Polycystic Ovarian Syndrome or PCOS is a group of symptoms that occurs due to a hormonal imbalance in women. It happens to be very common and affects 1 in 10 Indian women. While there is no complete cure for PCOS, lifestyle changes can help tackle it effectively. So then, why do gynaecologists prescribe birth control or oral contraceptive pills (OCPs) for PCOS? What are their benefits and how do they work?
One of the hallmarks of PCOS is irregular periods due to an imbalance of the hormones that control the menstrual cycle. OCPs help to reset the menstrual cycle. In addition, they have other benefits, such as reducing the risk of endometrial cancer, treating infertility, and having anti-androgen properties to help with symptoms of hirsutism and acne.
Combined Oral Contraceptive pills
Combined OCPs contain both oestrogen and progesterone, two essential hormones in the menstrual cycle.
The most common type of combined OCPs is the monophasic pills. These pills deliver the same dose of both oestrogen and progesterone daily. Because there is no rise in oestrogen, which is typical in the first half of the cycle, no follicle or egg is stimulated. Thus, no ovulation takes place. Since oestrogen is constant, there is very little development of the uterine lining (endometrium) as well. Progesterone also remains stable and protects the endometrium from growing in response to oestrogen. In the last week of the cycle, there are usually 4 to 7 placebo pills with no hormones, and it’s this withdrawal of progesterone that causes your period to come.
The other two types are multiphasic and extended cycle pills which work similar to monophasic pills. However, you only need to have a period every 3 months with the extended cycle pills.
AKA the ‘“mini-pill’”. These are less effective as birth control but can protect the endometrium in PCOS. Your doctor will prescribe these if there is a specific reason that you cannot take combined oral contraceptive pills (e.g., smoking, obese, or history of blood clots). The mini-pill works in the same way as the combined pill. But it usually doesn’t do much for the acne side effects.
Protection from Endometrial and Ovarian Cancer
PCOS leads to an added risk for endometrial cancer. With irregular periods, continuous exposure to oestrogen causes the uterine lining to grow in response to it. Since there is no signal to ovulate in PCOS, progesterone doesn’t increase and then drop, which causing menses (or bleeding). The predictable pattern of OCPs causes menses to occur monthly, thereby clearing out the lining. Another benefit of OCPs is that they have also shown to reduce the risk of ovarian cancer.
Resetting the Menstrual Cycle
In PCOS, getting pregnant can be tricky since ovulation doesn’t occur every month. The best remedy for increasing fertility in PCOS is losing weight. Even a 5% weight loss can cause women with PCOS to start ovulating monthly. Also, few months of OCPs can help to jumpstart regular cycles. Of course, while taking the pills, they will prevent pregnancy, but after discontinuation it can help to bring back regular cycles and allow for conception.
Unsure if missing your period is PCOS or a sign that you might be pregnant? An unwanted pregnancy sure is alarming! If you’re not currently trying to get pregnant and are sexually active, OCPs can have the dual benefit or regulating your cycles and acting as contraception.
Treating Hirsutism and Acne
Excessive androgens (male hormones) can lead to hirsuitism or unwanted facial and body hair. They also contribute to hair loss! OCPs help reset this imbalance. OCPs lower the overall androgen production in the ovaries since they suppress LH and FSH. In addition, the oestrogen increases a protein called sex-hormone binding globulin, which then causes a decreasing in circulating testosterone, which can help with hirsutism symptoms.
What’s more, OCPs can fix another beauty problem – acne. While the link between oestrogen and acne is not entirely understood, it is thought that the rise or fall in oestrogen can contribute to acne.
The thought of starting OCPs can be a bit confusing for some. So, we hope this guide has helped you understand them better.
If you’re interested in seeing which birth control pill is right for you, connect with a gynaecologist at Veera.`