PCOS: The Oral Contraceptive Pill

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Adolescent girls and young women are frequently prescribed oral contraceptive pills (also called the "Pill") for Polycystic Ovary Syndrome and for irregular or absent menstrual periods, menstrual cramps, acne, PMS, and endometriosis. Oral contraceptive pills lower hormone levels in girls with PCOS and regulate their menstrual periods. Hormone patches (Ortho-Evra, Xulane) and vaginal hormone ring (NuvaRing) can also help lower the hormone levels in girls with PCOS.

What are oral contraceptive pills?

Oral contraceptive pills contain two types of synthetic female hormones, progestin and estrogen. Similar hormones are made by the ovaries. There are many different kinds of oral contraceptives.

What are some of the possible medical benefits of oral contraceptive pills for young women with PCOS?

  • Regular and Lighter Periods: Oral contraceptive pills can help to regulate your menstrual cycle so your period comes about every 28 days or less often on extended pill cycles. The Pill usually causes lighter periods, too. This is important because not having your periods may result in excess growth of the lining inside your uterus, called the endometrium. Excess growth can lead to prolonged and heavy periods, or eventually a condition called endometrial hyperplasia. This is a precursor to endometrial cancer, therefore it is very important to ensure the endometrium is being shed in a daily or cyclic fashion.
  • Less Unwanted Hair: Oral contraceptive pills can lower androgen hormone levels and lessen the amount of excess hair growth (also called "hirsutism"). It can take 6 months before there's a decrease in unwanted hair on the face, chest, back, and stomach.
  • Clearer Skin: Oral contraceptive pills can improve acne. The hormones in most types of the Pill can help stop acne from forming. Be patient though, it can take a few months to see an improvement.
  • Fewer or Milder Cramps, or No Cramps:Oral contraceptive pills can help to lessen menstrual cramps.
  • Other Medical Benefits: Because there is less menstrual bleeding with the use of oral contraceptive pills, girls taking the Pill are less likely to become anemic. Oral contraceptive pills also decrease your chance of getting endometrial (lining of the uterus) cancer, ovarian cancer, and ovarian cysts.

What are the possible side effects of the oral contraceptive pill?

Most women have no side effects when taking the oral contraceptive pill, but it's possible to have irregular periods, nausea, headaches, or weight change. Each type of oral contraceptive pill can affect a young woman differently.

  • Spotting (you usually don't need to use a regular pad, just a panty shield) or very light bleeding: This may occur during the first 1–3 weeks of starting the Pill, or if you miss a pill. If the bleeding becomes heavier or lasts more than a few days or the bleeding happens after you have been on the pill for a few months, you should talk with your health care provider.
  • Nausea (or feeling like you need to throw up): Nausea occasionally occurs when you first start taking the Pill and will often go away in a few days. It is less likely to occur if the Pill is taken after dinner or with a bedtime snack.
  • Headaches: Headaches may occur because of stress at school or home, too little sleep, sinus infections, or migraines. The Pill can make headaches better or worse. If your health care provider thinks your headaches are related to the Pill, he/she may prescribe an oral contraceptive pill with a lower amount of estrogen or have you stop the Pill for a short time. If you have migraine headaches, talk to your health care provider about whether the Pill is right for you.
  • Mood changes: Feeling up and down emotionally can sometimes happen to anyone and is unlikely to be caused by the Pill. Exercising regularly and following a healthy diet may help along with talking to a counselor. Make sure you let your health care provider know how you are feeling.
  • Sore or enlarged breasts: Sometimes, your breasts may become tender and/ or get larger, but usually they will stay the same.
  • Weight change: Some teens gain weight and some teens lose weight while on the Pill, but most stay exactly the same. Remember to choose healthy foods, watch your portion sizes, drink lots of water, and get plenty of exercise.
  • Blood clots: A blood clot in your leg or lung is a very rare, but a serious side–effect. If you suddenly have pain or swelling in your leg, or shortness of breath and chest pain, see your health care provider right away. If you have a history of blood clots, you should not take the Pill. Tell your health care provider if any of your relatives have ever had blood clots, especially when they were young. Blood clots are more likely to develop if you are a smoker, overweight, having surgery, have a family history, or sitting on a plane for a long time. To lessen your chance of blood clots, don't smoke, and if you're on a long plane trip, get up, walk around, and drink lots of water. If you have a family history of blood clots, talk to your HCP. If you're scheduled for surgery, talk to your health care provider about stopping the Pill for 3–4 weeks before surgery and after the surgery until you have recovered.

If side effects from the Pill occur, they're usually mild and go away in the first three to four cycles. If you do have side effects, talk with your health care provider. If the side effects are uncomfortable or if they don't go away, your health care provider may switch you to a different kind of oral contraceptive pill.

Are there any reasons why I shouldn't take the oral contraceptive pill?

Most teens can take the oral contraceptive pill for PCOS, but for some, taking the combined Pill (with both estrogen and progestin) is not an option because of certain medical conditions, called "contraindications." If you can't use the combined Pill, your health care provider will talk to you about other medications to treat your PCOS.

Reasons why you should NOT take combined oral contraceptives:

  • History of blood clots Migraine headaches with aura (spots and flashing lights or difficulty seeing 5 to 30 minutes before the headache starts), or neurological symptoms (numbness, loss of speech)
  • Certain kinds of heart disease
  • High blood pressure that is not controlled with medication
  • Active hepatitis (liver disease) – for starting the Pill
  • Jaundice (yellowing of your skin or eyes during a previous pregnancy)

Taking the Oral Contraceptive Pill

The most common pill packs come with 21 active hormone pills and seven placebo pills, but some packs have 24, 26, or even 28 active pills. The example shown is for a 28–day pill pack in which you take 21 active hormone pills, and then seven placebo pills that contain no active hormones. These last seven pills are just "reminder" pills in most pill brands. They are taken during the fourth week, including during your period. With packages that have 24 active pills, the last 4 are "reminder" pills. There are also pill packages that have 84 active pills for extended continuous hormones and 7 "reminder" pills. Your health care provider will tell you whether you will be taking the active pills continuously or in cycles as shown below.

How to take birth control pills

How to take birth control pills

  1. To take the oral contraceptive pill, follow the instructions on the package. Your health care provider will explain how to use your pill pack. You will be told to start taking the oral contraceptive pill on a Sunday, on the first day of your menstrual period, or the day you are seen by your health care provider.
  2. You should take one oral contraceptive pill each day, at the same time of day until you finish the pack. Take the Pill at the same time as something that you do regularly so you don't forget. For example, you could keep them near your toothbrush, or set your cell phone alarm as a reminder. The best time is ½ an hour after a complete meal such as dinner, or at bedtime. You may have slight nausea the first month, but this usually goes away with time. Some young women who take the Pill first thing in the morning find that they are more likely to have nausea, especially if they skip breakfast, so taking the pill after dinner or at bedtime may cure this symptom.
  3. After completing a 28–day pack, you should immediately start a new packet of pills the next day. During your fourth week on the pill cycle, you should get your menstrual period. Your menstrual period should stop once you begin the new packet of pills.

If your hormone levels continue to be high or your excess hair growth doesn't improve, your health care provider may re–check your hormone levels, or may suggest that you take the Pill continuously. This means that you would take just the "active pills" for 3–4 months or longer. You would not have a menstrual period until you stop taking the active hormone pills. Some girls may have spotting while taking the Pill continuously.

The Oral Contraceptive Pill & PCOS FAQs

Do I need a pelvic exam before going on the oral contraceptive pill?

No. Although it's important for teens to have checkups as part of their general health care, a pelvic exam is not needed for girls with PCOS just to start oral contraceptive pills. Girls with PCOS may have an external genital examination or a pelvic exam as part of their first visit for PCOS, and/or they may have a pelvic ultrasound to look at their ovaries.

Is there any trouble getting pregnant after using the oral contraceptive pill ?

There is no change in fertility with the use of the oral contraceptive pill. However, if you have PCOS and your periods were irregular before you started taking the Pill, it is likely that your periods will be irregular again when you stop taking it.

Does the oral contraceptive pill cause birth defects?

No, the Pill does not cause birth defects or affect the health of future children.

Does the oral contraceptive pill cause cancer?

No. The Pill actually protects against cancer of the ovaries and cancer of the lining of the uterus. A woman is half as likely to get cancer of the uterus or ovaries if she takes the Pill. Most experts believe that taking oral contraceptive pills does not cause any increased risk of developing breast cancer. Even girls with a family history of breast cancer can take the Pill.

How long can I be on oral contraceptives?

It's safe for you to be on the Pill for years, whether to regulate your menstrual cycle, treat your cramps, or as hormone replacement or birth control.

Do I need to take a break from the Pill?

There's no medical reason that you need to take a "break" from the Pill.

What if I am also using the oral contraceptive pill for birth control?

If you're also taking the oral contraceptive pill for birth control, you should know that oral contraceptive pills do not protect you from sexually transmitted infections. Condoms help to prevent most sexually transmitted infections and they are also an important backup method of birth control if you miss more than one pill in a row, or if you are sick (vomiting). All of these things can lower the effectiveness of the birth control pill. Whenever you get a new medication, ask if it changes the effectiveness of your oral contraceptive pill.

What if my period is very light while I'm taking the oral contraceptive pill?

Your period may be so light when you are on the oral contraceptive pill that you may have only a brown smudge on a tampon, pad, panty shield, or underwear. The amount of hormones in the pills is very low. This means that the lining of your uterus doesn't become very thick, so very little blood needs to come out each month.

What if I forget to take one or more combined oral contraceptive pills?

  • If you miss 1 Pill, take the pill as soon as possible and then continue taking your pills at the usual time. You may take 2 pills on the same day (one at the moment you remember and the other at the regular time) or even 2 at the same time.
  • If you miss 2 or more active pills in a row, take the most recently missed Pill as soon as possible and then continue taking your pills at the usual time. You may take 2 pills on the same day (one at the moment you remember and the other at the regular time).If you are sexually active, use a backup method of birth control, such as condoms, or do not have sexual contact until you have taken the active hormone pills for 7 days (1 pill every day for 7 days in a row.)
  • If you missed the active pills in thethird week, don't take theinactive (hormone free pills). Instead, finish the currentactive hormone pills and then start a new pack right away. If you can't start a new pill pack right away and you are sexually active, use a backup method of birth control (such as condoms) or do not have sexual contact until you have taken active pills for 7 days (1 pill every day for 7 days in a row).
  • Talk to your health care provider about whether you should use emergency contraception, especially if you missed pills in the first week of the package, or had unprotected sex anytime during the past 5 days.

Emergency contraception is recommended if you've had unprotected intercourse during the time you missed your pills.

  1. The first "morning–after" emergency contraception pill methods approved in the United States are: Plan B One–Step™, Next Choice®, and MyWay®. These products contain one kind of hormone, a progestin, and come as 1 or 2 pills. EC works best if taken within 3 days (72 hours) of unprotected sex, but can be taken up to 5 days but the earlier it is taken the more effective it is. No prescription is needed. Anyone can buy it without needing to show an ID. It prevents ovulation; it does not affect pregnancy or work after ovulation. It might be less effective in overweight women.
  2. Ella™ (ulipristal acetate or UPA) is an emergency contraceptive that works by stopping or delaying ovulation. It's one pill (one dose) that can be taken up to 5 days or 120 hours after unprotected intercourse. A prescription is needed. It's best to check a pregnancy test first.
  3. Another type of emergency contraception uses regular birth control pills, which contain two hormones, estrogen and progestin. There are 2 doses. The first dose may be 2, 4, or 5 pills depending on the brand of birth control pills used, and is taken within 120 hours (5 days) of unprotected sex. The second dose is taken 12 hours after the first dose. A health care provider must prescribe how many pills should be taken for this kind of emergency contraception. This method is less effective than the other two, and is more likely to cause nausea. So you are unlikely to use this medication.

Are there any serious side effects that I should be worried about?

Most young women who take the oral contraceptive pill have few or no problems. If you do have any of the following problems, call your health care provider right away.

Remember: ACHES

  • Abdominal or stomach pain (severe)
  • Chest pain (severe), cough, shortness of breath
  • Headache (severe), dizziness, weakness, or numbness
  • Eye problems (vision loss or blurring), speech problems
  • Severe leg pain (calf or thigh)

The oral contraceptive pill is much more than a birth control pill. Adolescent girls and young women are frequently prescribed the oral contraceptive pill just for its medical benefits. It's a very safe and effective treatment for many types of medical problems, including PCOS, irregular menstrual periods, menstrual cramps, acne, PMS, and endometriosis.