The pill is often prescribed to women already with polycystic ovarian syndrome but does it actually assist with pain relief?
I WAS 14 when I was first prescribed the contraceptive pill for my cystic acne. Over the decade that followed, I tried several variations and brands of ‘the pill’ for an assortment of presenting symptoms as I progressed from my early to late teenage years and into adulthood.
Like me, most women who have sought medical intervention for birth control, acne, irregular periods and hormonal issues would be familiar with the uncomfortable downsides of the pill. Abnormal bleeding, weight gain, nausea and mood swings are just a few of the side effects found on the exhaustive list of caveats folded and neatly packed alongside a typical box of 28 tablets. One that’s not listed, however, is its effect on women susceptible to Polycystic Ovary Syndrome (PCOS).
The pill is often prescribed to women already diagnosed with the condition as a form of bandaid patched over the myriad of symptoms that come with it. But it has also been debated as to whether taking the pill can actually cause PCOS in women who have not yet been diagnosed. With this in mind, I turned to the experts to investigate the pill’s effect on PCOS.
Related: Eight signs you may have Polycystic Ovarian Syndrome
What is PCOS?
Senior gynaecologist and University of Melbourne associate professor Dr Alex Polyakov explains that this complex hormonal disorder affects only about 1 in 20 women of reproductive age, despite about 1 in 5 having polycystic ovaries.
For a diagnosis, at least two of three symptoms must be present: polycystic ovaries; irregular periods; and increased levels of the male-associated hormones known as androgens — this manifests in the form of high testosterone levels on blood tests, or through symptoms such as acne, excess facial and body hair, or even signs of male pattern hair loss.
“You also have to run a whole lot of blood tests to look at other conditions that may mimic PCOS like thyroid dysfunction or various other hormone abnormalities,” Dr Polyakov notes. “Some women will have fertility issues and metabolic disturbances like insulin resistance and weight gain, and also mood disorders as women with PCOS are more prone to depression and anxiety in the long term.”
So what does living with PCOS actually look like? Speaking to BAZAAR, Melbourne writer and editor Jasmine Wallis says the first signs showed up as painful periods at 15 years old — so painful she would vomit and miss school. After years on the pill, followed by three months off it at 18 years old, other symptoms rose to the surface including angry, red cystic acne, dark hair on her upper lip and an absence of her period.
“The doctor diagnosed me quickly as she said I had the ‘triangle’ of symptoms for PCOS,” says Wallis. “Over the next couple of years I battled my PCOS symptoms daily. At 19, my hair began falling out in clumps in the shower and I noticed my hairline receding. As someone who’s always had thick, healthy hair, it was devastating. My weight and energy levels fluctuated and I was having panic attacks almost weekly.”
Related: Period syncing: A true biological phenomenon or a reassuring myth?
How does the pill help PCOS?
While there is no definitive cure for PCOS, the pill is often prescribed to sufferers as it can help with numerous symptoms, both externally and internally. Women’s Health Melbourne director, gynaecologist and fertility specialist Dr Raelia Lew explains that one of the key ways in which the pill aids women diagnosed with PCOS is by preventing a precancerous condition known as endometrial hyperplasia.
“When a woman with PCOS is not regularly ovulating, her oestrogen levels are elevated for a prolonged period of time and that can cause endometrial — the lining of the womb — thickening which can cause very heavy periods,” says Dr Lew. “The pill keeps (the lining) thin and protects it against that precancerous change called endometrial hyperplasia, and that’s very important for future fertility.”
Another reason the pill is prescribed to treat PCOS is to help “mop up” any free testosterone that may be causing symptoms like excess hair growth and acne. It can also help to regulate periods and allow you to skip a period without the risk of endometrial thickening. Contraception is an added bonus, too, of course.
Related: Nine signs you might have an ovarian cyst
Can the pill actually cause PCOS?
Despite common myths and debates surrounding the contrary, Dr Lew affirms that the pill does not cause PCOS. However, she admits it is a band-aid solution. “It’s a good band-aid, it does a good job at what it’s supposed to do,” says Dr Lew. “But it’s not a cure.”
On the other hand, Dr Polyakov believes the pill is not a band-aid approach in that PCOS largely affects younger women. “As women get older, the number of follicles or cysts in the ovaries decreases,” he says. “So some women might have PCOS in their 20s but once the ovaries reduce in size in their mid to late 30s they might find they no longer have PCOS.”
The pill can also mask PCOS symptoms in someone who is yet to be diagnosed, where these characteristics develop while medicated and only come to the surface once ceasing medication, such as in Wallis’ case. Although she took a break from the pill initially, Wallis explains that she used the medication periodically for years to help with her symptoms.
“The pill helped the period pain but my acne and hirutism (hair growth) remained,” she says. “By the time I was 23 I decided that I’d had enough of the pill full stop. I know it works for some women but for me, I was worried it was being used as a band-aid to cover my hormonal imbalance, not get to the root cause of it. I also felt brain fog and like I had no idea what was going on in my body.”
Related: Everything you need to know about period underwear, and the six best brands to buy
Are there any alternative treatments to the pill for PCOS?
According to Dr Polyakov, the pill is the absolute first line approach to treating PCOS symptoms in a woman who doesn’t plan to get pregnant. However, Dr Lew has a slightly different outlook.
“I would say that almost in every circumstance, diet and lifestyle should be the first line intervention with PCOS,” she says. “There are definitely things we can do before turning to medication to treat PCOS holistically.”
It’s for this reason Dr Lew works alongside fertility naturopath Georgia Borowski to assist patients seeking alternative treatment to the pill, such as dietary changes and herbal and vitamin supplements. “Don’t underestimate how important diet and lifestyle is when treating PCOS … whether that be regular exercise or supporting stress and blood sugar,” Borowski says.
Borowski adds that about 70 per cent of her PCOS patients are also insulin resistant, therefore balancing their hormones and blood sugar can help tremendously with symptoms in the long term.
Likewise, Wallis was also able to ease her PCOS symptoms with the aid of a nutritionist and acupuncturist. Now in her late 20s, she is completely pill free and was able to get her period back to a regular cycle naturally. Although she experiences inflammation when eating excess amounts of sugary foods, processed carbohydrates, caffeine or alcohol, Wallis explains that she manages her flare ups through skincare, diet and exercise.
“I get laser hair removal on my face, neck and snail trail to combat the hirutism,” she adds. “Exercise helps a lot as well and I’m very aware of my period — if it’s too painful, too heavy, too short or long, I make some lifestyle adjustments to try to get balanced again.”
Related: Five signs you have a hormone imbalance, according to an expert
more from
features
What actually is the luteal phase?
