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PCOS - why I don't like prescribing birth control pills

Updated: Sep 8, 2021

PCOS (Polycystic ovary syndrome) is diagnosed when a women has irregular, infrequent periods and high levels of male hormones. The ultrasound diagnosis of multiple follicles in the ovaries alone is not diagnostic and in my opinion not necessary to make the diagnosis of PCOS.

The conventional treatment of PCOS is to suppress the ovulation with the birth control pill and to create pill withdrawal bleeding which make the patient feel they have a period. However, those bleeds are NOT real periods and by being on the pill, we never find out when the patient would actually have a real ovulation. The pill also increases SHBG (sexual hormone binding globulin) which binds the circulating androgens and makes the testosterone levels go down. That can improve acne and hair growth for patients. Unfortunately, the pill doesn’t address the root cause of the disease and suppressing ovulation doesn’t help the body either. And when you come of the pill, your ovulation can be suppressed for many months after (post pill amenorrhea) and the androgens bounce back even higher in some cases (post pill acne). That’s why some women develop new PCOS - simply from stopping the birth control pill. Additionally, birth control pills worsen inflammation, nutrient depletion and auto immune disorders all of which can contribute to PCOS (see my blog post on the pill).

Another conventionally used treatment is spironolactone which suppresses androgens but unfortunately also prevents healthy ovulation and when you stop it, the acne and hirsutism that return are even worse.

Hormone doctors (endocrinologists) and OBGYN doctors also love prescribing metformin. Metformin is a diabetes drug. It’s a more reasonable approach than the pill for those with PCOS who have insulin resistance, a driving force behind PCOS. But metformin has it’s own dangers: it can cause metabolic acidosis, be toxic to your liver, cause digestive problems and deplete your body of Vitamin B12. There are other ways of addressing insulin resistance through life style changes. For those unwilling to do those changes metformin can be an option but it only works as long as you are taking it. Furthermore, studies show that while metformin can help with menstrual irregularities it has limited benefit in treating hirsutism, acne or infertility.

By addressing the root cause of your insulin resistance, you lower your body's inflammation and have longer lasting effects than with any medication.

What is a natural approach to PCOS:

First you need to know the drivers of your PCOS: is it insulin resistance? Is it chronic inflammation? Did it happen after stopping the pill? Does your adrenal gland produce too many male hormones?

Together, we perform certain tests to figure out the cause of your PCOS. To check for insulin resistance we need to test you fasting insulin and glucose challenge test you.

If insulin resistance is the cause, then we need to address “sugar addiction”, unhealthy diet choices and lack of exercise. If it’s chronic inflammation causing your PCOS symptoms, we need to talk about your gut health and inflammatory foods. To check your adrenal gland, I order specific hormone tests.

There are multiple nutrients and supplements that I prescribe for my patients with PCOS. Those include zinc, magnesium, B vitamins, licorice, NAC, melatonin, and many more, however those treatments need to be tailored to your needs. There isn’t a “one size fits all” solution and I recommend you search the root cause of what led to your condition.

Book an appointment to discuss more details.

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