Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. It is characterized by infrequent or prolonged menstrual periods, excess androgen levels, and ovarian cysts. PCOS is also associated with infertility, obesity, acne, and abnormal hair growth. There is no cure for PCOS, but symptoms can be managed with lifestyle changes and medications like birth control pills. Many women with PCOS take birth control pills to regulate their menstrual cycles and suppress androgen levels. However, birth control pills do not get rid of PCOS completely. They only treat the symptoms. Once a woman stops taking birth control pills, the symptoms tend to return.
What is PCOS?
PCOS is a complex condition caused by hormonal imbalances. The exact cause is still unclear, but research suggests it is related to insulin resistance and excess androgen levels. The ovaries produce abnormally high amounts of androgens like testosterone. This causes irregular ovulation, cyst formation in the ovaries, and other symptoms. Some key features of PCOS include:
- Irregular, infrequent, or prolonged menstrual periods – Women with PCOS may have fewer than 9 periods per year or have periods that last more than 35 days.
- Excess androgen levels – Elevated male hormones can cause acne, hirsutism (excess facial/body hair), and thinning hair.
- Polycystic ovaries – The ovaries develop many small cysts along the outer edges. This is due to follicles that enlarge but fail to rupture and release an egg.
- Obesity – Up to 80% of women with PCOS are overweight or obese. The extra weight further exacerbates hormone imbalances.
- Infertility – PCOS is the most common cause of infertility due to lack of ovulation. However, some women with PCOS can still ovulate intermittently.
- Skin conditions – Skin tags, acanthosis nigricans (darkened skin patches), and acne are common.
The exact mechanisms behind PCOS are complex. Insulin resistance appears to be a major contributing factor. Insulin helps regulate the production of androgens like testosterone. When cells become resistant to insulin, more insulin is secreted by the pancreas. Excess insulin triggers the ovaries to produce more testosterone, worsening PCOS symptoms. Genetics and inflammation also play a role in the development of PCOS.
How is PCOS Diagnosed?
There are no definitive tests for PCOS. Doctors make a diagnosis based on a patient’s symptoms, medical history, physical exam, and blood tests. The diagnostic criteria include:
- Irregular menstrual cycles and ovulation problems
- Elevated levels of androgens like testosterone
- Polycystic ovaries on an ultrasound
Women must have at least two of these three criteria to be diagnosed with PCOS. Blood tests help check for elevated male hormones, diabetes risk, and other hormonal imbalances. Pelvic ultrasounds can detect ovarian cysts and enlarged ovaries. Once other potential causes have been ruled out, a PCOS diagnosis can be made.
What are the Treatment Options for PCOS?
While there is no cure for PCOS, symptoms can be managed with lifestyle changes, birth control, and other medications. Common treatment approaches include:
Lifestyle Changes
- Weight loss through diet and exercise if overweight
- Following a healthy, balanced diet
- Reducing refined carbs and sugary foods
- Managing stress levels
Losing just 5-10% of body weight can help restore normal menstrual cycles and ovulation. Regular exercise also helps improve insulin sensitivity.
Birth Control Pills
Birth control pills that contain estrogen and progestin can:
- Regulate menstrual cycles
- Reduce androgen levels
- Protect against endometrial cancer
- Clear acne
The estrogen decreases androgen production while progestin stabilizes the endometrium. Birth control pills do not cure PCOS but relieve symptoms. Once a woman stops the pill, symptoms usually return.
Other Medications
Other drugs that may be used include:
- Metformin to increase insulin sensitivity
- Clomiphene to induce ovulation
- Spironolactone to block androgen receptors
- Anti-androgens like cyproterone to reduce androgens
Doctors may prescribe a combination of medications to address both hormonal and metabolic factors. Fertility drugs can also help women with PCOS get pregnant.
Do Birth Control Pills Get Rid of PCOS?
Birth control pills cannot cure PCOS or get rid of it completely. They only treat and mask the symptoms while a woman is taking them. Once birth control pills are stopped, PCOS symptoms tend to return. This is because the root hormonal imbalances are still present. Birth control contains estrogen and progestin. These synthetic hormones work to:
- Inhibit follicle development and prevent new cyst formation
- Reduce male hormone levels
- Stabilize the endometrium and induce regular bleeding
So birth control pills can temporarily restore ovulation and periods. But they do not eliminate the fundamental problem of heightened androgen levels. Normal ovulation and menstruation will resume only while taking the pill.
Some key points:
- Birth control pills treat symptoms, not the underlying cause
- They regulate cycles through synthetic hormones, but do not fix hormonal imbalances
- PCOS symptoms usually return after stopping birth control pills
- The pills prevent new cyst growth, but do not shrink or eliminate existing cysts
In summary, birth control pills alleviate symptoms through their hormonal effects. But the relief is temporary. Once discontinued, PCOS manifests again since the imbalance of androgens and estrogen remains.
How do Birth Control Pills Help PCOS Symptoms?
Although birth control pills do not cure PCOS, they can provide substantial symptom relief. Here’s how they help:
Regulate Menstrual Cycles
Irregular, inconsistent periods are the hallmark of PCOS. Birth control pills can induce menstrual bleeding every month. The estrogen in the pills stimulates and stabilizes the endometrium. Progestin causes regular shedding. This restores normal cycles, though through artificial means.
Lower Androgen Levels
Excess androgens underlie most PCOS issues. Birth control pills suppress androgen production in the ovaries and adrenal glands. Reduced testosterone improves acne, unwanted hair growth, and other hyperandrogenic symptoms.
Protect Uterine Lining
Unopposed estrogen thickens the endometrium and raises endometrial cancer risk. The progestin in birth control counteracts estrogen’s effects on the uterine lining. This lowers endometrial cancer risk.
Restore Ovulation and Fertility
Many women with PCOS have irregular, absent ovulation leading to infertility. Oral contraceptives can help induce normal ovulation. However, fertility returns only while taking the pills.
Improve Insulin Sensitivity
Insulin resistance is central to PCOS. Estrogen in birth control pills can lower insulin levels. Progestin may also improve cellular sensitivity to insulin. This addressed the hyperinsulinemia behind PCOS.
Treatment of Acne and Hirsutism
Up to 80% of women with PCOS have acne. Birth control pills clear acne by lowering male hormones. Less androgen means less stimulation of the oil glands. The pills also reduce excessive facial and body hair growth.
So in summary, birth control pills temporarily restore ovulation, periods, and androgen balance. This provides symptomatic relief of PCOS. However, they do not treat the fundamental pathology.
What Happens When You Stop Taking Birth Control Pills for PCOS?
Once birth control pills are discontinued, most women with PCOS find their symptoms return within a few cycles. This includes:
- Irregular, absent, or heavy periods
- Worsening acne and hair growth
- Reappearance of cysts
- Infertility and anovulation
- Worsening of metabolic issues like insulin resistance
Since the pills only mask the symptoms, stopping them removes that cover. The high androgens, ovarian issues, and metabolic abnormalities persist underneath. Some women do notice improvements lasting a few months after discontinuing birth control pills. But for most, PCOS manifestations come back quickly.
That said, some symptoms may not recur as severely due to other lifestyle changes. For example, weight loss, exercise, and diet changes can have lasting benefits on insulin levels and inflammation. The pill’s effects on acne and hair growth are reversed once testosterone rises again. But the metabolic boost of lifestyle changes may blunt the impact.
In general, ovulation and menstrual regularity deteriorate rapidly after quitting birth control pills. But the metabolic aspects may worsen more slowly depending on other factors. Either way, the root PCOS pathology remains untouched.
Tips for Stopping Birth Control Pills for PCOS
To ease the transition off birth control pills:
- Adopt healthy lifestyle changes – Losing weight, exercising, and eating well will help counteract symptoms.
- Ask your doctor about metformin – Metformin can help manage elevated testosterone and insulin resistance.
- Consider other medication – Discuss options like spironolactone or clomiphene with your doctor.
- Track your cycles – Monitor your periods and symptoms to identify changes.
- See your doctor promptly if symptoms worsen – You may need other treatment.
Even if symptoms recur, the period off birth control pills allows the body to regain its natural rhythm. Doctors can better evaluate and treat PCOS issues. With close monitoring and lifestyle care, you can manage the transition smoothly.
The Takeaway
In summary:
- Birth control pills do not cure or eliminate PCOS itself
- They provide temporary relief by regulating cycles and hormones
- Once birth control pills are stopped, most women have PCOS symptoms return
- The fundamental hormonal/metabolic imbalances of PCOS persist
- Lifestyle interventions and other medications are needed to manage recurring symptoms
Birth control pills remain an effective treatment option for PCOS. But they are not a permanent fix. A multifaceted approach is required to manage PCOS in the long-term. While birth control pills alleviate certain symptoms, addressing the root causes via diet, exercise, stress relief, and insulin-sensitizing drugs provides lasting control of PCOS.
Frequently Asked Questions
Can you get rid of PCOS naturally?
There is no natural cure for PCOS. However, lifestyle changes and natural therapies can help manage symptoms without medication. Losing weight, exercising regularly, avoiding refined carbs, and reducing stress have been shown to regulate menstrual cycles, improve insulin sensitivity, and reduce androgens. Herbal remedies like spearmint tea, cinnamon, and turmeric may also provide some relief. But symptoms tend to return without ongoing lifestyle treatment.
Does PCOS go away with weight loss?
Weight loss can significantly improve PCOS symptoms, but does not cure the condition entirely. Dropping just 5% body weight through diet and exercise helps restore normal hormone levels and ovulation in overweight women with PCOS. But the underlying genetic and metabolic factors remain, and symptoms may eventually recur without weight maintenance.
Can birth control make PCOS worse?
Birth control does not worsen PCOS itself, but may mask underlying symptoms. The hormones can stabilize the endometrium and create artificial bleeds. But problems like lack of ovulation, insulin resistance, and androgen excess may progress unchecked. This can make conception difficult when trying to get pregnant after stopping birth control.
Do you ovulate on birth control with PCOS?
Birth control pills regulate cycles in women with PCOS but do not initiate true ovulation. The withdrawal bleeding that occurs monthly is due to drop in synthetic hormones. Ovulation requires follicular development and release of an egg, which does not occur on the pill since it suppresses these processes.
Can you still have cysts with PCOS while on birth control?
Yes, ovarian cysts can still be present with PCOS while taking birth control pills. Birth control prevents new cyst formation and growth of follicles. But it does not shrink or eliminate existing cysts. Typically, cysts start shrinking once the pill is stopped. But some may persist and require other treatment.
The Bottom Line
While birth control pills do not eliminate PCOS, they remain an effective treatment for managing troublesome symptoms like acne, hirsutism, and irregular periods. However, their effects are temporary and women usually face recurring symptoms after discontinuation. To tackle the root causes of PCOS, medications that improve insulin sensitivity combined with lifestyle changes like weight loss, exercise, and stress reduction are required. This multifaceted approach provides the best chance at long-term control of PCOS.