Center for Young Women's Health

PCOS:

The Oral Contraceptive Pill and PCOS

 

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Getting Treatment:
The Reproductive Endocrine Practice at Boston Children's Hospital offers special services in the diagnosis and treatment of Polycystic Ovary Syndrome (PCOS).

Adolescent girls and young women are frequently prescribed oral contraceptive pills (also called the "Pill") for Polycystic Ovary Syndrome and for irregular or absent menstrual periods, menstrual cramps, acne, PMS, and endometriosis. Oral contraceptive pills 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 girls with 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 oral contraceptive pills for young women with PCOS?

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's possible to have irregular periods, nausea, headaches, or weight change. Each type of oral contraceptive pill can affect a young woman differently.

If side effects from the Pill occur, they're 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:

Taking the Oral Contraceptive Pill

 

The most common pill packs come with 21 active hormone pills and seven placebo pills, but some packs have 24, 26, 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 extended 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 shown below.

 

28 Day Pill Calendar

  1. 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.
  2. 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 after dinner or at bedtime may cure this symptom.
  3. 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 doesn't improve, your health care provider may re–check your hormone levels, or may 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's 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 an external genital examination or a pelvic exam as part of their first 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's 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's 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're also taking the oral contraceptive pill for birth control, you should know that oral contraceptive pills do not protect you from sexually transmitted infections. Condoms help to prevent most sexually transmitted infections 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?

Emergency contraception is recommended if you've had unprotected intercourse during the time you missed your pills.

  1. The first "morning-after" emergency contraception pill methods approved in the United States are: Plan B One-Step™ and Next Choice®. Both products contain only one kind of hormone, a progestin, and it comes as 1 or 2 pills. A woman can take the total dose of 1.5 mg levonorgestrel in Plan B One-Step™ as one pill, or use Next Choice® and take both pills (.75 mg in each tablet) at the same time or take one pill followed by the second pill twelve hours later. Both kinds of EC work best if taken within 3 days (72 hours) of unprotected sex, but can be taken up to 5 days but the earlier it is taken the more effective it is. No prescription is needed for girls 15 and older.
  2. Ella™ (urlipristal acetate or UPA) is an emergency contraceptive that works by stopping or delaying ovulation. It's one pill (one dose) that can be taken up to 5 days or 120 hours after unprotected intercourse. A prescription is needed.
  3. Another type of emergency contraception uses regular birth control pills, which contain two hormones, estrogen and progestin. There are 2 doses. The first dose may be 2, 4, or 5 pills depending on the brand of birth control pills used, and is taken within 120 hours (5 days) of unprotected sex. The second dose is taken 12 hours after the first dose. A health care provider must prescribe how many pills should be taken for this kind of emergency contraception. This method is less effective than the other two, and is more likely to cause nausea.

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's a very safe and effective treatment for many types of medical problems, including PCOS, irregular menstrual periods, menstrual cramps, acne, PMS, and endometriosis.


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Written and reviewed by the CYWH Staff at Boston Children's Hospital

 

Updated: 5/20/2014

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