Polycystic ovary syndrome, or PCOS, affects up to 12 percent of Americans with female sex organs who are of childbearing age. When diagnosing PCOS, doctors look for two or more of the following: high levels of androgens (male hormones), a large number of immature ovarian follicles, and periods that are either abnormal, irregular, or absent. These hallmarks of the condition can lead to signs and symptoms, including facial-hair growth, acne, and difficulty becoming pregnant.
Finding the right birth-control method is especially important for people with PCOS, who may not be able to predict when they're ovulating — but settling on a birth-control method can also be difficult. "When picking a birth-control method, it is important to pay attention to one's PCOS symptoms because birth-control methods may improve some symptoms and could exacerbate other symptoms," Beth Rackow, MD, assistant professor of obstetrics and gynecology at Columbia University Medical Center and medical advisor at Allara, tells POPSUGAR. For example, "people with PCOS who struggle with weight gain should be cautious using injectable progestins (i.e., Depo-Provera) because some individuals experience weight gain on this medication."
Ultimately, there is no "best" choice when it comes to birth control for people with PCOS as recommendations should be based on a person's individual needs. But among the sea of birth-control methods, there are better options than others. Ahead, experts explain what to consider when choosing a birth control.
What Are My Options For Birth Control?
There are two major categories of birth-control methods: hormonal and nonhormonal.
Hormonal birth-control methods contain either a combination of estrogen and progesterone hormones or progesterone only. These methods work by either suppressing ovulation (therefore preventing an egg from being released), thickening cervical mucus to make it more challenging for sperm to reach an egg, or thinning the lining of the uterus to prevent implantation. Hormonal birth-control methods include oral contraceptives (the pill), hormonal intrauterine devices (IUDs), implants, injections, vaginal rings, and skin patches.
Nonhormonal birth-control options include barrier methods (such as condoms), copper IUDs, and vaginal gels, like Phexxi. These methods do not use supplemental hormones to prevent pregnancy.
Which Birth-Control Methods Are Best For PCOS?
According to experts, hormonal birth control is typically the first choice for people with PCOS. Those with PCOS often have hormonal imbalances that result in irregular cycles, making it very difficult to predict when they're most fertile. For this reason, among others, physicians often prescribe hormonal birth control to help restore some balance and regulate the menstrual cycle.
A combination of estrogen and progestin (a synthetic form of progesterone) is the most commonly prescribed hormonal birth-control method for those with and without PCOS. This type of birth control can be delivered through a pill, patch, or vaginal ring. Progestin-only hormonal birth-control methods include pills, injections, implants, and IUDs.
"Combination oral contraceptive pills are the mainstay for PCOS treatment," Jennifer Lew, MD, a board-certified ob-gyn at Northwestern Medicine Kishwaukee Hospital, tells POPSUGAR. She adds that this type of contraception, along with other combination methods, offers many benefits.
First, the estrogen in these birth-control methods helps to regulate periods, which can have long-term health implications. "When choosing a birth-control method, it is important to pick a method that helps to regulate the menstrual cycle," Renita White, MD, a board-certified ob-gyn in Georgia, explains. "This prevents the lining of the uterus from growing in an uncontrolled fashion, which can increase the risk of uterine cancer." That's crucial because people with PCOS are nearly three times more likely to develop endometrial cancer. Additionally, Dr. Rackow shares that contraceptives that contain estrogen work to lower testosterone, improving symptoms (like acne and facial hair).
For those who can't take estrogen-containing birth control for medical reasons (such as a history of blood clots), Dr. Lew says that progestin-only methods can be a good option. However, she cautions that this type of birth control, while an effective choice for preventing pregnancy, doesn't regulate the menstrual cycle. And, as Dr. Rackow alluded to earlier, progestin-only methods may exacerbate some symptoms of PCOS. Ultimately, only you and your doctor can decide which birth-control method best fits your needs, so make an appointment with your ob-gyn.