PCOS and The Pill
March 9, 2022

PCOS and The Pill

Sometimes something comes along that changes society completely. The oral contraceptive pill was one of those discoveries. It led directly to the sexual revolution and impacted the social lives of millions of women across the world, and still does.

It is the most popular medical intervention to ever exist on the planet!

Let’s take a closer look, as a lot of women take it whether they have PCOS or not.

Often, PCOS is diagnosed when the pill is stopped and a woman wants to get pregnant. She stops the pill and waits for her periods to return as expected, but they don’t. So she ends up at her GP’s office and low and behold the PCOS diagnosis is given. (This is not necessarily the case and other things may be at play, but lets simply play along with the story as it often works this way!)

So how does the pill work?

The pill contains two hormones, a synthetic oestrogen and a synthetic progestogen. The progesterone component can differ between the various brands.

They prevent ovulation by maintaining a consistent hormone levels. Without a peak in estrogen in the middle of the month, the ovary fails to signal the release of an egg. No egg, no pregnancy.

The standard treatment, as many of you would know, is to treat PCOS by putting you on the pill, especially if you are keen not to get pregnant. Two birds with one stone. We also know that using the pill will help to protect women from the small increased risk of cancer of the endometrium. It can also regulate the menstrual cycle (we all know and love that!). Some of the more modern preparations that contain the progestogen and cyproterone can help with acne and hirsutism. Yeah! Sounds like a win-win and a total no-brainer, doesn’t it?

Well, unfortunately what has been lacking over these decades is the proper examination of whether the pill exerts other long term metabolic consequences, which may increase the risk of developing other well-known long-term consequences associated with PCOS like type 2 diabetes, cardiovascular disease and fatty liver, because it seems that the pill actually might impact and worsen your insulin resistance.

Some studies show that using the pill for 3-6 months decreases insulin sensitivity and other research has shown it increases glucose dysfunction, which was more predominant in obese women. These two findings basically mean the same thing!

A recent review looking at whether women with PCOS should be on the pill was mixed and it suggested that every woman should be given the opportunity to discuss the long term implications. The review suggested that women with a metabolic dysfunction: such as insulin resistance, obesity, high blood pressure or high triglycerides, should be cautioned about their potential worsening of the underlying metabolic issues caused by the pill. Read more here and here.

At Vively we like to make sure we are using the precautionary principle and not only looking at the research but to look at the basic physiology as well. The precautionary principle basically puts safety first at every turn.

We know normal levels of oestrogen are associated with insulin sensitivity. But when oestrogen is either too high, or too low, this can lead to insulin resistance. It is the old chicken or the egg scenario. So it seems the oral contraceptive pill may impact the underlying function of the hormonal and metabolic systems and therefore may impact the underlying mechanisms at play in PCOS!

This is why we love lifestyle medicine, and try to aim to work alongside the natural physiology and metabolism of the body as best we can.

We acknowledge the use of the pill may be a clinical decision you choose to take, but using lifestyle medicine alongside your choice is invariably going to complement the underlying health mechanics.

Feel free to read more here, here and here.

Dr Michelle Woolhouse

Integrative GP and Vively Medical Director

Dr Michelle Woolhouse is an integrative GP, with over 20 years experience treating chronic conditions through lifestyle medicine