Hormonal Treatment for PCOS

Before we dive into treatments, here’s a quick review:

With PCOS, in general:

  • A woman doesn’t ovulate regularly
  • Her periods are irregular or absent
  • It’s more difficult for her to lose weight
  • She’s more likely to have acne & unwanted hair growth
  • She is likely to have an insulin resistance and is at risk for developing diabetes
  • She may have more challenges becoming pregnant
  • She has a higher risk of abnormal uterine bleeding and endometrial cancer

Treatments for PCOS

Treatments are aimed at restoring the balance of hormones, estrogen and progesterone and to decrease the unwanted side effects of acne and hair growth. Treatment goals are to help reverse insulin resistance, reduce weight and prevent diabetes as well as prevent and/or treat abnormal periods, decreasing the risk of endometrial cancer.

Why are women with PCOS at risk for Uterine Cancer?

In PCOS, the irregular cycles and lack of regular ovulation means that the uterine lining is exposed to estrogen without the balancing effects of progesterone. This can lead to uncontrolled growth of the uterine lining resulting in very heavy periods. It can also cause abnormal cell growth in the lining of the uterus, placing them at risk of uterine cancer.

To prevent that, it’s recommended that women with PCOS receive progesterone in one of the following ways:

  • Birth Control Pills with Estrogen and Progesterone
  • Progesterone only Pills
  • NuvaRing
  • A progesterone containing IUD
  • A progesterone containing Implant
  • DepoProvera progesterone injections

Though it might be tempting not to treat PCOS so that you can continue to skip periods, unless you’re taking a hormonal contraceptive or using an IUD, it’s very unsafe.

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.

2 Great resources for women with PCOS

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