Can Birth Control Pills Help Regulate Menstrual Cycles in PCOS Patients?

Can birth control pills be used to treat irregular menstrual cycles related to infertility (polycystic ovary syndrome)?

Hello Doctor, I am a patient with polycystic ovary syndrome (PCOS) who has not had regular menstrual cycles since menarche.
However, my condition is not severe; I still have monthly periods, but they are consistently delayed.
It is not severe enough to have periods every few months or experience amenorrhea.
I do not have acne or hirsutism, but I do have a tendency to gain weight.
After three years of marriage, I have been struggling to conceive naturally and have undergone treatments with ovulation induction medications and trigger shots.
I did conceive once after receiving a trigger shot, but unfortunately, the pregnancy ended in a miscarriage due to cardiac arrest.
I have also undergone infertility evaluations, and aside from PCOS and low vitamin D3 levels, there are no significant issues (both fallopian tubes are patent), and my husband's sperm analysis is normal.

I would like to ask the doctor:
1.
For someone like me with irregular menstrual cycles and infertility, would it be beneficial to take birth control pills for three months to regulate my cycle before undergoing ovulation induction treatments?
2.
Can taking birth control pills help determine a normal ovulation date (fertile window)? I am a bit confused about this; does taking birth control pills mean that the fertile window is not conducive to pregnancy (I understand that birth control pills are not 100% effective), or is there still a fertile window even while on birth control pills?
Thank you for your response, Doctor.

Lai Xiaojie, 30~39 year old female. Ask Date: 2018/03/25

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I am a patient with polycystic ovary syndrome (PCOS) who has never had regular menstrual cycles since menarche.
However, my condition is not severe; I still have monthly periods, but they are consistently delayed.
It is not severe enough to have periods every few months or to have amenorrhea.
I do not have acne or hirsutism, but I do have a tendency to gain weight.
After three years of marriage, I have difficulty conceiving naturally and have undergone treatment with ovulation medications and trigger shots.
I did conceive once after receiving a trigger shot, but unfortunately, the pregnancy ended in a miscarriage due to cardiac arrest.
I have also undergone infertility testing, and aside from PCOS and low vitamin D3 levels, there are no significant issues (both fallopian tubes are patent), and my husband's sperm analysis is normal.

I would like to ask the doctor: 1.
For someone like me with irregular menstrual cycles and infertility, would it be beneficial to take birth control pills for three months to regulate my cycle before undergoing trigger shot treatment? Answer: It is possible to take birth control pills for one month to prepare for implantation.
2.
If I take birth control pills, can I calculate a normal ovulation day (fertile window)? Answer: Taking birth control pills will suppress ovulation.

Reply Date: 2018/03/25

More Info

Birth control pills (BCPs) can indeed play a significant role in regulating menstrual cycles for patients with Polycystic Ovary Syndrome (PCOS). PCOS is a common hormonal disorder that affects women of reproductive age and is characterized by irregular menstrual cycles, excess androgen levels, and polycystic ovaries. While your situation indicates that you do not have severe symptoms of PCOS, the irregularity of your menstrual cycle can still be a concern, especially when trying to conceive.

1. Regulating Menstrual Cycles with Birth Control Pills: Taking BCPs for a few months can help regulate your menstrual cycle. The hormones in the pills can provide a consistent level of estrogen and progestin, which can help to stabilize the hormonal fluctuations that often lead to irregular periods in women with PCOS. By regulating your cycle, BCPs can also help to reduce the risk of endometrial hyperplasia, a condition that can occur due to prolonged unopposed estrogen exposure when ovulation does not occur regularly.

2. Understanding Ovulation and Fertility: When you take BCPs, they suppress your natural ovulation. This means that while you may have a withdrawal bleed (similar to a period) during the placebo week of the pill pack, you are not actually ovulating. Therefore, it is not possible to calculate a "normal" ovulation day or a "danger zone" for pregnancy while on the pill, as the primary purpose of BCPs is to prevent ovulation. Once you stop taking the pills, your body may take some time to return to its natural cycle, and ovulation may not resume immediately.

3. Transitioning from BCPs to Fertility Treatments: After a few months on BCPs, you can discuss with your healthcare provider the possibility of transitioning to ovulation induction treatments, such as Clomiphene Citrate (Clomid) or injectable gonadotropins. These medications can help stimulate ovulation, which is crucial for conception. Your doctor may recommend monitoring your cycle with ultrasounds and blood tests to determine the best time for ovulation and increase your chances of pregnancy.

4. Addressing Weight and Insulin Resistance: Since you mentioned having a tendency to gain weight, it’s also essential to consider lifestyle modifications. Weight management through a balanced diet and regular exercise can improve insulin sensitivity and may help regulate your menstrual cycles and improve ovulation. This is particularly important in PCOS, as many women with this condition have insulin resistance, which can exacerbate symptoms.

5. Consultation with a Specialist: Given your history of difficulty conceiving and the loss of a pregnancy, it may be beneficial to consult a reproductive endocrinologist. They can provide a comprehensive evaluation and tailor a treatment plan that addresses both your hormonal regulation and fertility needs.

In summary, taking birth control pills can be a useful strategy for regulating your menstrual cycle in the context of PCOS. However, it is essential to understand that while on BCPs, you are not ovulating, and thus cannot conceive. After a period of regulation, transitioning to fertility treatments may enhance your chances of conception. Always discuss your options with your healthcare provider to ensure that your treatment plan aligns with your reproductive goals and overall health.

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Online information is not always accurate. Please trust your attending physician. Thank you.