‘The Pill’ Might Give you a Bleed but It’s Not An Effective Treatment For PCOS
By Clare Goodwin
Last updated: September 3, 2020
Have you been prescribed ‘the pill’ or another form of hormonal contraception as a treatment for PCOS, either to ‘regulate your cycle’’?
Hormonal contraception such as the pill, the Mirena IUD, and the depo injection (hereafter also referred to as ‘the pill’) is an excellent contraception tool. That is what it’s designed to do, and that is what it does very well.
However, hormonal contraception was not designed to ‘regulate your cyle’ and it can never do this for the simple reason that a menstrual cycle is far more than a bleed. What actually kicks off our cycle is ovulation. After we ovulate, we get a rise the hormone progesterone, and then when our body realises that we’re not pregnant our progesterone falls which triggers our uterine lining to shed aka a period. This then triggers a rise in estrogen for the first half of the cycle.
The way that hormonal birth control works as a contraceptive is to block our body from ovulating. What’s contained in each one of those little pills is a synthetic form or estrogen (such as ethinyl estrodiol) and progesterone (progestin), which mimic our natural hormones. When you stop taking them and take the sugar pills instead, it mimics the fall in progesterone and therefore your uterine lining falls away (i.e. a period).
However, as you can now see, the bleed is only one tiny part of the menstrual cycle. The reason why you aren’t getting a period on your own, or why it’s so irregular is because your body is struggling to ovulate. Switching off ovulation altogether via the pill isn’t the answer, getting to the root cause of your PCOS is. Additionally, the pill can actually make things worse for you in the long run.
The Pill Causes Insulin Resistance, Which Worsens PCOS Symptoms
Unbeknownst to most women, the pill can actually cause insulin resistance – a huge contributory factor in worsening PCOS symptoms. Studies have shown that the pill causes a 30-40% reduction in insulin sensitivity and also stops exercise from improving insulin sensitivity.
Insulin resistance is also known as prediabetes. High insulin levels stimulate the ovaries to overproduce testosterone. These higher levels of testosterone cause PCOS.
High insulin levels also directly cause symptoms associated with PCOS, such as hirsutism. Insulin gets into the hair follicles on the face, back, and chest, causing abnormal facial hair growth.
The pill also causes a chronic increase in Luteinizing Hormone (LH), which stops ovulation, thereby reducing your likelihood of getting pregnant. LH and another hormone called Follicle-Stimulating Hormone (FSH) are the little known hormones that control ovulation.
If LH is too high then the ratio of LH to FSH is unbalanced. The result of this is that an egg won’t be released. What this means is that the pill can actually ‘cause’ PCOS for some women.
The Pill doesn’t treat the cause of high testosterone
Although the pill reduces testosterone levels, thereby helping with PCOS symptoms, it doesn’t fix the root cause of why the ovaries are over-producing testosterone in the first place. Instead, the pill increases the amount of Sex Hormone Binding Globulin (SHBG). SHBG is like a sponge for testosterone. Instead of turning the taps off to stop the basin from overflowing, you’re just throwing more sponges in there to mop up the water. Not only is this not an efficient method of treatment, we also don’t know the long term implications of increasing SHBG.
For 70-80% of women with PCOS, insulin resistance is the most likely cause of high levels of testosterone. Treating underlying insulin resistance is one of the most effective ways to reverse all PCOS symptoms.
What About Endometrial Cancer?
One reason that this pill is often claimed to be a ‘treatment’ for PCOS is because it can help to reduce the associated risk of endometrial cancer. It’s thought that irregular periods and a lack of bleeding causes a build up of the uterine lining, which can increase the risk of endometrial cancer.
Although not bleeding does increase the risk, endometrial cancer is actually quite rare. Based on recent data, there were only 25.7 cases of endometrial cancer per 100,000.
Conversely, a recent study in 2017 has shown that hormonal contraception increases the risk of breast cancer, especially with long term use. The study of 1.8 million women (followed for 11 years on average) found a 9% increased breast cancer risk among women taking hormonal contraceptives for under a year, and up to 38% increased risk if more than 10 years. As there are 124.9 cases of breast cancer per 100,000 women, the risk of long term use of hormonal contraception arguably outweighs the reduced risk of endometrial cancer.
There are risks with using hormonal contraception, and there are risks form not getting your period. My preferred method is to identify and treat the reason why you’re not ovulating naturally. .
But I Need Contraception, What Are My Non-Hormonal Options?
Contraception is a very personal choice and you need to make the choice that’s right for you. Hormonal birth control is a very effective and convenient contraceptive and this might be the right choice for you. My intention for writing this article is not to try and convince you not to use it for contraception, but instead help you see that it’s not ‘regulating your cycle’. However, if you do want a non- hormonal contraception, here are your options.
Fertility Awareness Method
Now, before you dismiss the fertility awareness method (FAM) as mere hope-contraception, hear me out! Studies have shown that the fertility awareness method is 98.2% effective for contraception. This is very similar to the pill.
You are only fertile for about six days, each cycle. The fertility awareness method uses fertility signs, such as cervical mucus and temperature, to confirm these fertile days. On these days you can use barrier protection methods (see below) or good old abstinence.
The caveat that the researchers gave when looking at the effectiveness of FAM is that ‘the right education must be given’. A good place to start learning about the fertility awareness method is the book, ‘Taking Charge of your Fertility’. The added bonus of practising FAM is that you’ll learn how to accurately detect when you’re ovulating, which is important if you do want to get pregnant in the future. A recent Australian study found that 87% of women who had been trying to conceive for a year, didn’t accurately know when they were ovulating (even though they thought they did).
If the fertility awareness method seems a little bit daunting, then another option is the Copper Coil or Copper IUD. The Copper IUD is 99.4% effective, making it the most effective form of birth control.
I’m a fan of the copper IUD because it is the only long term contraception method that doesn’t contain hormones or switch off ovulation. Instead, the copper IUD works by making your uterus an uninhabitable place for sperm.
Studies have shown that because you never actually stop ovulating, your fertility returns to normal as soon as the IUD is removed. This is important aside from the fertility aspect, as ovulation is also crucial for your health. It is the only way your body has of making natural progesterone. Progesterone is essential for cardiovascular health, promotes hair growth, mood and energy levels, protects against breast cancer and osteoporosis.
The downsides of the copper IUD is that it may cause heavier and more painful periods. However studies have shown that for a lot of women this decreases after 12 months.
Barrier Methods: Condoms and Diaphragm
Humble condoms are often overlooked as a viable long-term birth control method. But they’re actually 98% effective when used correctly. Unfortunately, even though condoms are the only contraceptive method that can also prevent STDs, they’re one of the least popular birth control methods. This is possibly due to the risk of breakage and reduced comfort.
The HEX condom, which is touted as the world’s first unbreakable condom, is aiming to change that. Designed in Sweden (of course), it uses a great design aesthetic which not only makes it stronger, but also thinner and able to ‘deliver more sensation’. Although it’s quite new on the market, it’s already been getting some great reviews.
The diaphragm and spermicide combination is another barrier method which is less well-known. The diaphragm is a shallow saucer-like silicon cup that you insert inside your vagina to cover the cervix and stop sperm from meeting your awaiting egg. It is most effective when used with spermicide which kills sperm. However, it is slightly less effective than condoms, at 92-96% effectiveness.
How Can I Reduce My Androgen Hormones Naturally?
For 70-80% of women with PCOS, insulin resistance is the likely cause of high levels of testosterone. Treating the underlying insulin resistance is really effective reversing all PCOS symptoms. There’s a lot of research into natural remedies that can help to treat insulin resistance.
I would really encourage you to come join us in The PCOS Protocol – our program to help you understand what’s likely stopping your body from ovulation naturally (as well as all the other symptoms: hair loss, hirsutism, acne, weight gain etc), and then what the most important things you can do are.