Taking Birth Control for PCOS

Everything You Need To Know About Taking Oral Contraceptives

Woman holding glass of water and taking capsule
Tom Merton/OJO Images/Getty Images

"The Pill" Basics

Taking the pill for PCOS is very common. It helps to regulate your menstrual cycle and may even help treat your symptoms like acne and hair loss. There are two types of birth control pills which are based on the types of hormones present: progestin-only pills and pills that are a combination of progestin and estrogen.

Hormones and the Menstrual Cycle

During the menstrual cycle, estrogen is secreted by the developing egg follicle and aids in thickening of the endometrium, in preparation for a pregnancy.

After ovulation has occurred, progesterone is secreted by the empty egg follicle, known as the corpus luteum. Progesterone levels peak approximately 7 days after ovulation. Progesterone also causes the endometrium to secrete special proteins to prepare it for the implantation of a fertilized egg. When fertilization does not occur, it prevents the body from creating and releasing more eggs in the second half of the menstrual cycle.

How do Oral Contraceptives Prevent Pregnancy?

By maintaining elevated blood levels of these hormones, the pill tricks the body in a few different ways. They primarily stop the release of a mature egg by preventing the change in hormone levels that is necessary for ovulation to occur. This also keeps the cervical mucus thick and tacky which stops any sperm from reaching the fallopian tubes.

Why Should I Take The Pill if I Have 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 proliferate and thicken. Right after ovulation, progesterone levels increase, then drop before menstruation. It is that drop in progesterone levels that triggers the lining of the uterus to be shed each cycle, known as a woman's period.

In PCOS, ovulation does not occur regularly, which prevents the rise and fall of progesterone which 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 than 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 (a fancy word for overgrowth of the uterine lining) which in rare cases can lead to endometrial cancer. Taking the birth control 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.

Progestin Only Pills

Eight forms of progesterone currently used in oral contraceptives. Most of these are used in conjunction with estrogen. However, two types of progestin are used alone in progestin-only pills: norethindrone and norgestrel, which is no longer available in the United States.

Combination Pills

Combination pills contain both progestin and estrogen. Combination pills can be differentiated on whether the dose of estrogen-progestin stays the same throughout the pill pack (monophasic), if progestin increases once about halfway through the pill pack while the estrogen stays the same (biphasic) or if the levels of estrogen and progestin are different each week of the pill pack.

Keep in mind that in each of these types of pills, the last week is only a sugar pill, which contains no active hormone. This allows for normal shedding of the uterine lining. Monophasic pills can be classified further based on the dosage of estrogen, known as ethinyl estradiol, in the pill. Low dose oral contraceptives contain 20mcg of estrogen plus the progestin. Regular doses​ contain 30mcg to 35mcg of estrogen plus progestin and high dose contains 50mcg of estrogen plus the progestin. The eight types of progestin include:

  • Desogestrel
  • Levonorgestrel
  • Norethindrone
  • Ethynodiol diacetate
  • Norgestimate
  • Norethindrone acetate
  • Norgestrel
  • Drospirenone

How Do I Take the Pill?

You should take one pill at the same time each day. Your doctor will instruct you when to begin the pill pack. For information on your individual pill, check the package insert to determine the type of pill you are taking and click on the link above.

Continue Reading