The contraceptive pill and PCOS
Dear Dr Mitchell,
I am a 21 year old woman who was recently diagnosed with polycystic ovary syndrome (PCOS). My doctor has since placed me on Minigynon for three months as well as Metformin. I was told the Minigynon would regulate my periods in the past so I am a bit confused about whether it is going to regulate my period or add to the problem. I am a bit sceptical about taking these pills until I find out exactly what they are going to do. I am aware that infertility is one of the effects of PCOS and although I’m not yet ready to get pregnant, I wouldn’t want to do anything that would make it harder for me to get pregnant when I am ready. Can you please explain to how Minigynon will help to correct my PCOS? Also what are my chances of getting pregnant later?
Polycystic ovarian disease is a condition which is associated with irregular menstrual periods, difficulty with becoming pregnant, excessive male hormone production, excessive weight gain and an increased risk of diabetes mellitus.
The excessive male hormone (testosterone) causes an increased risk of acne, excessive hair growth on the body (face and abdomen) and sometimes an enlarged clitoris. The condition is usually confirmed by doing hormonal studies to check the level of testosterone, leutinising hormone (LH) and follicle stimulating hormone (FSH). The blood sugar test should also be done because of the increased risk for developing diabetes mellitus.
A pelvic ultrasound usually shows the ovaries to be bigger than normal with multiple small peripheral cysts in the ovaries. The treatment of polycystic ovarian disease depends on the specific desires of the patient. If the menses are irregular then the oral contraceptive pills will help to regulate the menstrual periods making them more regular and predictable. The contraceptive pills also help to suppress ovarian function thus reducing the production of cysts. This is important since the longer the period of amenorrhoea (absent periods) then the greater is your risk of developing cancer of the uterus in your later years. This is because of the prolonged exposure to oestrogen without the usual balance of progesterone. The oral contraceptive pill helps to correct this imbalance.
Women who do not ovulate have a lower than usual production of progesterone. The contraceptive pills can also help to control acne and excessive facial hair growth. This is seen especially in preparations containing cypnoterone acetate. This is an antiandrogen and oppresses the effects of the testosterone produced in women with polycystic ovaries. Weight loss is an integral part of any treatment programme for polycystic ovarian disease. This will help to establish regular cycles, improve the chance of ovulation and help reduce the risk of diabetes mellitus. Metformin is a commonly used drug in the management of patients with polycystic ovaries. It helps to correct the insulin resistance that causes diabetes mellitus and also helps to improve the chances of ovulation.
Your chance of becoming pregnant is very good. You should just work on a regular exercise programme and diet programme to get to your ideal weight for height. Once you are ready to conceive then your doctor can consider adding Clomid to your medications if ovulation does not happen on its own. In the interim, the oral contraceptive pill is a good choice. Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; write to All Woman, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025. We regret we cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor or other professional healthcare provider.
