Can I Use Birth Control Pills with Migraines and PCOS?

I have migraines; can I take birth control pills long-term?

Hello Doctor: I have been experiencing irregular menstrual cycles for a long time.
Whenever my period is late, I visit the doctor.
This situation has been ongoing for over two years.
On December 5th, I consulted a gynecologist and underwent a pelvic examination, which revealed that I have polycystic ovary syndrome (PCOS).
The doctor prescribed me medication, "Provera and Estring," and instructed me to take it for five days.
After that, I need to return for a follow-up appointment five days before my next period.
The doctor mentioned, "Let's see how it goes for six months to a year." Does this mean I should take birth control pills? Can polycystic ovary syndrome be completely cured? If, after my follow-up, the doctor does not prescribe birth control pills, can I purchase them on my own for long-term use and treatment? I have migraines; is it safe for me to use oral contraceptives? I found articles stating that birth control pills are contraindicated for migraine patients.
Does this mean I can take birth control pills to regulate my cycle as long as I am on migraine medication? On that day, I also consulted a family medicine doctor and received medication for my migraines (Ibudone), which is said to be a vasoconstrictor.
Can I take this medication simultaneously with the aforementioned drugs? I have read that patients with polycystic ovary syndrome can use oral contraceptives or an intrauterine device (IUD) for treatment without affecting the androgen levels in my body.
Is this correct, and can this really be an effective treatment? Thank you!

Kimy, 20~29 year old female. Ask Date: 2018/12/05

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the treatment for Polycystic Ovary Syndrome (PCOS) is summarized as follows:
For patients who do not wish to become pregnant: Regular administration of progesterone (every 45-60 days) can induce menstruation and reduce the risk of endometrial cancer.
Alternatively, oral contraceptive pills can be used, which suppress the secretion of gonadotropins, inhibit ovarian production of androgens, and help maintain regular menstrual cycles.
In cases of significant virilization, stronger anti-androgen contraceptives may be prescribed.
The occurrence of PCOS is primarily due to the body's poor utilization of insulin, so medications used to treat type 2 diabetes, such as metformin, can be effective for managing PCOS.
Inositol is currently classified as a dietary supplement and is considered a non-standard treatment option.
For patients with PCOS who wish to become pregnant: The main reason for infertility in PCOS patients is anovulation.
The most commonly used medication is the oral ovulation inducer Clomiphene Citrate.
For those who do not respond to oral ovulation medications, injectable ovulation drugs such as HMG, FSH, and r-FSH may be considered.
If you have a history of migraines, it is advisable to consult both a neurologist and an obstetrician-gynecologist to assess the suitability of using contraceptive pills.
If they are not suitable, other treatment options mentioned above can be pursued.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2018/12/05

More Info

When considering the use of birth control pills in conjunction with migraines and polycystic ovary syndrome (PCOS), it is essential to approach the situation with caution and a thorough understanding of the potential risks and benefits involved.

Polycystic ovary syndrome is a common hormonal disorder that affects women of reproductive age. It can lead to irregular menstrual cycles, excess androgen levels, and polycystic ovaries. Treatment often focuses on managing symptoms, which may include irregular periods, weight gain, and acne. Birth control pills are frequently prescribed to help regulate menstrual cycles and reduce androgen levels, which can alleviate some symptoms of PCOS.

However, the presence of migraines, particularly those with aura, complicates the decision to use hormonal contraceptives. Estrogen-containing birth control pills can increase the risk of stroke in women who experience migraines with aura. Therefore, if you have a history of migraines, especially if they are severe or accompanied by visual disturbances, it is crucial to discuss this with your healthcare provider. They may recommend alternative forms of contraception that do not contain estrogen, such as progestin-only pills, hormonal IUDs, or non-hormonal methods.

Your doctor’s suggestion to monitor your condition for six months to a year likely indicates that they want to assess how well your body responds to the initial treatment before making further decisions regarding long-term management, including the potential use of birth control pills. If your doctor does not prescribe birth control pills during your follow-up visit, it is not advisable to self-prescribe them without medical guidance, especially given your migraine history.

Regarding the use of migraine medication, such as the one you mentioned (likely referring to a triptan or another type of medication), it is essential to consult with your healthcare provider about potential interactions. Some migraine medications can interact with hormonal contraceptives, either diminishing their effectiveness or increasing the risk of side effects. Your healthcare provider can help you navigate these concerns and determine the safest and most effective treatment plan for both your migraines and PCOS.

As for the impact of birth control pills on androgen levels, it is true that many formulations can help lower testosterone levels and improve symptoms associated with excess androgens, such as hirsutism and acne. However, the specific effects can vary depending on the type of birth control pill used. Some pills are specifically designed to address these issues, while others may not be as effective.

In summary, while birth control pills can be an effective treatment for managing PCOS symptoms, their use in patients with migraines, particularly those with aura, requires careful consideration. It is crucial to have an open dialogue with your healthcare provider about your symptoms, treatment options, and any potential risks associated with the medications you are considering. They can provide personalized recommendations based on your medical history and current health status, ensuring that you receive the most appropriate care for your unique situation.

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