Treat PCOS Without Birth Control Or Weight Loss: Fact or Fiction?

There are a lot of things about Polycystic Ovary Syndrome (PCOS) that, quite frankly, suck. Managing the symptoms is hard, and it’s made even harder by health professionals and your Auntie Susan telling you the only treatment options are losing weight and going on the birth control pill. But on the other hand, there are influencers online telling you that birth control is toxic! It makes it all so confusing. So is it possible to treat PCOS without birth control or weight loss?

Please note that this blog is not intended for medical advice and should not replace any advice given to you by your doctor and/or pharmacist. This blog is for educational purposes only.

Is PCOS Treatment Without Birth Control Possible?

And to that, I say, it depends!

There are some facts, like these, that I just can’t deny:

1. Weight loss improves the symptoms of PCOS.
2. Oral Contraceptives (OCPs) can improve your hormonal imbalances by lowering testosterone, which helps with acne, hirsutism, and hair loss.

However, as an FYI, there are more options than just losing weight and/or taking the pill to manage PCOS. Little known facts, I know!

Some other uncommon knowledge:

1. You CAN improve PCOS symptoms without weight loss!!!

There are many options to treat PCOS with nutrition, lifestyle, supplements, or medications that can help you improve insulin sensitivity, lower inflammation, and improve your hormonal balance that does not involve weight loss. If you want to lose weight, cool. There is nothing wrong with that!

My only issue with people pushing weight loss for women with PCOS is that our society pushes weight loss as the only answer to any ailment when it isn’t always necessary or helpful! Some women also have lean PCOS and do not need to lose weight! Check out another blog of ours on lean PCOS.

2. Hormonal Birth Control Is A Great PCOS Treatment Option But May Not Be The Best Fit For Everyone

Hormonal birth control methods, such as pills, patches, or vaginal options, rely on two key hormones: estrogen (ethinyl estradiol or estradiol valerate) and progestin. These hormones work together to regulate hormone levels, resulting in fewer male-like hormones and changes in the distribution of fats and cholesterol in the body. For women with PCOS, birth control pills can alleviate symptoms associated with excess male-like hormones and certain lipid abnormalities. This can be a godsend if you are struggling with high androgen symptoms like hair loss or acne. However, it’s important to note that there can be potential side effects, especially for women with PCOS who have other health risks.

One potential concern is that the extra estrogen from birth control pills can lower insulin sensitivity, and the choice of progestin can either improve or worsen this situation. As Dietitians, we cannot give medication advice but I do recommend asking your doctor about the types of progestin that have fewer androgenic effects and the risk of these options for increased risk of blood clots.

Another noteworthy point is that birth control pills may increase inflammation in the bodies of PCOS patients, possibly due to alterations in hormones like aldosterone and renin. Aldosterone, for instance, can exacerbate inflammation, and birth control pills may prompt its overproduction, resulting in issues such as fluid retention, high blood pressure (which occurs more frequently in women with PCOS), aggravated insulin resistance, weight gain, and mood changes. It’s worth mentioning that these problems are less common in PCOS patients without insulin resistance or women without PCOS. Note that there are different types of PCOS and not all women with PCOS have insulin resistance. If you need a refresher, check out our blog on the types of PCOS.

Additionally, the extra estrogen in birth control pills may impact cortisol, a stress hormone, making the body hold onto more of it. This leads to more male-like hormones made by the adrenal glands. It is important to remember that earlier studies have revealed the involvement of adrenal glands in the excessive production of male-like hormones in PCOS. Consequently, the use of birth control pills in PCOS patients with additional health risks requires careful monitoring for potential side effects.

There are newer birth control pills with lower levels of estrogen that show promise for treating higher levels of androgens but there are concerns regarding the long-term impact on heart health and metabolism. We need studies with larger participant groups and refined methodologies are required to comprehensively evaluate the cardiovascular and metabolic risks.

In conclusion, we are not against hormonal birth control nor do we give advice to our clients on which medications they should take. We just want our clients to know that birth control pills can offer advantages for women with PCOS but it is important to be aware of the potential considerations and closely monitor any associated side effects, particularly for those with additional health risks.

I would love to see more research on which type of hormonal birth control is a good fit for each type of PCOS! That would make treatment plans a little more clear for both clients and healthcare providers.

If you are wondering why I am concerned about insulin resistance or high testosterone levels, read more on the driving factors of PCOS in our free resource for PCOS. If you want to learn more about syncing workouts to your cycle, read this blog post.

So, what are some other options you may have?

Optimal PCOS management includes:

• Restorative sleep
• Stress management
• Improving your gut health
• WHY you eat
• WHAT you eat
• Regular physical activity
• Strategic supplementation

I won’t ever tell you NOT to lose weight or try hormonal birth control – I just believe it is important for you to be an advocate for your own health!

After all, this is YOUR life, YOUR body, and YOUR journey.

You deserve to know that there are more options than just weight loss or hormonal birth control!

And remember, if you need help or are struggling with any of the bullet points I listed, you can always book a consultation call with me (your first one is always free!).

If you’re curious about what working with me looks like, I’ve outlined a helpful guide to the process here on my website, under the What to Expect page.

References:

Armanini D, Boscaro M, Bordin L, Sabbadin C. Controversies in the Pathogenesis, Diagnosis and Treatment of PCOS: Focus on Insulin Resistance, Inflammation, and Hyperandrogenism. International Journal of Molecular Sciences. 2022; 23(8):4110. https://doi.org/10.3390/ijms23084110

Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human reproduction (Oxford, England), 33(9), 1602–1618. https://doi.org/10.1093/humrep/dey256