Use of the Pill (combined oral contraceptive pill) has dropped by over 20% in the last 10 years and a significant part of this decline is due to young women relying on Social Media and, specifically, Dr TikTok, for advice about contraception. The pill has been around for 60 years and is an established and effective method of contraception. It was a game changer for young women in the 1960s who were suddenly free from the constant fear of unwanted pregnancy during a time when there was no legal termination of pregnancy, no financial support for ‘unmarried mothers’ and widespread social stigma for babies born ‘out of wedlock’.
The Pill contains both oestrogen and progesterone which prevent ovulation occurring and prevent pregnancy with a 99% effectiveness. It also keeps the lining of the womb (the endometrium) thin and therefore helps in the management of gynaecological conditions such as endometriosis (which can cause heavy, painful periods), premenstrual syndrome or in regulating the cycle in women with PCOS.
Can the pill be used to manage PCOS symptoms?
The Pill is one of the most common and effective methods for managing key symptoms of PCOS such as irregular and heavy periods and high testosterone levels which cause acne and excess hair growth. Before we look in detail about how the Pill works and how it can help with the symptoms of PCOS, I need to debunk some of the myths about the Pill that have resulted in an increase in women switching to other less reliable methods of contraception and, inevitably, an increase in unplanned and unwanted pregnancies. Now 20% of UK pregnancies end in an abortion, notwithstanding the wide availability of the ‘morning after’ pill.
What are the side effects of the contraceptive pill?
Like all medicines, the Pill can have some unwanted side effects such as mild weight gain, headaches, mood swings and a small increased risk of blood clots. But do remember that pregnancy, especially if ‘accidental’ also causes weight gain , headaches and blood clots! These side effects of the Pill vary between users, often disappear after a few months of use and can usually be cured by switching to a different formulation of Pill. We are now in the Fourth Generation of Pill which has much lower levels of oestrogen (which caused the metabolic side effects) and there are new progesterones which are more strongly anti-androgenic and therefore more effective in dealing with the acne and hirsutism (excess hairiness) that can come with PCOS.
So what are these myths about the pill that need debunking?
Does the pill cause cancer?
No! There is a slightly increased risk of breast cancer in long term Pill-takers, BUT family history, drinking alcohol and being overweight are equivalent risk factors. The risk reverts to normal 10 years after stopping taking the Pill. Women who take the Pill are less likely to use barrier contraception and so have a small increased risk of cervical cancer but, hopefully, the HPV jab that teenagers get nowadays should soon make this disease a thing of the past.
Pill taking actually protects against endometrial (womb) cancer especially in women with PCOS and ovarian and colorectal (bowel) cancer.
Does the pill reduce your sex drive?
In women, libido (sex drive) is related amongst many factors to do with moonlight and roses to testosterone levels and suppressed testosterone has been attributed to reduced libido in about 10% of Pill taking women. This is really not a problem for women with PCOS who have slightly raised testosterone levels even when taking the Pill! For women experiencing heavy, painful and unpredictable periods taking the pill may actually help their libido by improving these symptoms.
Does the pill cause mood changes and make you depressed?
Mood swings, depression, eating disorders (especially bulimia) and feelings of low self-esteem are sometimes reported after commencing the Pill and they are relatively rare but switching to a different brand of Pill can help. All of these symptoms are recognised to occur much more frequently in women with PCOS and this is why long term psychological follow up of PCOS women is recommended by the RCOG (Royal College of Obstetricians and Gynaecologists).
Does the pill change the type of people you’re attracted to?
Some alarming reports are circulating on Social Media, claiming that taking the Pill makes women more attracted to ‘feminine looking’ men or even to women. This is just TikTok misinformation. Properly conducted large scale randomised clinical studies have shown these claims to be totally false.
Can the pill cause PCOS?
This is one of the most alarming claims raised on Social Media about the Pill. Does the Pill ‘cause’ PCOS? Definitely not!
There are two issues to consider here. Teenage girls and young women with irregular , painful periods (and possibly some ‘androgenic’ issues such as acne and hirsutism) are often prescribed the Pill to help with their symptoms and give them a light , regular period. It’s not a ‘proper’ period because there has been no ovulation, but for the 10% of all schoolgirls who have PCO it helps them feel more like their peer group and alleviates their symptoms.
Today’s young girls are often looking at ten years or more of school, then college and career training before they can even think about babies, and so PCO women may have spent a decade or more taking the Pill before the time is right to stop contraception and start trying for a baby.
For most Pill users there is little or no delay between stopping the Pill and their periods resuming. For PCOS women there may be a little more delay (up to 6 months) and then their periods, when they do restart, may be irregular and heavy. This is not the Pill’s fault!
It is just that their pre-Pill PCO menstrual pattern has returned. How many young women in their mid-20s can actually remember what their teenage periods were like, or recall how pleased they were that a daily tablet could help with their teenage acne and irregular, heavy and unpredictable bleeding?
It is well recognised that weight gain is associated with an increase in the severity of all PCOS symptoms so gaining even 1 or 2 stone may ‘tip the balance’ from mild towards moderate PCOS. One of the questions I always ask my patients with PCOS who consult for irregular periods and infertility is ‘What did you weigh when you last had regular cycles or managed to get pregnant?’
What are the most effective treatments for PCOS symptoms?
There are several effective treatments for infertility associated with PCOS that are accessible and relatively safe (such as Clomiphene tablets and gonadotropin injections) and which require medical supervision, but many PCOS women want to try therapies that will restore a normal, regular cycle and give them the opportunity to become pregnant naturally when the time is right.
All the PCOS experts agree that weight loss is an important part of managing not only the symptoms of PCOS but also the long term health risks. We know that obesity is a major factor in the epidemic of Type 2 diabetes and that this is a significant drain on NHS resources . 50% of all women who have PCOS and are overweight or obese at the age of 40 will develop Type 2 diabetes by the end of their 50s and face the associated heart health and stroke risks.
Fortunately, in addition to following a low carbohydrate ‘Mediterranean’ type diet that is high in fresh vegetables, fruit and fibre, taking supplements such as Inofolic Alpha has been shown in clinical trials to help restore cycle regularity, reduce acne and hirsutism and lower cholesterol levels in women with PCOS.
“The Mediterranean diet is recommended by many fertility nutritionists because it includes so many of the foods that are known to boost fertility. The basis of a Mediterranean diet is fresh food such as fruit, vegetables, whole grains, nuts, spices, legumes and olive oil. Extra virgin olive oil has the added benefit of being rich in healthy fats and helping to absorb fat-soluble vitamins. The focus of this diet is on whole, single-ingredient foods, rather than processed foods.”
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The PCOS supplement for women for life
