Three Reasons Why ‘The Pill’ Is Not An Effective Treatment For PCOS
Have you been prescribed ‘the pill’ or another form of hormonal contraception as a treatment for PCOS, either to reduce testosterone or to ‘regulate your period’?
I was. I obediently listened to the advice given and went along with it. However, it was only after much research that I found out that it was actually making my PCOS worse, not better.
There is no doubt that hormonal birth control methods, such as the pill, the Mirena IUD, and the depo injection (hereafter also referred to as ‘the pill’) are convenient methods of birth control. However, the pill can also cause long term changes to your fertility hormones and increase insulin resistance.
Here are three reasons why the pill is not an effective treatment for PCOS:
1. 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.
2. A Pill Cannot ‘Regulate your Period’
The pill is often prescribed as a ‘treatment’ for PCOS, helping to regulate periods. Unfortunately, the pill is unable to actually regulate periods. Instead, it merely results in a facade of a regular period. A real period is withdrawal bleeding caused by estrogen and progesterone. The bleeding caused by the pill is withdrawal bleed caused by the chemicals ethinylestradiol, levonorgestrel, and drospirenone.
The effects may seem subtle, but the pill may actually be causing huge changes. What’s more is that as soon as you remove the synthetic hormones, you’re back to not having a period at all. Now you might also have developed insulin resistance too, which further exacerbates PCOS.
Many women with PCOS still ovulate. If you are able to tell when you are ovulating then this can help with fertility, especially if you want to get pregnant at some stage. Another thing that the pill does is stops ovulation. This means that you won’t know if you’re ovulating, and therefore whether you are fertile.
3. 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. The only safe bet is to get your period naturally, and the this fits my preferred method of treatment: to try and reverse the root cause of why you’re not getting your period in the first place and fix your fertility that way.
I Need Contraception, What Are My Non-Hormonal 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. It also has the .
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 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 also strongly advise that you seek the assistance of a functional nutritionist or naturopath. Ideally, one who is also an expert in PCOS. They will be able to create a treatment plan for you based on your hormone profile and blood tests. Using specially-tailored herbs and micronutrients, you should start ovulating again.