From the Guidelines
For women with PCOS, combination hormonal contraceptives are the first-line birth control option due to their multiple benefits, including regulation of menstrual cycles, reduction of androgen levels, and improvement of acne and hirsutism symptoms. These benefits are crucial in managing PCOS symptoms and reducing the risk of related complications, such as endometrial cancer 1. The typical regimen for combination hormonal contraceptives involves taking one pill daily for 21 days, followed by 7 days of placebo pills or no pills.
Some of the commonly used combination hormonal contraceptives for PCOS include:
- Combined oral contraceptives (COCs) like Yaz, Yasmin, or Ortho Tri-Cyclen, which contain both estrogen and progestin
- The contraceptive patch (Xulane)
- Vaginal ring (NuvaRing) Alternatives to combination hormonal contraceptives include progestin-only options like the mini-pill, Depo-Provera injection, hormonal IUDs (Mirena, Kyleena, Liletta), or the implant (Nexplanon), which are suitable for women who cannot take estrogen due to risk factors like high blood pressure or history of blood clots 1.
Non-hormonal options like copper IUDs (Paragard) provide long-term contraception without affecting hormone levels, but may not address specific PCOS symptoms. When choosing birth control with PCOS, it is essential to consider both contraceptive needs and symptom management goals, as some methods may better address specific PCOS symptoms than others 1. Regular follow-up with a healthcare provider is crucial to monitor effectiveness and manage any side effects.
From the Research
Birth Control Options for PCOS
- Combined oral contraceptives (COCs) are the first-line medical treatment for the long-term management of PCOS, as they restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer 2, 3.
- COCs contain low doses of estrogen and different types of progestin, and the choice of progestin can affect the anti-androgenic effects, with drospirenone being a relatively new progestin that has shown benefit in the PCOS population 4.
- The use of COCs in women with PCOS requires individualized risk stratification and management, taking into account factors such as age, smoking, obesity, glucose intolerance, hypertension, dyslipidemia, thrombophilia, and family history of venous thromboembolic events 2, 3.
- Metformin can be used to regularize menstrual cycles and decrease body mass index, serum testosterone levels, and dehydroepiandrosterone sulfate (DHEAS) levels in women with PCOS, particularly in those with insulin resistance or metabolic risk 5.
- The choice of hormonal contraceptive for women with PCOS depends on the individual's PCOS phenotype, with combined hormonal contraceptives (CHC) being an effective and safe treatment option for symptom relief in women with hyperandrogenism, and a vaginal contraceptive ring being preferred for patients with metabolic risk or overweight 6.
Types of Birth Control Options
- Combined oral contraceptives (COCs) with ethinyl estradiol and drospirenone 4, 5
- Metformin 5
- Vaginal contraceptive ring 6
- Combined hormonal contraceptives (CHC) with myo-inositol 6
Considerations for Birth Control Options
- Individualized risk stratification and management 2, 3
- Cardiometabolic risk factors, such as age, smoking, obesity, glucose intolerance, hypertension, dyslipidemia, thrombophilia, and family history of venous thromboembolic events 2, 3
- PCOS phenotype, including hyperandrogenism, insulin resistance, and metabolic risk 6