Polycystic ovary syndrome—aka PCOS— is the most common endocrine disorder, but we still don't fully understand why it happens. It predominantly affects women of reproductive age, and it manifests in the form of chronic inflammation, irregular menstrual cycles, weight issues, fertility problems, acne, and excess facial and body hair.
Ob-gyn Felice Gersh, founder/director of the Integrative Medical Practice of Irvine and author of PCOS SOS! A Gynecologist's Lifeline to Naturally Restore Your Rhythms, Hormones and Happiness (out this fall), says that PCOS is a normal variation of women that's been exacerbated by the endocrine disruptors we're exposed to on a daily basis. Back in ancient times, she says, slightly elevated levels of testosterone would have been a survival mechanism. But now, women who have this underlying tendency find that it manifests in much more severe ways because of our environment.
That's what makes choosing a birth control when you have PCOS complicated. You're dealing with a hormonal system that is irregular. There's no one-size-fits-all approach to the best birth control for PCOS, but there are some general guidelines you can use so that when you visit your ob-gyn you're armed with knowledge.
First, it's important to understand the role of hormones in women with PCOS. "Estrogen is the master hormone that regulates all the female body," Gersh says, adding that contrary to popular belief, women with PCOS actually have a reduced amount of estrogen—not an elevated amount. When their body tries to create more estrogen, it ends up making more of the hormone LH, which stimulates testosterone production. In essence, the balance of hormones is off.
Another thing that contributes to increased levels of testosterone is inflammation. Gersh says studies have shown that women with PCOS have an impaired gut barrier function, which messes with everything from the immune system to inflammation levels, and drives metabolic dysfunction and high levels of insulin. These elevated insulin levels drive testosterone production and can also lead to weight gain.
If you have PCOS and you want to go on birth control to either treat your symptoms or prevent pregnancy—or both!—choosing your method can be tricky. Gersh says to stay far away from birth control pills. "The common remedy is birth control pills. That's a very poor choice," Gersh says. Because women with PCOS don't have proper estrogen, she explains, they're more prone to blood clots. One of the risks of birth control pills is also blood clots, and combining the two is a "recipe for potential disaster," according to Gersh. She also notes that women with PCOS have higher rates of anxiety and depression—two other risk factors of the pill.
She also doesn't recommend implants or IUDs, because they foster hormonal imbalances. She emphasizes that reproduction isn't a tacked-on feature of the female body. It's integrated into the whole and should be treated as such. "The optimal birth control doesn't exist," she says. But for now, we have to work with what we have—especially because an unwanted pregnancy isn't an optimal outcome, either.
The best birth control method for PCOS, then, is going to be barrier methods like condoms and diaphragms, according to Gersh. However, it should be noted that these need to be used correctly to prevent pregnancy. She also says that a copper IUD (which doesn't contain hormones) is another option for women with PCOS looking to prevent pregnancy. There are limitations to this method, though. While a copper IUD is highly effective at preventing pregnancy, copper is inherently inflammatory, and women with PCOS are already dealing with high levels of inflammation.
Certain lifestyle changes can help manage the symptoms of PCOS. She recommends changing up your eating habits and trying the ProLon intermittent fasting diet, which has been shown to help reduce inflammation. She also recommends resveratrol supplements. Resveratrol is an antioxidant that has been shown to help lower testosterone. And because women with PCOS often have reversed circadian rhythms, she says supplementing with melatonin can be beneficial. Gersh says treating PCOS with hormonal birth control is just a way to cover—not treat—the underlying issues. And you can only cover them for so long. She advocates for more research into better birth control options for women, and we're wholeheartedly on board.