My second PCOS blog discussed the treatment options that you may receive for PCOS, specifically the nutrition and lifestyle ones.
According to evidence, lifestyle and nutrition treatment is the first line and most essential treatment for PCOS. However, I want to show you the different medications used in treatment of PCOS, so you become aware of them and your treatment plan(s). Being aware and informed is so empowering, do you agree?
Each treatment route depends on your PCOS goals: either to ovulate, to reduce insulin resistance, to reduce androgens (male hormones), to get rid of acne or excess hair growth, to conceive for a baby, or other goals.
Medications are only prescribed by your doctor. Your dietitian should be aware of those medications you are taking as they may have nutritional and health implications. They may also have potential interactions with supplements or food.
Medical treatments are usually prescribed weighing the benefits and risks for the individual. They are chosen when benefits outweigh risks.
Unfortunately, sometimes they are prescribed for convenience and time limitations. Sometimes those treatments treat the symptoms and not the root cause. However, they might be beneficial for certain period of time in your PCOS journey. I suggest you ask questions if these are the only option for you and what your treatment plans are. Also be clear on your health goals and plans.
In this blog post, I partnered with one of my favourite pharmacists and friend, Anan Ahmed, and asked her about information and a pharmacist's perspective on the birth control pills for PCOS.
Oral Contraceptive Pills (Bith Control Pill) or (The Pill)
The oral contraceptive pill (OCP) is the first line and the most used treatment for PCOS. The pill is not a cure for PCOS. It helps with some symptoms such as acne, excess hair, and absent period.
OCPs are a group of external synthetic women's sex hormones (estrogen and progesterone). There are two types of oral contraceptive pills that differ in terms of their action:
1. Combined estrogen-progesterone (i.e. Alesse, Alysena, Aviane, Yaz)
2. Progesterone only (synthetic: pregestin) Minipill (i.e. MinOvral)
The most commonly prescribed oral contraceptive pill for PCOS is the combined hormonal pill with estrogen and progestin.
Mechanism of Action of Different OCP:
if you look back at our menstrual cycle blog, you can review the role of different hormones that get involved in it from the beginning to the end. This will make understanding the action of the pill easier.
Action of The combined pill: "Ethenylestrogen Component:
Suppression the follicle-stimulating hormone (FSH)
Stabilization of endometrium
Potentiation of progestin action
Suppression of dominant follicle formation
Increase in sex hormone-binding globulin
Decrease in free androgen
Progestin component (variable according to preparation)
Suppression of luteinizing hormone (LH)
Inhibition of luteinizing hormone surge
Hostile cervical mucus
Decrease in ovarian androgen secretion
Possibly androgen-blocking effects" (Nader & Diamanti-Kandarakis, 2007)
Unfortunately, the pill partly shuts down the ovaries and the natural hormonal actions from the hypothelamus to create its own action. This results in reduction of clinical signs of androgens (acne, excess hair, hair loss) and results in a predictable bleeding (vs missed period or long cycles).
Many professionals refer to the pill as a band-aid or temporary treatment, because it does not address the root cause of PCOS and the actual hormonal imbalances.
From my research and understanding, OCP might be needed if the uterus lining is thick and no ovulation or bleeding is happening to release it outside the body, which can be a risk factor for endometrial cancer. That is why using the pill to get rid of the accumulating lining is necessary. Side Effects of the Pill
You might get overwhelmed with the long side effects of medications, but it's important to be aware of them. Side effects vary depending on the dose and the hormones used in the pill. It is important to be monitored regularly by your health care provider.
Once started on an oral contraceptive, some women (not all) experience side effects. These can include mood changes, possible weight gain or loss, headaches, bloating, and sore breasts.
A few months in, some women may experience light spotting which generally is not an issue unless it happens very often. If the spotting happens often, you would have to consider switching to a different birth control pill.
You may experience breakthrough bleeding on low-dose formulations than high-dose ones.
"Birth control pills should not be used by women who have a history of:
undiagnosed vaginal bleeding
uncontrolled high blood pressure or heart disease
liver tumors or liver disease
increased blood clotting or stroke risk
or if currently pregnant" (Drugs.com, 2020)
There are also some long term side effects of the pill that vary from woman to woman, especially that women with PCOS may have some metabolic issues due to PCOS.
Nutritional Effects of Oral Contraceptive Pills The pill depletes a lot of important nutrients such as riboflavin (vitamin B2), B6, B12, folate, vitamin C and E, and the minerals: magnesium, selenium and zinc (Palmery et al., 2013). That is why it is important to eat a variety of nutritious high nutrient dense food such as fish, nuts, seeds, legumes, and whole grains.
Getting Off the Pill
When stopping taking the pill, make sure you protect against unwanted pregnancy if you may get pregnant. Your period may be absent for a while. You may get acne and unwanted hair.
Make sure that you need to replenish nutrients and eating enough food. Some supplements may help and again, treating the root cause of PCOS is key. I absolutely can help with that!
This topic was not an easy one to write on, especially that most of the research is done on women without PCOS. There are also so many names and preparations for birth control pills that I am unaware of due to my scope of practice as a dietitian. My goal was to help you understand your treatments and make you aware of it.
It is always important to ask questions to your doctor to ensure that this is the best treatment for you at the point of time and to follow up with them regularly.
Nader, S., & Diamanti-Kandarakis, E. (2007). Polycystic ovary syndrome, oral contraceptives and metabolic issues: new perspectives and a unifying hypothesis. Human Reproduction, 22(2), 317-322.
Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci, 17(13), 1804-13.