What’s the best birth control for PCOS

Many forms of birth control can regulate the menstrual symptoms of PCOS

By Heidi Borst | Jul. 9, 2024 Medically reviewed by Kimberly Bowman, MD

Polycystic ovary syndrome (PCOS) is a common women’s health condition caused by an imbalance of reproductive hormones. It results in problems such as irregular, heavy periods, decreased fertility, acne, and unwanted hair growth. If you have PCOS, your healthcare provider might recommend using hormonal birth control like the combination pill, patch, or intrauterine device (IUD) to help manage symptoms of PCOS. Here’s what you need to know about the best types of birth control for PCOS.

What is PCOS?

Polycystic ovary syndrome, sometimes called polycystic ovarian syndrome, is a condition in which a woman’s ovaries produce a greater amount of androgens (male hormones) than normal, says Kim Langdon, MD, OB-GYN and founder of Coologics. This hormonal imbalance can prevent ovulation (the release of eggs from the ovaries) and cause irregular periods. Signs of PCOS typically begin during puberty but can also occur later in adolescence or early adulthood. Symptoms include:

Irregular periods: On average, women with PCOS menstruate less than eight times yearly. That’s because ovulation doesn’t occur regularly, causing the lining of the uterus, or endometrium, to become thicker than usual. When a period does occur, it can be heavy or last for a longer amount of time. What’s more, missing periods leads to an increased risk of endometrial cancer.
Weight gain: In approximately 50% of women, PCOS correlates with weight gain and obesity, which can develop as early as puberty.
Hair growth: PCOS can cause abnormal body hair growth, or hirsutism, on the neck, chin, upper lip, sideburn area, chest, abdomen, upper arm, and inner thighs.
Acne: Altered hormone levels cause blocked hair follicles and oily skin.
Infertility: Due to irregular ovulation, it may be harder for women with PCOS to get pregnant without fertility treatments.
Sleep apnea: Up to 50% of women with PCOS experience sleep apnea, a condition in which breathing stops for brief periods during sleep.

PCOS affects an estimated 6% to 12% of women of reproductive age, according to the Centers for Disease Control and Prevention. PCOS is associated with serious health conditions like insulin resistance and Type 2 diabetes, high blood pressure, high cholesterol, heart disease, and stroke. Women with PCOS are also more likely to experience depression, anxiety, sexual dysfunction, and eating disorders like bulimia and binge eating.

Combination hormonal contraception pills containing estrogen and progesterone are the first-line treatment for PCOS. The patch, vaginal ring, shot, and hormonal intrauterine device (IUD) are also options. But for individuals who can’t take estrogen, the progestin-only pill, or “mini-pill,” is an option.

How birth control helps PCOS

There is no cure for PCOS, but birth control can benefit people with PCOS in many ways, says Greg Marchand, MD, a board-certified OB-GYN in Mesa, Arizona, and founder of the Marchand Institute.

Birth control works to manage PCOS in the following ways:

Decreasing testosterone and other androgen levels
Regulating the menstrual cycle and ovulation
Reducing the risk of endometrial cancer

According to Dr. Marchand, birth control works faster than other PCOS treatments, such as metformin, which can take months or years to regulate periods. And because it works against testosterone, birth control decreases excess hair growth and acne caused by PCOS, he says, adding that as long as you are not trying to become pregnant, your best bet is to be on birth control with PCOS.

Other treatment options for PCOS include:

Weight loss via lifestyle changes such as diet and exercise
Progestin therapy, taken for 10-14 days each month to help regulate periods
Clomiphene citrate, an anti-estrogen medication taken at the beginning of each menstrual cycle to help with ovulation
Letrozole, a breast cancer medication that can improve ovulation
Metformin, which stimulates ovulation and helps with weight loss
Gonadotropins, hormones given via injection to promote ovulation
Spironolactone, an androgen-blocking medication that improves symptoms of acne and hair growth
Eflornithine, a topical cream that can decrease hair growth
Hair removal, including electrolysis, laser hair removal, and shaving
Acne treatments, such as pills, gels, and creams

Best birth control for PCOS

Although many forms of birth control can regulate the menstrual symptoms of PCOS, oral contraceptive pills are also effective at improving acne and reducing unwanted hair growth. No single brand of birth control pill has been shown to be superior in its effects, and combination treatment with antiandrogen medications or laser therapy is the most effective treatment for hirsutism.

Side effects of these drugs include breast tenderness or pain, headaches, heavy bleeding, abnormal menstruation, nausea, and bloating.

PCOS and birth control FAQs

Can birth control help with PCOS weight loss?

“No, your doctor should prescribe you metformin—with or without a GLP-1 agonist medication, such as Ozempic or Wegovy—if weight control from PCOS is a problem,” says Dr. Marchand.

Is birth control a cure for PCOS?

There is no cure for PCOS, but birth control pills are an effective long-term treatment for women who are not trying to become pregnant, says Dr. Langdon.

Who shouldn’t use birth control for PCOS?

Women trying to conceive should not use birth control to treat PCOS. Additionally, estrogen-containing birth control should be avoided in women older than 35 who smoke, women who have had a previous heart attack or stroke, or women who live with migraines with auras, says Dr. Marchand. Women with a history of blood clots should not take it either, says Dr. Langdon.

Can birth control make PCOS worse?

“No, but the medroxyprogesterone acetate injection (Depo-Provera shot) can make you hungrier, which can lead to weight gain,” says Dr. Marchand. Many women with PCOS are already obese, so It’s the least desirable birth control option, he says.