PCOS and The Pill

If you've been diagnosed with PCOS, your GP might suggest starting with medication to manage your symptoms. Here’s what you should think about when deciding if medication is right for you:

• What are your goals? Consider what you hope to achieve with the medication.

• What are your health preferences? Think about how the medication aligns with your overall health goals.

• How do you feel on certain medications? Reflect on how different options make you feel.

• What is accessible for you? Assess what medications are available and convenient for you.

• What are the risks? Understand the potential side effects and risks associated with the medication.

Oral Contraceptive Pills (OCPs) for PCOS

According to the IEBG (2018), combined oral contraceptive pills (OCPs) are often prescribed as a first-line treatment for managing PCOS symptoms like excessive testosterone and irregular menstrual cycles. OCPs work by increasing sex hormone-binding globulin (SHBG), which helps reduce free testosterone levels and ease related symptoms.

However, choosing the right OCP isn’t always straightforward. Different combinations of oestrogen and progestin have their own benefits and drawbacks. For example:

• The Diane Pill: This older progestin is effective for controlling facial hair but can negatively impact cholesterol levels and increase clotting risks.

• Yasmin: A newer progestin with oestrogen, Yasmin doesn’t carry the same metabolic and cardiovascular risks as older options but may not be as effective for controlling hyperandrogenism.

Potential Side Effects

While OCPs can help manage PCOS symptoms, they come with a range of potential side effects:

• Migraines

• Gastrointestinal discomfort (e.g., bloating, nausea)

• Worsening blood sugar and insulin levels

• Weight gain

• Menstrual spotting and continuous bleeding

• Mental health issues

Pros and Cons

Pros:

• Increase SHBG levels, helping manage PCOS symptoms

• Provide a predictable menstrual cycle

• Reduce the risk of ectopic pregnancy

Cons:

• Risk of increased clotting

• Potential worsening of skin and hair issues

• Metabolic effects like weight gain

• Possible gastrointestinal discomfort and menstrual irregularities

Remember, while The Pill can help with symptom management and provide regular monthly bleeding, it doesn't regulate natural menstrual cycles.

Understanding Menstrual Bleeding on the Pill

A true menstrual period occurs about two weeks after ovulation. However, the pill works by shutting down your natural cycle and blocking ovulation. The monthly bleed you experience while on the pill is not a true period but a result of the oestrogenic effects building up the lining of the uterus. When you take a 7-day break from the hormonal pills, as per the packet instructions, this lining is shed, resulting in what is commonly referred to as a withdrawal bleed.

It’s important to emphasise this distinction because many women are led to believe that the the pill will fix and regulate their periods. In reality, the pill is merely masking the symptoms of irregular cycles associated with PCOS.

When the pill is stopped—often because women wish to start families—their periods frequently return to their pre-pill state, or may even be worse. This is because the underlying PCOS remains untreated and the issues with ovulation persist.