The oral contraceptive pill is often prescribed to PCOS patients who are not looking to get pregnant (now or ever).
The pill is prescribed for a few reasons which include:
- lower testosterone levels
- improved acne
- decreased risk of endometrial hyperplasia and endometrial cancer i.e. uncontrolled growth of the uterine lining that can happen when periods go missing
- improved heavy bleeding
- providing contraception (especially if your periods are irregular and you’re not wanting to get pregnant)
There are risks involved with taking the pill, like a slightly increased risk of blood clots and slightly increased risk of breast cancer.
However, when it comes to health, we always need to do a risk-benefit assessment on an individual basis and move forward from there. Where you are in life, what your values are, what capacity you have to invest time and money into your health, where your health is at, what your goals are, which options are presented to you, how your options are presented to you, who’s on your healthcare team, your base knowledge, your geography, your family and culture, and other factors determine the health decisions you make.
Even though I cannot prescribe the pill, I always talk about this treatment option for PCOS patients because that’s my job: to lay out options and information and help you select the one that works for you. This is patient-centred care and your decision is not set in stone — it can be re-evaluated whenever you’d like. Some patients choose the pill or continue to use the pill if they’ve been on it because the peace of mind they get from contraception and improvement in other symptoms is worth it for them. Some patients don’t feel well on the pill or simply don’t want to be on the pill and we create a different plan for them (which is the majority of my patients). And some of my patients are looking for fertility support so the pill doesn’t really help us there 😉 Anyway, my job is not to judge! It is to support.
Ultimately, the pill doesn’t address the insulin resistance that is often involved in PCOS or the some of the other components we’re understanding more and more with time and research. It also isn’t going to reduce cardiovascular disease risk, so there’s a role for lifestyle medicine regardless of whether you go on it or not. But it is a tool that can be used if you decide to go that route.