Bitterroots Natural Medicine

and PCOS

Are Oral Contraceptives Right for You?

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Oral Contraceptives effect on fertility of high-androgen women with PCOS

Someone has asked about PCOS and oral contraceptives (OC), how they help to regulate bleeding and whether it is true that a woman with PCOS is more likely to conceive after stopping oral contraceptives. Great questions!

It doesn’t look like we should count on any reliable burst of fertility after stopping oral contraceptives. This is a persistent story, because in fact some women do become pregnant soon after stopping OC, and it’s typically a dramatic, notable event for that reason. But, more do not. The circumstances that are required for successful pregnancy are fairly specific. The difficulty women with PCOS have in conceiving, especially in early adulthood, is mostly related to biochemistry of the ovary that is not affected by the hormones in contraceptives. It looks like blood sugar regulation and managing inflammation is most essential for supporting ovarian function to achieve spontaneous or natural conception.

There are also many stories about women with PCOS apparently beginning or reverting to regular, spontaneous, ovulatory menstrual cycles once they have had their first baby. That happens to be my personal experience. However, I cannot find research directly measuring how often that happens. Research is typically done to answer questions for creating new treatments- unfortunately there is a lot less interest in studying what happens when no one is selling a drug or a surgery to create the effect being studied.

Assisted conception relies on stimulating ovulation, typically with clomiphene citrate, supported by metformin. This combination looks like it has about a 40% success rate, depending on a woman’s total circumstance. OC can be used to sort of over-take your system for 3 or so months. This creates a uterine and ovarian environment that is controlled for the timing of stimulation of ovulation for IVF, so that is one possibly helpful use for OC with PCOS.

OC are very effective at lowering androgen levels. OC are reliable for clearing acne and if used for at least 6 months can improve hirsutism. OC provide progestins (synthetic progesterone) that women with PCOS typically are low in when we are not ovulating. Progestins protect us from the effects of over-exposure to estrogens, including causing the endometrium (the lining of your uterus) to shed roughly monthly, in an imitation of a regular menstrual cycle. OC do not cause ovulation, but you do get that monthly bleed, which helps protect us against the small risk of endometrial cancer.

OC do have side effects, more than I can discuss in this post, but blood clots, migraine headaches and potentially increased breast cancer risk are among the known risks. Many studies suggest weight gain is a minor issue; anecdotally, women experience significant weight gain while on OC. One study has demonstrated that lean-appearing women with PCOS gain visceral fat after using OC, even though their waist measurement and BMI don’t change. It’s possible all the other studies that deny significant fat-gain did not measure visceral fat effectively. Adding metformin did change that story, so women with PCOS taking OC and metformin together do see improved body composition.

OC, especially the estrogen portion, will increase risk of blood clots and cardiovascular disease in women. Interestingly one study did not see the expected increase in cardiovascular events in PCOS women on OC, and those authors wonder if there is some protective effect specific to PCOS that make us safer than the average woman using OC.

Bottom Line for me is that OC have some benefits, some side effects. Each one of you will ideally be assessed by your care provider and educated about what your individual expression of PCOS is, what diagnostic categories best describe your circumstance, so treatment decisions can be made with your specific best interests in mind. Depending on where your personal distress is, what your additional risk factors are, OC can be a helpful tool, but should not be thought of as completely without risk. You will still be a woman whose underlying genetic tendency will be to trend toward higher androgens and insulin resistance. OC will cover over but not “cure” the androgen levels; OC will not help your tendency to insulin and blood sugar problems, and these are the underlying issues for both successful ovulation and carrying a healthy baby to term.

Thanks for sending in questions! I am happy to address exactly what interests you! I have long experience and special expertise in helping high-androgen women learn how to live comfortably in their strong, healthy bodies. If you’d like my personalized recommendations to accelerate your own kindness, compassion & vibrant good health revolution, visit me at www.PCOSConsultations.com, and we can get started!

Walking with you to joy, peace and a fulfilled life,
Nan

References:

  1. Aydin K, Cinar N, Aksov DY, Bozdag G, Yildiz BO Body composition in lean women with polycystic ovary syndrome: effect of ethinyl estradiol and drospirenone combination. Contraception. 2013 Mar;87(3):358-62. doi: 10.1016/j.contraception.2012.07.005. Epub 2012 Aug 13.
  2. Bozdag G, Yildiz BO, Combined oral contraceptives in polycystic ovary syndrome – indications and cautions. Front Horm Res. 2013;40:115-27. doi: 10.1159/000341823. Epub 2012 Oct 18.
  3. Glintborg D, et al Adiponectin, interleukin-6, monocyte chemoattractant protein-1, and regional fat mass during 12-month randomized treatment with metformin and/or oral contraceptives in polycystic ovary syndrome. J Endocrinol Invest. 2014 Aug;37(8):757-64. doi: 10.1007/s40618-014-0103-8. Epub 2014 Jun 7.
  4. Helvaci N, Yildiz BO, Oral contraceptives in polycystic ovary syndrome. Minerva Endocrinol. 2014 Sep;39(3):175-87. Epub 2014 Jul 8.
  5. Mendoza N, Simoncini T, Genazzani AD. Hormonal contraceptive choice for women with PCOS: a systematic review of randomized trials and observational studies. Gynecol Endocrinol. 2014 Sep 25:1-11. [Epub ahead of print]
  6. Spritzer PM, Motta AB, Sir-Peterman T, Diamanti-Kandarakis E, Novel strategies in the management of polycystic ovary syndrome Minerva Endocrinol. 2015 Mar 17. [Epub ahead of print]
  7. Wu CC, Lei P, Ruan YM, Lin XM, Xiong YL, Yang GY Effects of oral contraceptive pretreatment on controlled ovarian hyperstimulation and outcomes of IVF-ET.Zhonghua Nan Ke Xue. 2012 Jul;18(7):623-6.
  8. Yildizhan R, Gokce AI, Yildizhan B, Cim N, Comparison of the effects of chlormadinone acetate versus drospirenone containing oral contraceptives on metabolic and hormonal parameters in women with PCOS for a period of two-year follow-up. Gynecol Endocrinol. 2015 Mar 4:1-5. [Epub ahead of print]

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