The symptoms of PCOS (Polycystic Ovarian Syndrome) can be so frustration. As a solution, a woman with PCOS is often met with the birth control pill, maybe an androgen blocker and then sent along her merry way. Told there is nothing that can be done. Told she will never conceive naturally. And told that it’s just in her genes.
And since she is more likely to experience anxiety or depression at some point in her life, she’ll also likely be offered the opportunity to join the ranks of the 1 in 4 women who are prescribed an antidepressant for a physical condition rather than a purely mental one.
But I’m here to tell you that I work with the exceptions to this conventional narrative every day. A job for which I am grateful for. An opportunity to help women understand their bodies and create lives of vitality that don’t involve drugs. In my view, there is no best birth control pill for PCOS.
What Exactly is PCOS?
The diagnosis of PCOS is based on clinical diagnosis, which means you need to have the symptoms AND have ruled out other underlying disorders.
Sure, there is a genetic component to PCOS, but that doesn’t mean your fate is sealed. You may have to work a little harder to create hormonal and metabolic balance, but it is entirely possible to do so through nutrition and lifestyle interventions.
To understand how these therapies can be effective, let me first explain a bit about what we believe causes PCOS.
Do We Know What Causes PCOS?
Not quite. It was once thought that this was a hormonal disorder alone with the consequences of the disease progression being solely hormonal— acne, weight gain, excessive hair growth, irregular periods, ovarian cysts, and infertility.
But as we’ve begun to learn more about PCOS it has become apparent that insulin resistance plays a very large role and that PCOS has many metabolic ramifications. This makes a quick fix with birth control without regard for the root cause of the condition downright dangerous.
You see, the birth control pill doesn't actually correct the underlying cause of PCOS. Instead, it masks the hormonal symptoms, which are the most pronounced and bothersome. So, while there may be hormonal relief, it can allow for other problems to occur.
Irregular Periods is a common reason women with PCOS are prescribed the pill.
We know as many as 60% of women prescribed the pill are on it for non-pregnancy related reasons. From irregular periods to acne and PMS, women are given the pill opposed to a root cause resolution. And there's not even a mention of the long term risks, let alone Post-Birth Control Syndrome or possible infertility.
Women with irregular periods, a common symptom of PCOS, are more likely to be prescribed the pill. Irregular periods put women at higher risk of never seeing their period return once they stop the pill.
In my clinical practice, I've helped many women who have reported regular periods before going on the pill, only to find irregular or absent periods once they discontinue it. Research has shown about a 2-3% risk of infertility after stopping the pill in women who experienced regular periods prior to starting it. That statistic has been estimated to be as high as 30-40% in women with irregular periods.
Insulin Resistance & PCOS
Insulin resistance is a state in which your cells no longer respond to insulin in the way that they should, i.e. bringing sugar into the cell. This means that sugar is left in the blood stream, where your cells can not use it. With all that sugar left to wander your blood stream, your tissues begin to suffer damage. In short, insulin resistance can lead to type 2 diabetes — which results in damage to your blood vessels, eyes, kidneys, heart, brain, and other tissues.
Since insulin stimulates secretion of testosterone in the ovaries, we also see an increase in male pattern hair loss on the scalp, increased hair growth on the face and the rest of the body, and acne.
Insulin also inhibits the secretion of sex hormone binding globulin (SHBG), a protein made in the liver that binds to sex hormones to ensure there isn’t excess available in the body. The increase in testosterone, plus the decrease in SHBG means there is plenty of excess testosterone circulating in the body. So, again, this presents as a hormone-only issue, when it really has roots in a metabolic disorder.
This is one way the pill seemingly helps PCOS, it raises SHBG, which lowers free testosterone levels in the body. But those changes can work a little too well and the result is an absent libido.
What kind of lab tests are available?
Lab testing can help your doctor make the diagnosis of PCOS, but this is definitely one of those conditions where the lab tests can leave your doctor with the wrong impression.
Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), and Testosterone may be normal, especially if tested at the wrong time of the month. It is a common occurrence for a woman to come to my office stating that her doctor ruled out PCOS with a random hormone test, meaning they did not correlate the lab results to the patient’s menstrual cycle.
That said, these labs can vary, despite getting the labs drawn on the correct day of your menstrual cycle. To make matters even more complicated, not every woman with PCOS will have abnormal hormones or cysts on her ovaries.
Some symptoms of PCOS include:
- Irregular periods
- Long cycles (we’re talking months)
- Hirsutism – thick, dark facial hair, body hair on chest and abdomen
- Thinning hair
- Hair loss
- Dark skin on the back of your neck
- Adrenal dysfunction
- Blood sugar imbalances
- Underlying inflammation
Risks associated with PCOS
What’s more alarming than you missing some periods? Hello heart disease and stroke! (Although if you are not ready for a baby, missing your period may feel like your heart might just stop.) PCOS is associated with increased risk of heart disease and stroke, which is made worse by the pill. Read Birth Control—What Your Doctor Didn't Tell You
Now, I’m totally with you when you say, “Dr. Brighten I really want to have a regular period.” If it’s important to you, then it is important to me. And you know what I say: “Fertility is a sign of vitality!”
But here’s the deal, having a regular period is awesome, but having a heart that works and a really high probability it’ll keep working is pretty much necessary for life.
Yes, you can be thin with PCOS AND have heart disease. I have plenty of ladies as patients who are fit and simultaneously struggling with PCOS.
Not only is your heart at risk, but for those who are concerned with fertility, there is a 20-40% increase risk of miscarriage for those with PCOS. (2)
How should you approach treatment?
Well, it’s no coincidence that we are seeing increases in insulin resistance, inflammation, hormonal disorders, autoimmune disease, and PCOS. Many chronic conditions are on the rise. It has a lot to do with our current environment, how we care for our body, what we were exposed to as kids and even what our mom's environments were like as well.
If we're going to achieve optimal hormone balance and regulate our cycles then we have to be focused on the root cause and individualized medicine… and a bit of what I’ve been preaching for years— we must take care of our moms!
Your mom’s health influenced your genes, your gut health, immune system, and ultimately your hormones. What she served you for dinner, how much play you got, and what habits you carried with you when you left home all had an impact on your current state of health. Not to mention, what her mom was exposed to had an effect on your mom, which she passed along to you. A bit complicated, right?
Now wait. This is not the time to go call your mom or grandma and ask them why they didn't leave a “cleaner life.” She was operating with the best information she had at the time—just like you. (And this is from the gal that was raised on margarine.)
But this all laid the foundation for your health today. And what you do now will make all the difference.
Because PCOS has such a strong metabolic component, we can leverage lifestyle medicine to sensitize our cells to insulin so they are no longer resistant, lower inflammation, and create hormones that are in balance.
Top 3 Ways to Regulate Blood Sugar and Support Hormonal Health
Moderate exercise in the form of walking, biking, jogging, yoga, and resistance training reduces insulin resistance and helps modulate the stress response. (3) Do be aware, though, that too much exercise can create stress on your adrenal glands leading to blood sugar dysregulation and increased inflammation. If you’re running marathons or powerlifting, you may want to talk about your routine with your doctor.
#2 Eat regular meals.
Keeping your blood sugar well regulated is a key to reversing this condition. And eating regular, whole foods based meals every 3-4 hours can do wonders for your blood sugar. Make sure that every meal contains a balance of healthy fats, protein, and carbohydrates (mostly in the form of colorful veg!).
#3 Support natural detox.
Your body is detoxifying right now. That’s it’s job. It’s our job to support those detox pathways with plenty of filtered water, deep breathing, cruciferous vegetables, and high quality protein. The more we nurture our bodies in these ways, the more inflammation will lessen, arresting the vicious cycle of blood sugar dysregulation → inflammation!
If you're looking for how to support your body naturally read How to do a Holistic Detox to Balance Hormones.
For detox support if you're on the pill or have discontinued it download the birth control recipe guide to help you bring your hormones back into balance.
The Hormones Matter
PCOS is more than just a hormonal disorder — it's a metabolic disorder. But I know the hormonal symptoms can be uncomfortable, embarrassing, and are what often drive women to seek help.
As women, our hormones have a large role to play in how we experience and enjoy life. It is important that you work with a doctor who will help you achieve great hormones, while also taking care to look out for you as a whole person.
There is no shame in treating unwanted symptoms like acne or hair growth while working on the root cause. In fact, I encourage it with my patients. We use natural treatments to improve the look of the skin and reduces inflammation, which is highly beneficial to clearing acne.
We also know that hirsutism (the dark hair on the chin, chest, and abdomen) is irreversible, meaning you will need to have some form of an intervention to remove it. That may be plucking, sugaring (opposed to wax, which can contain hormone disrupting chemicals), or electrolysis. Most of my patients choose the later if the hair is more pronounced.
If you're using the birth control pill for pregnancy prevention, you'll want to consider your non-hormonal contraceptive options before stopping the pill.
If you're thinking about transitioning off of the pill then I recommend partnering with an experienced doctor who can support you whether you choose to ditch the pill or stick with it a bit longer. There are many ways to support your body to lessen the effects of Post-Birth Control Syndrome and enable you to create balanced hormones through lifestyle interventions.
- Michael L Traub. Assessing and treating insulin resistance in women with polycystic ovarian syndrome. World J Diabetes. 2011. 2(3). 33–40.
- Chakraborty P1, Goswami SK, Rajani S, Sharma S, Kabir SN, Chakravarty B, Jana K. Recurrent pregnancy loss in polycystic ovary syndrome: role of hyperhomocysteinemia and insulin resistance. PLoS One. 2013. 8(5). e64446.
- Borghouts LB1, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med. 2000. 21(1). 1-12.