HEALTH TIPS: POLYCYSTIC OVARIAN SYNDROME (PCOS) – Part 4 – ‘Never Choose Indifference’

Dr Tariq Jagnarine
Fam Medicine, Endocrinology / Diabetes

Oral contraceptives
Oral contraceptives are the most common and the most effective option used to manage PCOS symptoms. There are two types of oral contraceptives: combination pills and progestin-only pills. Both types of birth control are effective for treating PCOS symptoms, and can help patients to:
• Ovulate regularly – release an egg every 28 days
• Have regular periods
• Have lighter periods
• Reduce cramping
• Have clearer skin
• Lower the risks for endometrial cancer, ovarian cancer, and ovarian cysts
• Reduce extra hair growth
Most women who have PCOS don’t experience side effects when taking the pill, but different types of birth control affect users differently. They may experience one or more of the following:
• Mood changes – mild to moderate
• Possible weight gain or loss
• Nausea
• headaches
• Sore breasts
• Some spotting
Combination pills
Combination pills contain estrogen and progestin, two synthetic hormones similar to the ones made by the ovaries. The amount of hormone present varies from brand to brand. The best approach is to opt for low- or high-dose formulations. For example, low-dose combination pills contain about 20 micrograms (mcg) of estrogen. High-dose birth control pills typically have between 30 and 35 mcg of estrogen.
• Progestin-only pills
Progestin-only pills, known as mini pills, are an effective alternative for women who have PCOS and are unable to take combination birth control pills. PCOS causes women to have low levels of the hormone progesterone. Progestin-only pills increase their progesterone, which would cause them to have regular periods and lower their risk of endometrial cancer. Progestin-only pills can contain up to 35 mcg of synthetic progestin.
• Skin patch
The contraceptive patch is a thin plastic patch that contains estrogen and progestin. Wear the patch for 21 days, remove it for seven days to allow for a menstrual period, then replace it with a new patch. Like the pill, the patch has the same functions and side effects.
• Vaginal ring
The contraceptive ring (NuvaRing) is a soft, flexible plastic ring that is inserted into the vagina. It is worn for 21 days, removed for seven days to allow for a period, and then replaced with a new one for the next month. Works Like the pill and the patch.

Combination birth control — whether in the form of a pill, ring, or patch — is the most popular and recommended form of treatment for PCOS. If someone is unable to take the combination pill or use other combination methods, then it is recommended to use the progestin-only pill. There are also other alternatives, including:
• Progesterone therapy: Use of progesterone for 10 to 14 days every one to two months. This treatment doesn’t prevent pregnancy or improve androgen levels, but it can help manage PCOS symptoms.
• Progestin-containing intrauterine device (IUD) and IMPLANTS: IUDs and Implants that contain progestin can help ease the symptoms of PCOS in the same way combination or progestin-only pills do.
• Metformin: This medication for type 2 diabetes lowers insulin and androgen levels and improves insulin resistance. Insulin resistance commonly occurs with PCOS, and metformin might be used to treat this. It isn’t approved by the U.S. Food and Drug Administration to treat PCOS specifically, so this is considered off-label use; but research has shown that it may help restart ovulation and lead to regular periods.

• Using birth control to protect against pregnancy
Although PCOS is the leading cause of infertility, it affects every woman differently. Some women may become infertile at a young age, and others may find that pregnancy is still possible.
On average, the birth control pill is about 91-99% percent effective at preventing pregnancy. This means that about 9 out of every 100 women using the pill will become pregnant each year. Missing a dose increases one’s risk of pregnancy. Set a reminder on a phone app to help remember to take the pill at the same time every day.
Those with PCOS can speak with a health care provider about treatment options that are optimal, considering the following:
• Ease of use: think about what type of oral contraceptive would be easier to use. If it may be hard to take a pill every day, then the ring or patch may be a better option.
• Side effects: Most hormonal birth control options share similar side effects. Health care workers may be able to recommend one over another, if you have concerns. It may take trying a few different options before you find the one that is best for your body and your lifestyle.
• Cost: If you can, check in with your insurance company to find out whether any birth control methods are covered, and what your out-of-pocket costs may be. If you’re uninsured, talk with your doctor about patient assistance programmes.
PCOS is a complex condition. The central mechanism is difficult to understand and state. Thereby, no treatment can be claimed as a magic bullet, as it targets the clinical symptoms rather than curing the syndrome. Alternative drugs such as herbal or medicinal plants should be considered by knowing their mechanism of action. Improvising lifestyle could ease the PCOS-related symptoms.