Managing PCOS: Concerns About Birth Control and Weight Gain

Polycystic ovary syndrome (PCOS) - The doctor prescribed birth control pills, but there is obesity?

Hello Doctor, I would like to share my symptoms: I was diagnosed with polycystic ovary syndrome (PCOS) since middle school, and my condition has not been normal.
My weight has been increasing every year.
During this time, I have visited a gynecologist, and the doctor prescribed progesterone for four consecutive months, which resulted in a weight gain of nearly 20 kilograms.
Until the year before last, I managed to lose weight and had regular menstrual cycles.
However, at the end of last year, due to a busy work schedule with overtime and late nights for over a month, my period came for three days and then stopped until now.
I only recently got my period again after taking medication to induce menstruation, but the flow is very light, and I have continued to gain weight.
I have gained about 15 kilograms now.
I am currently exercising and trying to return to a normal lifestyle.

I would like to ask: The doctor mentioned prescribing medication to regulate my menstrual cycle.
Initially, it was stated that it was not a contraceptive pill, but after picking up the medication from the pharmacy, I found out it was "Alesse." Given my current obesity (BMI > 30, body fat 46%, which has skyrocketed since my period stopped), is it safe for me to take this? I am really concerned about the risk of thrombosis.
Additionally, when I saw the doctor, there were no blood tests conducted.
Is it necessary to have a health check before taking contraceptive pills? I would appreciate your clarification on this matter.
Thank you.

Yuejing kuai zhengchang, 20~29 year old female. Ask Date: 2016/06/18

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, your underlying issue is obesity.
If you lose weight, your menstrual cycle may normalize.
Therefore, I suggest trying to lose weight to see if your cycle becomes regular.
A BMI over 30 is certainly not a good thing.
Taking birth control pills merely supplements hormones externally to regulate your menstrual cycle; the fundamental solution is still weight loss.
Wishing you good health.

Reply Date: 2016/06/18

More Info

Managing Polycystic Ovary Syndrome (PCOS) can be quite challenging, especially when it comes to concerns about weight gain and the use of birth control methods like oral contraceptives. Your situation highlights several important aspects of PCOS management, and I will address your concerns regarding the differences between PCOS and PCO-like conditions, the implications of using birth control pills, and the importance of weight management.

Differences Between PCOS and PCO-like Conditions
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder characterized by a combination of symptoms, including irregular menstrual cycles, excess androgen levels (which can lead to symptoms like hirsutism and acne), and polycystic ovaries visible on ultrasound. In contrast, a PCO-like condition may present with some features of PCOS, such as irregular cycles and ovarian cysts, but lacks the full spectrum of symptoms or the severity typically associated with PCOS.
Your case seems to align more with a PCO-like condition, particularly since you mentioned that you do not exhibit other classic symptoms of PCOS. The management of PCO-like conditions often focuses on lifestyle modifications, such as diet and exercise, to improve insulin sensitivity and regulate menstrual cycles. This approach can be effective, as evidenced by your improvements in body composition and metabolic markers following exercise and dietary changes.

Concerns About Birth Control Pills
Regarding the use of oral contraceptives like "Alesse" (the brand name you mentioned), these medications can be beneficial for managing menstrual irregularities and reducing androgen levels in women with PCOS. However, there are valid concerns about the potential for weight gain and the risk of thromboembolic events, especially in individuals with obesity (BMI > 30) and elevated body fat percentage.

Before starting any hormonal contraceptive, it is crucial to undergo a thorough health evaluation, including blood tests to assess your lipid profile, liver function, and any other relevant metabolic parameters. This is particularly important given your history of weight gain and irregular menstrual cycles. If you have risk factors for thrombosis, such as obesity, a family history of blood clots, or smoking, your healthcare provider may recommend alternative treatments or additional monitoring.

Weight Management and Lifestyle Changes
Weight management is a cornerstone of PCOS treatment. Studies have shown that even a modest weight loss of 5-10% can significantly improve insulin sensitivity, regulate menstrual cycles, and enhance fertility. Since you have already made strides in improving your physical activity and dietary habits, it is essential to continue these efforts. Regular exercise not only aids in weight loss but also helps regulate hormones and improve overall metabolic health.

In addition to exercise, consider working with a registered dietitian who specializes in PCOS to develop a personalized nutrition plan. A balanced diet rich in whole foods, low in refined sugars and processed foods, can help manage insulin levels and support weight loss.

Conclusion
In summary, while birth control pills can be an effective treatment for managing menstrual irregularities associated with PCOS, it is essential to consider your overall health status and potential risks. Prioritize a comprehensive evaluation before starting any hormonal treatment. Continue focusing on lifestyle changes, including diet and exercise, as these are fundamental to managing your symptoms and improving your quality of life. If you have further concerns or questions, do not hesitate to reach out to your healthcare provider for personalized advice and support.

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