PCOS Guide for Teens: The Oral Contraceptive Pill and PCOS

PCOS Guide for Teens:

The Oral Contraceptive Pill and PCOS

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Adolescent girls and young women are frequently prescribed oral contraceptive pills (also called the "Pill") for irregular or absent menstrual periods, menstrual cramps, acne, PMS, endometriosis, and for Polycystic Ovary Syndrome (PCOS). Oral contraceptives lower hormone levels in girls with PCOS and regulate their menstrual periods. Hormone patches (Ortho Evra) and vaginal hormone rings (NuvaRing) can also help lower the hormone levels in PCOS.

What are oral contraceptive pills?

Oral contraceptive pills contain two types of synthetic (man–made) female hormones, progestin and estrogen. Similar hormones are made by the ovaries. There are many different kinds of oral contraceptives.

What are some of the possible medical benefits of the oral contraceptive pill for young women with PCOS?

Regular and Lighter Periods
Oral contraceptive pills can help to regulate the menstrual cycle so your period comes about every 28 days. The Pill usually causes lighter periods, too.
Less Unwanted Hair
Oral contraceptive pills can lower androgen hormone levels and lessen the amount of excess hair growth (also called "hirsutism"). It can take 6 months before there is a decrease in unwanted hair on the face, chest, back and stomach.
Clearer Skin
Oral contraceptive pills can improve acne. The hormones in most types of the Pill can help stop acne from forming. Be patient though, it can take a few months to see an improvement.
Decreased Cramps, Or No Cramps
Oral contraceptive pills can help to decrease menstrual cramps.
Other Medical Benefits
Because there is less menstrual bleeding with the use of oral contraceptive pills, girls taking the Pill are less likely to become anemic. Oral contraceptive pills also decrease your chance of getting endometrial (lining of the uterus) cancer, ovarian cancer, and ovarian cysts.

What are the possible side effects of the oral contraceptive pill?

Most women have no side effects when taking the oral contraceptive pill, but it is possible to have irregular periods, nausea, headaches, or weight change. Each type of oral contraceptive pill can affect a young woman differently.

Spotting (you don’t need to use a regular pad, just a panty shield) or very light bleeding: This may occur during the first 1–3 weeks of starting the Pill, or if you miss a pill. If the bleeding becomes heavier or lasts more than a few days or the bleeding happens after you have been on the pill for a few months, you should talk with your health care provider.
Nausea (or feeling like you need to throw up): Nausea occasionally occurs when you first start taking the Pill and will often go away in a few days. It is less likely to occur if the Pill is taken after dinner or with a bedtime snack.
Headaches: Headaches may occur because of stress at school or home, too little sleep, sinus infections, or migraines. The Pill can make headaches better or worse. If your health care provider thinks your headaches are related to the Pill, he/she may prescribe an oral contraceptive pill with a lower amount of estrogen or have you go off the Pill for a short time. If you have migraine headaches, talk to your health care provider about whether the Pill is right for you.
Mood changes: Feeling up and down emotionally can sometimes happen to anyone and is unlikely to be caused by the Pill. Exercise and a healthy diet may help along with talking to a counselor. Make sure you let your health care provider know how you are feeling.
Sore or enlarged breasts: Very occasionally, your breasts may become tender and/or get larger, but usually they will stay the same.
Weight change: Some teens gain weight and some teens lose weight while on the Pill, but most stay exactly the same. There are no calories in the Pill. Try to remember to watch your portion sizes, avoid fast food, and eat 5–7 servings of fruits and vegetables each day. Drink lots of water and don’t forget to exercise!
Blood clots: A blood clot in your leg or lung is a very rare, but serious side effect. If you suddenly have pain or swelling in your leg, or shortness of breath and chest pain, see your health care provider immediately. If you have a history of blood clots, you should not take the Pill. Tell your health care provider if anyone in your family (blood relative) has ever had blood clots, especially when they were young. Blood clots are more likely to develop if you are a smoker, overweight, having surgery, or sitting on a plane for a long time. To lessen your chances of blood clots, don't smoke, and if you are on a long plane trip, get up, walk around, and drink lots of water. If you are scheduled for surgery, ask your health care provider about stopping the Pill for 3–4 weeks before surgery and after the surgery until you are up and around.

If side effects occur, they are usually mild and go away in the first three to four cycles. If you do have side effects, talk with your health care provider. If the side effects are uncomfortable or if they don't go away, your health care provider may switch you to a different kind of oral contraceptive pill.

Are there any reasons why I shouldn’t take the oral contraceptive pill?

Most teens can take the oral contraceptive pill for PCOS, but for some, taking the combined Pill (with both estrogen and progestin) is not an option because of certain medical conditions, called "contraindications." If you can't use the combined Pill, your health care provider will talk to you about other medications to treat your PCOS.

Contraindications for taking combined oral contraceptives:

History of blood clots
Migraine headaches with aura (spots and flashing lights or difficulty seeing 5 to 30 minutes before the headache starts), or neurological symptoms (numbness, loss of speech)
Certain kinds of heart disease
High blood pressure that is not controlled with medication
Active hepatitis (liver disease)
Jaundice (yellowing of your skin or eyes) during pregnancy

Taking the Oral Contraceptive Pill

The most common pill packs come with 21 active hormone pills and seven placebo pills, but some packs have 23, 24, or even 28 active pills. The example shown below is for a 28–day pill pack in which you take 21 active hormone pills, and then seven placebo pills that contain no active hormones. These last seven pills are just "reminder" pills in most pill brands. They are taken during the fourth week, including during your period. With packages that have 24 active pills, the last 4 are "reminder" pills. There are also pill packages that have 84 active pills for continuous hormones and 7 "reminder" pills. Your health care provider will tell you whether you will be taking the active pills continuously or in cycles as illustrated below.

28 Day Pill Calendar

To take the oral contraceptive pill, follow the instructions on the package. Your health care provider will explain how to use your pill pack. You will be told to start taking the oral contraceptive pill on a Sunday, on the first day of your menstrual period, or the day you are seen by your health care provider.
You should take one oral contraceptive pill each day, at the same time of day until you finish the pack. Take the Pill at the same time as something that you do regularly so you don't forget. For example, you could keep them near your toothbrush, or set your cell phone alarm as a reminder. The best time is ½ an hour after a complete meal such as dinner or at bedtime. You may have slight nausea the first month, but this usually goes away with time. Some young women who take the Pill first thing in the morning find that they are more likely to have nausea, especially if they skip breakfast, so taking the pill at dinnertime may cure this symptom.
After completing a 28–day pack, you should immediately start a new packet of pills the next day. During your fourth week on the pill cycle, you should get your menstrual period. Your menstrual period should stop once you begin the new packet of pills.

Girls who are diagnosed with Polycystic Ovary Syndrome (PCOS) are often prescribed oral contraceptive pills (or hormone patches, or vaginal rings) to lower their hormone levels and regulate their menstrual periods.

If your hormone levels continue to be high or your excess hair growth does not improve, your health care provider may re–check your hormone levels, or suggest that you take the Pill continuously. This means that you would take just the "active pills" for 3–4 months or longer. You would not have a menstrual period until you stop taking the active hormone pills. Some girls may have spotting while taking the Pill continuously.

The Oral Contraceptive Pill & PCOS FAQ's (Frequently Asked Questions)

Do I need a pelvic exam before going on the oral contraceptive pill?

No. Although it is important for teens to have checkups as part of their general health care, a pelvic exam is not needed for girls with PCOS just to start oral contraceptive pills. Girls with PCOS may have a pelvic examination as part of their initial visit for PCOS or they may have a pelvic ultrasound done to look at their ovaries.

Is there any trouble getting pregnant after using the oral contraceptive pill?

There is no change in fertility with the use of the oral contraceptive pill. However, if you have PCOS and your periods were irregular before you started taking the Pill, it is likely that your periods will be irregular again when you stop taking it.

Does the oral contraceptive pill cause birth defects?

No, the Pill does not cause birth defects or affect the health of future children.

Does the oral contraceptive pill cause cancer?

No. The Pill actually protects against cancer of the ovaries and cancer of the lining of the uterus. A woman is half as likely to get cancer of the uterus or ovaries if she takes the Pill. Most experts believe that taking oral contraceptive pills does not cause any increased risk of developing breast cancer. Even girls with a family history of breast cancer can take the Pill.

How long can I be on oral contraceptives?

It is safe for you to be on the Pill for years, whether to regulate your menstrual cycle, treat your cramps, or as hormone replacement or birth control.

Do I need to take a break from the Pill?

There is no medical reason that you need to take a "break" from the Pill.

What if I am also using the oral contraceptive pill for birth control?

If you are also taking the oral contraceptive pill for birth control, you should know that oral contraceptive pills do not protect you from sexually transmitted diseases. Condoms help to prevent most sexually transmitted diseases and they are also an important backup method of birth control if you miss more than one pill in a row, or if you are sick (vomiting). All of these things can lower the effectiveness of the birth control pill. Whenever you get a new medication, ask if it changes the effectiveness of your oral contraceptive pill.

What if my period is very light while I'm taking the oral contraceptive pill?

Your period may be so light when you are on the oral contraceptive pill that you may have only a brown smudge on a tampon, pad, panty shield or underwear. The amount of hormones in the pills is very low. This means that the lining of your uterus doesn’t become very thick so very little blood needs to come out each month.

What if I forget to take one or more combined oral contraceptive pills?

If you miss 1 or 2 active (hormone) pills in a row, take the pill(s) as soon as possible and then continue taking pills daily, 1 each day. You may take 2 pills on the same day (one at the moment you remember and the other at the regular time) or even 2 at the same time.
If you miss 3 or more active (hormone) pills in a row, take the pill as soon as possible and then continue taking pills daily, 1 each day. If you missed the pills in the third week, finish the hormone pills in your current pack, throw away the reminder pills (inactive pills), and start a new pack of pills.
If you are sexually active and missed 3 pills, use condoms or do not have sex until you have taken active (hormone) pills for 7 days in a row.
Talk to your health care provider about whether you should use emergency contraception.
Note: If you are taking very low dose pills with just 20ug of ethinyl estradiol and miss 2 pills, you should follow the instructions for missing 3 or more pills.

Emergency contraception is recommended if you have had unprotected intercourse during the time you missed your Pills. If you are 17 or older, you can buy "Plan B" without a prescription. If you are under 17, you will need a prescription from your health care provider.

Are there any serious side effects that I should be worried about?

Most young women who take the oral contraceptive pill have few or no problems. If you do have any of the following problems, call your health care provider right away.

Remember: ACHES

Abdominal or stomach pain (severe)

Chest pain (severe), cough, shortness of breath

Headache (severe), dizziness, weakness, or numbness

Eye problems (vision loss or blurring), speech problems

Severe leg pain (calf or thigh)

The oral contraceptive pill is much more than a birth control pill. Adolescent girls and young women are frequently prescribed the oral contraceptive pill just for its medical benefits. It is a very safe and effective treatment for many types of medical problems, including PCOS, irregular menstrual periods, menstrual cramps, acne, PMS, and endometriosis.

Next: PCOS, Insulin, and Metformin

Written by the Center for Young Women's Health Staff

Updated: 8/25/2009

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Oral Glucose Tolerance Test	Nutrition Labels and Food Shopping
My Period Trackers	PCOS-Friendly Food Suggestions
PCOS and The Pill	Healthy PCOS Snack Attack
PCOS, Insulin, and Metformin	Sample PCOS-Friendly Menus
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PCOS Nutrition Guide	PCOS Fitness Plan Worksheets
Top 10 PCOS Tips	Additional PCOS Resources