Hello!
Apologies for my actual post being a little late - have had a hectic week!
Holly and I noticed that there are so many similar posts relating to pills and contraception for PCOS ladies, that we have started a sticky as a reference guide.
I'm not a GP, but I do have extensive experience with pills and have done absolutely loads of research for myself, for this forum and because when I was younger I wanted to go into medicine. On a less positive note, I have spent so much time researching this because I received so little help from doctors and gynaecologists over the years, I literally had to rely on my own knowledge to find the most suitable treatment. So, there's a little background info to help you understand why I'm a Pill-geek!
You may be familiar with the need for PCOS to be "controlled" somehow. For most women, the combined pill is the best option because it
a) suppresses ovulation therefore reduces the occurence of ovarian cysts;
b) controls the other hormone-related side effects of PCOS;
c) regulates periods (which may have ceased altogether if PCOS has been unmanaged or only recently diagnosed). The periods you have on the pill are not true periods, but they keep the womb healthy by shedding any build-up of tissue, which is at a reduced rate in comparison to women who don't take the pill.
The combined pill comes in varous guises. I'm going to concentrate on the best form for PCOS, which is the standard-strength monophasic combined pill. This means pills which contain between 30-35mg of Ethinylestradiol (the synthetic oestrogen), plus a progestogen (synthetic progesterone). Monophasic means that every pill contains the same amount of synthetic hormones, and doesn't vary at all. There are other types such as "bi-phasic" and "tri-phasic" pills, and this simply means that the hormone proportions change according to the day/week of the pill. These can be helpful if monophasic pills don't help symptoms however.
Having PCOS can limit your choice of Pill significantly. You need one which combines Ethinylestradiol with an
anti-androgenic progestogen. This means a progestogen which reduces or prevents the testosterone effects of the male hormone, i.e. excess hair, acne and hair loss. Combined with synthetic oestrogen, anti-androgenic progestogens will alleviate PCOS symptoms after a few months' usage and continued usage. Normally effects on hair and skin can be seen 6 months after starting treatment, though this can take 9 months depending on severity.
I really hate it when doctors tell women that every pill is the same, and changing brand won't make a difference. This is complete rubbish in most cases. I also hate it when doctors prescribe cheaper, older pills to PCOS sufferers who in fact need more thoughtful treatment.
You should avoid and refuse the following pills because they are too androgenic and will likely make any existing PCOS symptoms such as acne and hair issues worse, as well as possibly making depression and low moods more significant:
Microgynon 30/30 ED (contains levenorgestrel)
Ovranette (same as above)
Loestrin 20 (low oestrogen plus high amount of norethisterone acetate)
Loestrin 30 (as above)
...any other pills which contain norethisterone acetate, levenorgestrel, norethisterone or gestodene.
The best progestogens cause little or no androgenic activity and don't have a very strong progestogenic effect (may be called "oestrogen-dominant pills". These are:
cyproterone acetate
drospirenone
desogestrel
norgestimate
The pills containing these progestogens are:
Dianette (for short-term use, e.g. 3-6 months before continuing with another pill from this list due to DVT risk)
Yasmin (drospirenone)
Marvelon (desogestrel)
Cilest (norgestimate)
If you smoke, are obese or don't "get on" with oestrogen, then you might prefer to take the lower oestrogen-version of Marvelon, called Mercilon. If you CANNOT TAKE OESTROGEN, then the progestogen-only pill (mini-pill) called Cerazette is the best option. Cerazette inhibits ovulation, is taken continuously without any breaks, reduces bleeding and may even cause bleeds to stop altogether after 6-12months and contains desogestrel, mentioned above.