Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects people with ovaries, leading to symptoms such as irregular periods, acne, excessive hair growth (hirsutism), and ovarian cysts. Contraceptive pills, particularly birth control pills, are commonly prescribed to manage these symptoms.

Prevalence:

Globally, about 18% of women use oral contraceptives for PCOS. In developed countries like the U.S. and Europe, the prevalence is higher, around 20-30%. In contrast, developing regions and rural areas tend to have lower usage rates, often below 10%. In Latin America, usage is around 15-25%, while in Africa, it is typically 5-10%. Access to healthcare, education, and cultural attitudes significantly influence these figures.

What causes PCOS?

  • Hormonal Imbalances: In women with PCOS, there is often an imbalance in reproductive hormones, such as higher levels of androgens (male hormones like testosterone). This imbalance can interfere with the normal development of eggs in the ovaries and their release during ovulation.
  • Insulin Resistance: Many women with PCOS have insulin resistance, which means the body’s cells don’t respond well to insulin, leading to higher insulin levels in the blood. This can increase the production of androgens (testosterone) by the ovaries, which contributes to symptoms like acne, excess hair growth, and irregular periods.
  • Genetics: PCOS often appears within the same families, indicating a genetic influence. A family history of PCOS in your mother or sister raises your own risk.
  • Inflammation: Women with PCOS often experience some level of chronic, low-grade inflammation. This inflammation can contribute to insulin resistance and other metabolic problems.
  • Environmental Factors: Lifestyle factors such as diet, exercise, and stress may exacerbate the condition. Although these don’t directly cause PCOS, they can worsen symptoms.

How is PCOS diagnosed? 

To be diagnosed with PCOS, a woman typically needs to meet at least two of the following three criteria (the Rotterdam Criteria is commonly used):

  1. Irregular or anovulation (irregular periods or no periods).
  2. Hyperandrogenism (high levels of male hormones, leading to symptoms like excess hair growth, acne, or thinning hair).
  3. Polycystic ovaries (multiple small cysts visible on ultrasound).

How contraceptive pills help with PCOS:

  • Contraceptive pills help normalise the menstrual cycle, which is often irregular in PCOS.
  • High androgen levels in PCOS can cause acne. Birth control pills reduce androgen levels, helping improve skin and reduce acne.
  • Birth control pills can lower androgen levels, reducing unwanted hair growth (hirsutism).
  • Irregular periods in PCOS can lead to a thickened uterine lining, which can be prevented by taking birth control pills.

Types of contraceptive pills for PCOS:

  • Combination Pills (Oestrogen and Progestin): 

These are the first-line treatments for PCOS. They contain both oestrogen and progestin, which help regulate hormones and manage symptoms like acne and hirsutism.

  • Progestin-Only Pills: 

These may be prescribed if a person cannot tolerate oestrogen or has other health concerns, but they are less commonly used for PCOS management.

Can contraceptive pills be taken by women with PCOS long-term?

 Long-term use of hormonal pills can have some risks and considerations, including:

  1. Health Risks: Long-term use of birth control pills can slightly increase the risk of blood clots, especially in women who smoke or are obese and over 35. It’s important to assess your overall health and any preexisting conditions with a healthcare provider.
  2. Fertility: While birth control pills help manage symptoms, they don’t address the underlying causes of PCOS, such as insulin resistance or ovarian dysfunction. If you plan to get pregnant, you’ll need to stop the pills, and fertility treatments may be required depending on your situation.
  3. Side Effects: Some women may experience side effects like mood changes, headaches, or weight gain, though these vary from person to person.
  4. Alternative Treatments: Depending on the severity of symptoms and individual needs, other treatments may be recommended for long-term management, such as metformin (for insulin resistance), anti-androgens (for excess hair or acne), or lifestyle changes like diet and exercise.

Potential Risks and Side Effects:

  • Oestrogen-containing pills can slightly increase the risk of blood clots, particularly for those who smoke, are over 35, or have a family history of blood clots.
  • Some individuals may experience elevated blood pressure, which increases the risk of heart disease or stroke, especially those with diabetes, obesity, or a history of heart disease.
  • Hormonal fluctuations can cause irritability, anxiety, or depression, especially in those with a history of mental health conditions.
  • Some people experience nausea or modest weight gain, particularly during the initial months of use.
  • Long-term use of oral contraceptives can affect liver function, and rare cases of liver issues may arise.
  • While a slight increase in breast cancer risk is noted, this is very small and tends to return to baseline levels after stopping the pill.
  • Some people experience reduced sexual desire due to hormonal changes.
  • These include headaches, breakthrough bleeding, and spotting, especially in the initial months of use.

Are the hormone pills the solution for PCOS? 

While hormonal pills are effective for managing certain symptoms of PCOS, they may not address other aspects of the condition, such as insulin resistance or fertility issues. Depending on the individual’s symptoms and health goals, other treatments might be recommended:

1. Lifestyle Changes:

Diet and exercise are important for managing PCOS. Weight loss helps to improve the symptoms of PCOS. A balanced diet that helps control insulin levels, along with regular physical activity, can help improve symptoms like weight gain, insulin resistance, and metabolic issues.

2. Medications for Insulin Resistance:

Metformin is commonly prescribed for women with PCOS who have insulin resistance or are at risk of type 2 diabetes. It helps improve the body’s response to insulin, which can also help with weight management and regulate menstrual cycles.

3. Anti-androgen Medications:

For women with symptoms like excessive hair growth or acne, anti-androgen medications like spironolactone can be used. These block the effects of androgens on the body.

4. Weight loss medications:

Weight loss medications like Wegovy and Mounjaro can directly or indirectly help to manage PCOS. Weight loss improves insulin sensitivity and hence reduces testosterone production.