Options for Managing Periods with PCOS
Polycystic Ovary Syndrome (PCOS) is a common condition caused by a combination of genetic and environmental factors. The ovaries of someone with PCOS are very sensitive to levels of insulin, and this sensitivity can cause the ovaries to work differently than people without PCOS. When someone has PCOS, the ovaries do not release an egg (ovulate) each month. Without regular ovulation individuals may have no periods, skipped periods, irregular periods, or very heavy and long bleeding. For people who have irregular periods, treatment is recommended to prevent excessive bleeding and to keep the lining of the uterus healthy.
There are many options for managing periods with PCOS. All of the treatments contain progestin, which keeps the lining of the uterus thin and protects it from future problems. The one you choose will depend on what is important to you. Some things to consider in making this decision are:
- Do you have bothersome acne, and do you want an option that helps with this?
- Do you have concerns about extra hair on your face and body, or thinning of your hair on your head, and do you want an option that helps with this?
- How do you feel about taking a medication each day, or would you rather use something that is longer acting?
- When someone is using hormonal therapy, the lining of the uterus stays thin and healthy. Unlike when not on hormonal therapy, it is very safe to have fewer periods or none at all. Do you want an option that can help you safely have fewer or no menstrual periods?
- What else is important to you about your option to keep the uterus healthy?
Below are some treatment options based on individual symptom concerns. For more information, and to make an appointment to discuss your options, call our clinic.
| Treatment Choice | How to Use | What happens to period bleeding? | Does it help with cramps? | Does it also work as birth control? |
|---|---|---|---|---|
The Pill |
Take 1 pill every day. |
|
Yes |
Yes (Make sure to take every day, no missed pills) |
The Patch |
Change every week. | Yes |
Yes (Does not work as well if you weigh more than 198 pounds) |
|
The Ring |
Change every month. | Yes |
Yes (Avoid oil-based lube and anti-yeast creams) |
| Treatment Choice | How to Use | What happens to period bleeding? | Does it help with cramps? | Does it also work as birth control? |
|---|---|---|---|---|
Progestin Withdrawal
|
Take 1 pill each day for 10 days in a row. | Uterine lining will shed 1-2 weeks after the last pill. | No | No |
Depo-Provera |
Injection in office or at home every 3 months. | May have irregular bleeding at first but then likely no bleeding. | Yes |
Yes (Get injection every 11-13 weeks) |
| Treatment Choice | How to Use | What happens to period bleeding? | Does it help with cramps? | Does it also work as birth control? |
|---|---|---|---|---|
Implant |
Clinic visit to have inserted under skin in upper arm. | May have no bleeding or irregular bleeding. | Yes |
Yes (The implant and IUDs are the most reliable forms of birth control) |
Progestin IUD |
Clinic visit to have inserted into uterus. | No periods or lighter periods. No or less cramps. | Yes |
| Treatment Choice | How to Use | What happens to period bleeding? | Does it help with cramps? | Does it also work as birth control? |
|---|---|---|---|---|
Norethindrone Acetate (NETA) |
Take 1 pill each day. | Use in extended or continuous dosing to have fewer or no scheduled periods. | Yes | No |
Drospirenone POP
|
Period each month. Can use in extended or continuous dosing. | Yes |
Yes (Make sure to take every day, no missed pills) |
|
Progestin-Only Pill
|
May have no bleeding or irregular bleeding. | Yes |
Yes (Take same time each day, no missed pills) |