Girl pondering life

When women come to my office with any one or all of the following complaints I see this as an important opportunity to change a woman’s life for the better. The signs and symptoms of PCOS are:

  • No periods for > 3 months
  • Excessive bleeding
  • Difficulty losing weight
  • Excessive hair growth
  • Acne
  • Infertility

One of the most disturbing aspects of PCOS is how it affects a woman’s appearance. Acne and excessive hair growth are very common, however there are treatments that can help keep these under control.

Remember these symptoms are not your fault and you didn’t cause them. We can help by correcting the imbalance of hormones by using a birth control pill that contains both estrogen and progesterone.

If you want to learn more about what’s happening with PCOS, read my other post PCOS: An overview of the biology. (link to PCOS: An overview of the biology)

Birth Control Pills

Another really important part of the treatment of PCOS is to help reduce the androgenic or male-type hormones, DHEA, DHEAS and Testosterone that women with PCOS have in much higher amounts than women with typical cycles.

When a woman uses a combined oral contraceptive (containing both Estrogen and Progesterone) the pill is metabolized by the liver in what’s known as a “first pass effect” and the liver, thank goodness, produces a very special protein, Sex Hormone Binding Globulin or SHBG.

What SHBG does is to bind with the androgenic hormones in the blood, which decreases what goes to the tissues and causes acne and excessive hair.

This is why all birth control pills can help reduce acne. It usually takes about 3 months to see the full benefit.

Women who are 35 and smoke, those with a history of blood clots , and those with migraines with visual changes should not use the birth control pill. For a list of other contraindications and warnings about the pill click here.


Many women with PCOS also find that their skin is very oily. Facial washes and scrubs can help, though most find that their acne improves dramatically after 3 months on the pill or NuvaRing.

Adding the medication Spironalactone in low dosages can also help. In addition, some women see improvement when they start metformin, as their weight comes down, their acne also improves.

If after 3-6 months, you don’t see improvement, do speak to a dermatologist about using Accutane. However it’s important not to start Accutane unless you’ve already tried the Pill or NuvaRing for at least 3 months.

Treating Excessive Hair

Most women with PCOS spend a lot of time and money on hair removal. It can feel overwhelming and depressing to see thick coarse hair on the upper lip and chin.

Do consider using a combined birth control pill. It takes at least 3 months to see an improvement in the amount of hair growth and the texture, which should become softer and less coarse.

If hair continues to be a problem, then do consider laser treatments or electrolysis for permanent hair removal. I know these are expensive, but this issue is not going to get better and you’ll end up spending a lot more money every month for hair removal for many years.

If the hair growth is still problematic after 3 months, ask your health care provider about using Spironalactone, a medication that can be helpful in reducing the amount of hair and making it thinner and less coarse.

You may also find that adding Metformin reduces your hair growth.

2 Great resources for women with PCOS

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