Does the birth control pill solve PCOS?

Why is the pill the number one pharmaceutical prescribed for PCOS?

The pill is the first-line of treatment for the management of PCOS (1). Hormonal contraceptives have been shown to improve androgenic symptoms by increasing SHBG (a protein that binds to sex hormones like testosterone) and decreasing LH (which is usually elevated in PCOS) reducing ovarian androgen production (2). Many women with heavy periods, acne, or other symptoms do find relief from the pill, at least temporarily. It also forces a withdrawal or “pill bleed"‘ to shed the uterine lining.

This all sounds great in theory but is this the answer to solving PCOS?

The effects of the pill

We have to remember that the pill introduces synthetic hormones into the body, shutting off ovulation and the communication between the brain and the ovaries. The hormones introduced by the pill are not like our hormones. They do not supply the same benefits. In fact, they can shift a lot of things in the body:

Depletes vitamins and minerals

Nutrients such as folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc and the antioxidant coQ10 are depleted on hormonal BC. These are crucial nutrients for healthy cycles and ovulation, insulin and thyroid function, and much more. I always suggest at least a good quality prenatal supplement alongside a diet rich in whole foods to make sure you are meeting your needs. Testing may be required to verify your levels and adjust your supplementation.

Zinc is a mineral that is needed to produce stomach acid, and support the immune system, insulin regulation and the breakdown of carbohydrates, and thyroid function. It is also an important nutrient for the repair of the intestinal lining, especially in cases of leaky gut. And it is even anti-androgenic! Meaning it can help with acne, hirsutism, and hair loss (3).

Folate is a crucial B vitamin especially for any woman looking to conceive, as it helps prevent neural tube defects and reduces liver fat content or fatty liver disease (common in PCOS women) (4).

Folate supplementation has been shown to reduce oxidative stress and inflammation as well as metabolic markers in PCOS women (5) (6). Avoid the synthetic form “folic acid” and choose methyl folate as most of us cannot properly convert the synthetic form in the body.

Magnesium is an essential mineral however it is commonly deficient in the general population and PCOS women may be 19 times more likely to be low in magnesium.

Magnesium has been shown to improve insulin regulation, regulate cortisol, reduce inflammation, improve mood, and increase glucose tolerance (7). Deficiency can promote insulin resistance. Magnesium is also a nervous system and muscle relaxant so great for PMS, cramps, muscle soreness, and anxiety.

Promotes insulin resistance

The hormonal contraceptive pill can trigger or worsen Insulin resistance by modifying carbohydrate metabolism and decreasing insulin sensitivity (8) (9).

As many as 70% of PCOS women are insulin resistant and 10% have diabetes. This is a big problem and an underlying factor in PCOS, worsening phenotypes and symptoms. In order to manage PCOS and reverse symptoms blood sugar and insulin management are one of (if not the) most important factors to consider. This is why all physicians should educate their patients on this risk when taking birth control in order to take the necessary steps to manage their blood sugar.

Alters thyroid function

Hormonal BC has been shown to alter thyroid function by increasing thyroxine-binding globulins which binds onto thyroid hormones making them unavailable to the body for use - meaning less available thyroid hormone for the body to use. In addition, the thyroid gland relies heavily on nutrients such as zinc, selenium, and tyrosine to function properly but these are depleted by the pill.

PCOS women are more prone to thyroid disorders than the general population and many of the symptoms related to low thyroid function may mimic PCOS (10). Thyroid disorders have also been associated with ovarian changes and even cysts which is why it’s important to rule out thyroid conditions before diagnosing PCOS (11).

Suppresses adrenal function

The BC pill is associated with higher cortisol secretion which may be due to increased inflammation and even changes in the brain (12). This combined with low nutrient status can suppress adrenal gland function over time and lead to HPA axis dysfunction resulting in symptoms like low libido, fatigue, weight gain, and insomnia.

Promotes an estrogen dominance state

The pill introduces synthetic estrogen and progesterone and shuts down ovulation. This means you are taking in more estrogen but not making progesterone (since ovulation is needed to make progesterone). This ultimately creates a state of estrogen dominance. Many PCOS women experience this situation and some signs of estrogen dominance include hair loss, PMS, ovarian cysts, cellulite, tender breasts, and mood swings. This is why the pill does not actually balance hormones because it turns off your own natural hormones while supplying synthetic hormones that are not at all the same.

Raises inflammation

HBC has been shown to increase inflammatory markers which in turn can increase cortisol and result in reduced fat burning, PMS, anxiety, and depression (13) (14). We have to remember that chronic inflammation is the driving force of many chronic diseases and illnesses such as metabolic syndrome, autoimmune disease, and cardiovascular disease, and PCOS is characterized by a chronic state of inflammation as well. So logically, we don’t want to be adding more oil to the fire!

Damages the gut

Studies show the use of hormonal birth control may alter gut bacteria and even modify colonic barrier function - increasing the risk of leaky gut. Moreover, the risk of bowel disease has been shown to increase in studies done comparing non-BC users with BC users (15). If you are already suffering from gut problems the pill can further exacerbate it.

As mentioned, the pill supports an estrogen dominance state which can actually promote yeast overgrowth, which is much more common among pill users. Yeast can proliferate systemically meaning it can show up with vaginal yeast infections and become dominant in the gut. Learn more about candida here.

So not only is the pill increasing estrogen in the body, but by modifying gut function it can also reduce excretion and detoxification of excess estrogen, resulting in a buildup of estrogen that cannot be adequately eliminated.

Shrinks the ovaries

So what happens to the ovaries on hormonal birth control? Studies have actually shown that they can significantly alter ovarian size, meaning your ovaries shrink, as well as reduce the number of follicles (16) (17). Normal ovarian function should return once the pill is stopped however the effects can last for a while longer. It can take 6 to 7 months for a woman’s ovaries to normalize and twice as long for women to conceive post-pill. This is why if you are looking to become pregnant it is advised to start prepping your body before and stop hormonal contraceptives at least a few months prior, if not 12 months ideally.

Messes with our mood

The evidence is clear, hormonal contraceptives increase the risk of depression, among users, especially teenagers (18). This does make sense as most of the imbalances mentioned in this article will affect mental health. Not only that, the pill actually can influence brain size. MRI scans found that women on BC had significantly smaller hypothalamic volume than non-users (19). This was correlated with increased anger and depression. And PCOS women are already more at risk for anxiety and depression due to physiological changes but also the emotional impact of symptoms such as hirsutism and acne.

The use of hormonal contraceptives has been positively associated with increased risk of anti-depressants and increased suicide attempts (20) (21). Adolescent women seem to be at the highest risk for declined mental health while using hormonal contraceptives.

What can you do?

If you are on the pill, this article is not meant to scare you, but to educate you. You have the right to be educated about your body and then make the right choice for you, whether that be taking the pill or not. this is not about shaming this is about empowerment. I too was on hormonal birth control for years until I learned of the effects and decided it was no longer for me.

A regular menstrual cycle is important in order to regularly shed the endometrial lining, therefore it’s vitally important to get to the bottom of your period issues!

Thankfully there are many things that you can do to support your body whether you are on the pill or transitioning off the pill and wanting to restore your cycles naturally. You can read more about that here.

Do you need more support with this?

Learn how you can start working with your body in order to restore healthy hormones over the long term inside my coaching programs where I teach you how to tap into your feminine, nourish yourself from the inside out, and get to the root cause of your symptoms.

Find out more here here.

Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a healthcare provider before implementing changes. Read additional disclaimer info here.