From the Guidelines
For individuals with Polycystic Ovary Syndrome (PCOS) seeking to regulate menstrual cycles, combined hormonal contraceptives are typically the best option. These medications, such as birth control pills containing both estrogen and progestin (e.g., Yasmin, Yaz, or Ortho Tri-Cyclen), are often prescribed as first-line treatment 1. They work by suppressing ovulation and providing regular hormonal withdrawal bleeds, which helps establish predictable cycles. Additionally, they reduce testosterone levels, improving other PCOS symptoms like acne and excess hair growth, and protect the endometrium from unopposed estrogen exposure, reducing the risk of endometrial hyperplasia and cancer that can occur with irregular cycles.
The standard dosage of these contraceptives contains 20-35 micrograms of ethinyl estradiol combined with a progestin. Some patients may experience side effects like nausea, breast tenderness, or headaches when starting these medications, but these typically subside after a few months 1. If oral contraceptives aren't suitable, other combined hormonal methods like the vaginal ring or patch can provide similar benefits with different delivery methods. It's also important to note that the use of combined hormonal contraceptives has been associated with a reduced risk of endometrial and ovarian cancers, as well as other benefits such as regulation of menstrual cycles and improvement of acne symptoms 1.
Key points to consider when prescribing combined hormonal contraceptives for individuals with PCOS include:
- Starting with a low-dose pill (containing ethinyl estradiol 35 μg or less) and a progestin such as levonorgestrel or norgestimate 1
- Counseling patients on the importance of daily adherence and providing strategies to promote adherence, such as cell phone alarms and support from a family member or partner 1
- Informing patients about potential side effects and drug interactions, and providing guidance on what to do if pills are missed 1
- Considering the use of extended or continuous cycles for patients who prefer amenorrhea or have medical conditions that can be exacerbated cyclically 1
Overall, combined hormonal contraceptives are a highly effective and recommended treatment option for individuals with PCOS seeking to regulate menstrual cycles and improve related symptoms.
From the Research
Forms of Contraception for PCOS
- Combined oral contraceptive (OC) pills are the first-line medical therapy for the long-term management of PCOS, as they restore regular menses, improve androgen excess, and provide effective contraception and protection from endometrial cancer 2.
- 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 OCs 2, 3.
Comparison of Contraceptive Pills
- A study comparing the effects of 30 μg and 20 μg ethinyl estradiol (EE) among women with PCOS found that an oral contraceptive pill containing 20 μg EE has similar effects on androgen levels to those of a pill containing 30 μg EE 4.
- Another study compared the effects of combined oral contraceptives (OCs) containing cyproterone acetate and drospirenone in the treatment of PCOS, and found that cyproterone acetate containing OCs seem to be more effective to treat clinical hirsutism in patients with PCOS after 12 months of treatment 5.
Considerations for Contraceptive Use in PCOS
- Before prescribing an OC, clinicians should document individual risk factors including age, smoking, obesity, any degree of glucose intolerance including prediabetes and diabetes, hypertension, dyslipidemia, thrombophilia, and personal or family history of a venous thromboembolic event 2.
- The use of ethinylestradiol/drospirenone combination in patients with PCOS has been shown to provide clinical improvement in the areas of excessive hair growth, unpredictable menses, acne, and weight gain 6.