Is it safe to use Oral Contraceptive Pills (OCPs) to skip periods for patients with Polycystic Ovary Syndrome (PCOS) or other causes of dysmenorrhea?

From the Guidelines

It is generally safe for patients with Polycystic Ovary Syndrome (PCOS) or dysmenorrhea to use Oral Contraceptive Pills (OCPs) to skip periods, as long as they do not have contraindications to estrogen use, such as a history of blood clots, certain migraines, high blood pressure, or smoking over age 35 1.

Safety Considerations

When using OCPs to skip periods, patients should be aware of the potential risks and benefits. The most serious adverse event associated with OCP use is the increased risk of blood clots, which increases from 1 per 10,000 to 3 to 4 per 10,000 woman-years during OCP use 1. However, the risk of venous thromboembolism associated with pregnancy and postpartum is 10 to 20 per 10,000 woman-years, of which 1% to 2% are fatal 1.

Implementation and Management

To implement this approach, patients simply skip the placebo pills in their pack and immediately start a new pack of active pills. This can be done for 3-4 months at a time, or even longer in some cases. Breakthrough bleeding may occur initially but typically improves over time. Common OCPs used include monophasic combinations like ethinyl estradiol with levonorgestrel, norethindrone, or drospirenone.

Benefits for PCOS and Dysmenorrhea

This method helps manage symptoms by suppressing ovulation, reducing endometrial buildup, and decreasing prostaglandin production that causes menstrual pain. For PCOS specifically, OCPs also help regulate hormones and reduce androgen levels. Patients should be aware that this approach doesn't affect future fertility and can be discontinued when regular cycles are desired.

Alternative Options

However, for patients with contraindications to estrogen, alternative options such as progestin-only pills or intrauterine devices (IUDs) may be recommended 1. The progestin-only pill is an effective, but not highly effective, contraceptive, and the IUD is a highly effective alternative that does not increase the risk of venous thromboembolism. Some key points to consider when using OCPs to skip periods include:

• The risk of blood clots and other adverse events
• The importance of regular follow-up visits to monitor for adverse effects and address any concerns
• The potential benefits of OCPs for managing symptoms of PCOS and dysmenorrhea
• The availability of alternative options for patients with contraindications to estrogen.

From the FDA Drug Label

Breakthrough bleeding, spotting, and amenorrhea are frequent reasons for patients discontinuing oral contraceptives. In breakthrough bleeding, as in all cases of irregular bleeding from the vagina, non-functional causes should be borne in mind In undiagnosed persistent or recurrent abnormal bleeding from the vagina, adequate diagnostic measures are indicated to rule out pregnancy or malignancy. If both pregnancy and pathology have been excluded, time or a change to another preparation may solve the problem Changing to an oral contraceptive with a higher estrogen content, while potentially useful in minimizing menstrual irregularity, should be done only if necessary since this may increase the risk of thromboembolic disease

The safety of using Oral Contraceptive Pills (OCPs) to skip periods for patients with Polycystic Ovary Syndrome (PCOS) or other causes of dysmenorrhea is not directly addressed in the provided drug labels. Key points to consider when using OCPs for this purpose include:

• The potential for breakthrough bleeding and amenorrhea
• The need to rule out pregnancy or malignancy in cases of abnormal vaginal bleeding
• The potential increased risk of thromboembolic disease with higher estrogen content OCPs However, the FDA drug label does not provide sufficient information to fully answer the question regarding the safety of using OCPs to skip periods for PCOS or other causes of painful menses. 2 2

From the Research

Safety of Using OCPs to Skip Periods for PCOS or Other Causes of Painful Menses

The use of Oral Contraceptive Pills (OCPs) to skip periods for patients with Polycystic Ovary Syndrome (PCOS) or other causes of dysmenorrhea is a common practice. Here are some key points to consider:

• Benefits of OCPs for PCOS: OCPs are the first-line medical therapy for the long-term management of PCOS, restoring regular menses, improving androgen excess, and providing effective contraception and protection from endometrial cancer 3.
• Risks associated with OCPs: The benefits of hormonal contraception outweigh the risks in the vast majority of women with PCOS, but concerns have been raised about potential adverse cardiovascular and metabolic effects of OCPs, including an increased relative risk of venous thrombosis and potential increased risk of diabetes in morbidly obese women with PCOS with severe insulin resistance 3.
• Efficacy of OCPs for dysmenorrhea: Combined OCPs have been shown to be effective in reducing pain in women with primary dysmenorrhea, with a moderate reduction in pain compared to placebo 4, 5.
• Comparison of different OCP regimens: Continuous use of OCPs may be more effective than the standard regimen in reducing pain, but the safety of long-term use needs to be ensured 5.
• Alternative treatments: Some women may prefer alternative treatments, such as acupuncture and herbal supplements, which have been shown to be effective in regulating menstrual cycles and improving symptoms of PCOS 6.
• Consensus recommendations: Consensus statements have been developed to provide guidance on the use of OCPs in women with PCOS, including recommendations on the choice of OCP, indications, contraindications, and concerns regarding short, intermediate, and long-term use 7.

Key Considerations for Patients

Some key considerations for patients using OCPs to skip periods for PCOS or other causes of painful menses include:

• Individualized risk stratification: Patients should undergo individualized risk stratification and management to determine their personal cardiometabolic risk profile at baseline and during follow-up 3.
• Monitoring for adverse effects: Patients should be monitored for adverse effects, such as irregular bleeding, headaches, and nausea, which are common with OCP use 5.
• Alternative treatment options: Patients should be informed about alternative treatment options, such as acupuncture and herbal supplements, which may be effective in regulating menstrual cycles and improving symptoms of PCOS 6.
• Regular follow-up: Patients should have regular follow-up appointments with their healthcare provider to monitor their symptoms and adjust their treatment plan as needed.

Important Factors to Discuss with Your Healthcare Provider

Before starting OCPs to skip periods for PCOS or other causes of painful menses, patients should discuss the following factors with their healthcare provider:

• Medical history: Patients should discuss their medical history, including any history of cardiovascular disease, diabetes, or other medical conditions that may affect their risk of adverse effects from OCPs.
• Current medications: Patients should discuss any current medications they are taking, including any medications that may interact with OCPs.
• Lifestyle factors: Patients should discuss their lifestyle factors, including their diet, exercise habits, and stress levels, which may affect their symptoms and treatment plan.