Birth Control Pills for PCOS: A Guide for Patients

Issues with Oral Contraceptives

Hello Doctor, I have polycystic ovary syndrome (PCOS).
Following my doctor's prescription, I have been taking Diane for my menstrual cycle for the past two to three years.
Typically, my period starts a few days after finishing the 21st pill, and it usually comes every two months.
My last menstrual period was at the beginning of September, and after not taking the medication for two months, my period did not come.
Recently, due to contraceptive needs, I started taking Diane again.
I would like to ask when I should start the first pill of the next pack after finishing the 21 days.
The instructions state to begin taking the first pill of the new cycle on any day between days 1 to 5 of the menstrual period, but since I did not have a period when I took the first pack, I am unsure when to start the second pack.
Should I start it on any day between days 1 to 5 of this upcoming period, or should I just follow the instructions and take 21 days, stop for 7 days, and then start the next pack on the eighth day after finishing the pills? I would also like to know when the second pack will start providing contraceptive effects.
After that, should I continue taking it in the 21 days on and 7 days off pattern? Thank you very much!

E, 20~29 year old female. Ask Date: 2015/12/15

Dr. Tian Yiwen reply Obstetrics and Gynecology

After completing 21 days of medication, stop taking the pills for seven days (days 22-28).
Then, start the second pack on day 29, which is the first day of the next medication cycle.
From the start of the second pack, you no longer need to track which day of your menstrual cycle it is.
According to the 21 (days of medication) + 7 (days of withdrawal) = 28-day cycle theory, contraceptive effectiveness should begin with the second medication cycle.
However, it is important to take the pills consistently at a time that you are less likely to forget.
If you take the pill late, you can still take it within the same day (which may result in taking two pills in one day: one to make up for the missed dose and the regular dose).
However, if you miss two consecutive days, you should assume that the contraceptive effectiveness for that cycle is reduced.

Reply Date: 2015/12/15

More Info

Understanding birth control pills, especially for patients with Polycystic Ovary Syndrome (PCOS), is crucial for managing symptoms and achieving effective contraception. In your case, you have been prescribed Diane (黛麗安), which is a combination oral contraceptive pill that can help regulate menstrual cycles and manage symptoms associated with PCOS.

Starting Your Next Pack
Since you have been on Diane for a while and have experienced irregular menstrual cycles, it is essential to clarify how to proceed with your next pack. According to standard guidelines for starting a new pack of birth control pills:
1. If you have a withdrawal bleed (which is the bleeding that occurs during the pill-free week), you should start your next pack on the same day you would normally start after your pill-free week. This typically means starting the new pack on the 8th day after finishing the last pill of the previous pack.

2. If you do not have a withdrawal bleed after completing the 21 pills, you should still start your next pack on schedule. This means you would begin taking the first pill of the new pack on the same day you would have started after your pill-free week, regardless of whether you had a period or not.

Timing and Effectiveness
Regarding the effectiveness of the pill for contraception, it generally takes about 7 days of consistent use for the pill to become effective if you are starting it for the first time or after a break. Since you have been on Diane previously, if you start your new pack as described, you should be protected from pregnancy after 7 days of taking the pills consistently.

Ongoing Use
After starting your new pack, you will continue to take one pill daily for 21 days, followed by a 7-day break during which you will likely have a withdrawal bleed. This cycle of 21 days on and 7 days off is standard for combination oral contraceptives.

Additional Considerations
1. Monitoring Symptoms: Since you have PCOS, it's important to monitor your symptoms while on the pill. If you notice any significant changes in your menstrual cycle, mood, or physical health, consult your healthcare provider.

2. Regular Check-ups: Regular follow-ups with your healthcare provider are essential to ensure that the birth control method is working effectively for you and to make any necessary adjustments based on your health and lifestyle changes.

3. Lifestyle Factors: Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help manage PCOS symptoms and improve the effectiveness of your treatment.

4. Potential Side Effects: Be aware of potential side effects of Diane, such as nausea, headaches, or mood changes. If you experience severe side effects or any symptoms that concern you, reach out to your healthcare provider.

Conclusion
In summary, you should start your next pack of Diane on the 8th day after finishing your last pack, regardless of whether you had a withdrawal bleed. Continue taking the pills for 21 days, and remember that it takes about 7 days for the contraceptive effect to kick in if you are starting the pill for the first time. Regular communication with your healthcare provider will help ensure that you are managing your PCOS effectively while using birth control. If you have any further questions or concerns, do not hesitate to reach out to your doctor for personalized advice.

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