When we get the treatments with patients with PCOS, we really have to individualize treatments. We know there is recommendations, but we have to go with what the patient needs and their goals, and their health. If they have obesity or diabetes or lipids. Once patient’s goals are to regulate their cycle, decrease bleeding and help hirsutism or acne, one of the first treatments that we usually offer is birth control pills. Why birth control pills? I know we try to control your hormones, but it’s because the disease comes from hormone dysregulation. So if you want to help, we have to play on androgen and usually on the insulin as well.
Birth control pills helps because it decreases the production of androgen by the ovaries. They also increase the hormones that link with the testosterone making it less active. It also decreases the chance of ovarian cysts, protects the uterus against cancer, decreases the heaviness of bleeding and make it more regular. Also, it will help your skin and hair, but it takes a good six months for that part. So we have to be patient and wait to have the effectiveness.
If, you’re someone that tends to forget the pills or you prefer not taking the pills and you prefer patch or ring, it’s another possibility. It will still help to decrease the androgen and help your skin, but it’s a bit less effective.
If you have a contraindication to take estrogen or if you mainly suffer from irregular cycle or if you want to protect against uterine cancer, we can give you also only progesterone. It can be given as a cyclic medication to prevent cancer given every two three months. Also an implant that can go in your arms or an IUD that goes in your uterus. It’s all good options. And after discussions then we can decide for a plan.
If you try the birth control pills or other treatments and you don’t see enough improvement on your, hirsutism or acne, there is some time medication we can add like anti androgens. The anti-androgens will decrease even more the androgen and give some effectiveness. But again, it takes a good 6 to 9 months. Because the hair follicle has a cycle of life of about six months, and all follicles are not in the same phase, it means that to really hit all of those follicles, you really need a good six months. When we give birth control pills, sometimes there’s a bit of side effects like irregular bleeding or spotting, mood, breast tenderness. And usually, those side effects are at the beginning and within a few weeks they will go away. So, you really have to try a good three four months at least for the birth control pills to see effectiveness. And if you want to see effectiveness regarding hirsutism or acne, it’s a good six months.
