why your doctor is recommending it by considering and asking the following questions:

  • Is the pill being prescribed to regulate your cycles?
  • Is it for contraceptive purposes?
  • Is it to help treat some of the symptoms of PCOS?
  • You can also ask how taking the pill will help accomplish those goals, and if there are alternatives that might be equally as effective.

Why the Pill Works for PCOS

One of the most common symptoms of PCOS is irregular menstrual periods. During a normal menstrual cycle, the endometrium, or lining of the uterus, is exposed to hormones, like estrogen and progesterone, which cause the lining to thicken and develop. Right after ovulation, progesterone levels increase, then drop before your period. It is that drop in progesterone levels that triggers the lining of the uterus to be shed each cycle.

In women with PCOS, ovulation does not occur regularly.

This prevents the rise and fall of progesterone that brings on a woman's period. Instead, the lining is not shed and is exposed to estrogen for a longer period of time causing the uterine lining to grow much thicker then normal. This can cause heavy and erratic bleeding. However, this is not a true period because ovulation has not occurred.

Over time, lack of exposure to progesterone may cause endometrial hyperplasia, which in rare cases can lead to endometrial cancer.

Taking the birth control pill regulates your menstrual cycle by providing the progesterone that your body needs, causing the uterine lining to be shed frequently and reducing the risk of endometrial hyperplasia

PCOS Treatment Alternatives to the Pill 

If you do get regular periods, at least every 28 to 35 days, you do not need to take the pill. But you should keep track of your cycles so that if they become more irregular, you can talk to your doctor about what to do.

There is another medication that doctors sometimes prescribe, called provera or medroxyprogesterone. It is a form of progesterone that mimics the second half of your menstrual cycle and can bring on a period. When taken regularly, it also reduces the risk for endometrial cancer. Provera is a pill that you take every day for 5 – 10 days and you should start to bleed within two weeks after finishing the last pill.

If you don’t, please speak with your doctor – the drug might not work for you or you might just need a different dose.

For women with PCOS who also suffer from obesity, weight loss may be an effective alternative. Some studies have shown that dropping even a little weight resulted in more regular menstrual cycles for some women. Talk to your doctor about safe weight loss, and check out this article for some ideas on losing weight when you have PCOS.

Making Yourself Heard

Make sure to clearly explain why you are opposed to taking the pill. Is it for religious or moral reasons? Or are you having side effects from a specific type or brand of pill? It can sometimes take a little while (and trying several different pills) to find the right one for you. Communicating with your doctor is crucial to helping him choose a brand that you can tolerate. On the other hand, if you oppose the pill because of moral or religious reasons, there is very little that the doctor will be able to do or say to change your mind, and your viewpoints should be respected.

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