From the Guidelines
The best contraceptive for Polycystic Ovary Syndrome (PCOS) is typically a combined hormonal contraceptive pill containing both estrogen and progestin, such as Yasmin, Yaz, or Diane-35, which should be taken daily for 21 days followed by a 7-day break or continuously depending on the specific prescription. These options are particularly beneficial for PCOS because they regulate menstrual cycles, reduce androgen levels that cause hirsutism and acne, and provide protection against endometrial hyperplasia 1. They also decrease the risk of ovarian and endometrial cancers while providing effective contraception. Some key points to consider when choosing a contraceptive for PCOS include:
- Regulation of menstrual cycles
- Reduction of androgen levels
- Protection against endometrial hyperplasia
- Decreased risk of ovarian and endometrial cancers
- Effective contraception For women who cannot take estrogen due to risk factors like migraines with aura or blood clotting disorders, progestin-only options such as the levonorgestrel IUD (Mirena), desogestrel pills, or the etonogestrel implant (Nexplanon) are good alternatives 1. These options still provide contraception and endometrial protection but may have less effect on androgen-related symptoms. It's also worth noting that more recent studies have shown that natural estrogens such as 17βE or its valerate ester may have a potentially more physiological and safer pharmacological profile compared to synthetic estrogens like ethinylestradiol (EE) 1. However, further studies are needed to systematically demonstrate the safety of 17βE-containing COC in terms of thromboembolism. Regular follow-up with a healthcare provider is important to monitor side effects and ensure the chosen method is working effectively for both contraception and PCOS symptom management.
From the Research
Best Contraceptive for PCOS
The best contraceptive for Polycystic Ovary Syndrome (PCOS) is often a combined oral contraceptive (COC) that contains a combination of estrogen and progestin.
- COCs are effective in restoring regular menses, improving androgen excess, and providing effective contraception and protection from endometrial cancer 2, 3, 4.
- The choice of progestin component is important, with drospirenone being a relatively new progestin that has shown benefit in the PCOS population when used in conjunction with ethinyl estradiol 2, 5.
- However, COCs may increase the risk of venous thromboembolism (VTE) and may have adverse cardiovascular and metabolic effects, particularly in women with pre-existing risk factors such as obesity, smoking, and glucose intolerance 3, 4.
- A tailored clinical approach to oral contraception in women with PCOS requires individualized risk stratification and management, including determination of each patient's personal cardiometabolic risk profile at baseline and during follow-up 3, 4.
Factors to Consider
When choosing a contraceptive for PCOS, the following factors should be considered:
- The patient's medical history, including any pre-existing medical conditions such as diabetes, hypertension, or dyslipidemia 3, 4.
- The patient's lifestyle, including smoking status and level of physical activity 3, 4.
- The patient's preferences and values, including any concerns about potential side effects or the importance of contraceptive efficacy 3, 4.
- The potential benefits and risks of different contraceptive options, including COCs, progestin-only pills, and non-hormonal methods 3, 4.
Alternative Options
Alternative contraceptive options for PCOS include:
- Metformin, which may be effective in regularizing menstrual cycles and improving hyperandrogenism, particularly in women with insulin resistance 5.
- Progestin-only pills, which may be a suitable alternative for women who cannot use estrogen-containing contraceptives due to medical reasons 6.
- Non-hormonal methods, such as intrauterine devices (IUDs) or barrier methods, which may be a suitable alternative for women who prefer not to use hormonal contraceptives 6.