What’s the Best Birth Control for Women with PCOS?

Medically reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT on May 17, 2017Written by Annamarya Scaccia on May 17, 2017

How birth control can help

Polycystic ovary syndrome (PCOS) is a health condition that causes enlarged ovaries with small cysts on the outer edges.

One in 10 women has PCOS, according to the Office on Women’s Health.

Many women with PCOS take hormonal birth control to help manage the symptoms caused by the condition. For example, PCOS can cause you to miss your period for months at a time. Birth control can help regulate your menstrual cycle.

Other symptoms that birth control can help manage include:

  • hormonal imbalance
  • bloating
  • cramps
  • acne
  • pelvic pain
  • excess hair growth
  • irregular periods
  • lack of ovulation

Keep reading to learn which forms of hormonal birth control may be useful for you.

Oral contraceptives

Oral contraceptives are the most common and 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 you:

Most women who have PCOS don’t experience side effects when taking the pill, but different types of birth control affect everyone differently.

You may experience one or more of the following:

  • mood changes
  • possible weight gain or loss
  • nausea
  • headaches
  • sore breasts
  • some spotting

If you have health insurance, your plan may cover the cost of this medication entirely. You may also be able to get it at little to no cost through Medicaid or a patient assistance program.

Without coverage, a pack of combination pills typically costs between $20 and $50 each month. Progestin-only pills typically cost around $50 for a month’s supply

Combination pill

Combination pills contain estrogen and progestin, two synthetic hormones similar to the ones made by your ovaries. The amount of hormone present varies from brand to brand. You can 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. Your doctor will help determine the right dosage for you.

Progestin-only pill

Progestin-only pills, known as minipills, are an effective alternative for women who have PCOS and are unable to take combination birth control pills. PCOS causes you to have low levels of the hormone progesterone. Progestin-only pills increase your progesterone, which will cause you to have regular periods and lower your risk of endometrial cancer.

Progestin-only pills can contain up to 35 mcg of synthetic progestin.

Learn more: How to choose the right birth control pill »

Skin patch

The contraceptive patch is a thin plastic patch that contains estrogen and progestin. You 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 can help you:

  • ovulate
  • regulate your periods
  • reduce bloating and cramps
  • reduce acne
  • reduce excess hair growth
  • lower your cancer risk

Common side effects of the patch include:

  • irritated skin
  • nausea and vomiting
  • mood changes
  • sore breasts
  • headache
  • possible weight gain
  • high blood pressure

A monthly supply of the birth control patch typically costs $30 to $35. Most insurance companies will cover the skin patch at no cost.

Vaginal ring

The contraceptive ring (NuvaRing) is a soft, flexible plastic ring that you insert into your vagina. You wear the ring for 21 days, remove it for seven days to allow for a period, and then replace it with a new one for the next month.

Like the pill and the patch, the vaginal ring can help you:

  • ovulate
  • regulate your periods
  • reduce bloating and cramps
  • reduce acne
  • reduce excess body hair
  • lower your cancer risk

Common side effects of the ring include:

  • headache
  • dizziness
  • nausea
  • sore breasts
  • fatigue
  • possible weight gain
  • appetite changes

The vaginal ring costs as much as the skin patch, or $30 to $35 for a month’s supply. The ring is also covered by most insurance plans.

Will any form of hormonal birth control work?

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 you’re unable to take the combination pill or use other combination methods, your doctor may recommend the progestin-only pill.

There are also other alternatives, including:

  • Progesterone therapy: You can take 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 your symptoms.
  • Progestin-containing intrauterine device (IUD): IUDs 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, brand name Glucophage, 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.

Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

Learn more: All about off-label prescription drug use »

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.

Talk with your doctor about your status and what options are available to you, whether that’s plans for conception or assistance with contraception.

If you decide to use birth control for PCOS management and want to reap the contraceptive benefits, there are a few things you should know.

About oral contraceptives

On average, the birth control pill is about 91 percent effective at preventing pregnancy. This means that about 9 out of every 100 women using the pill will become pregnant each year.

If you miss a dose, your risk of pregnancy increases. Set a reminder on your phone to help you remember to take the pill at the same time every day.

About the contraceptive patch and vaginal ring

The contraceptive patch and vaginal ring are also about 91 percent effective. This means about 9 out of every 100 women using either method will become pregnant each year.

It’s important to replace your vaginal ring or skin patch on time so that you are continually protected. Your chance of becoming pregnant increases each day that you aren’t on birth control.

Choosing the best option for you

If you have PCOS, talk to your doctor about what treatment option would be best for you.

When you and your doctor work through your options, remember to consider:

  • Ease of use: You should think about what type of oral contraceptive would be easier for you to use. If it may be hard to take a pill every day, then the ring or patch may be a better option for you.
  • Side effects: Most hormonal birth control options share similar side effects. Still, your doctor 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 programs.

Learn more: Does menopause affect PCOS? »

CMS Id: 121507