How To Manage PCOS Without Hormonal Birth Control
You’re probably here reading this because you’ve been told that you have PCOS, or you think you might have PCOS, and you’ve been told that the only way to manage PCOS is with hormonal birth control.
As a Fertility Awareness Educator (FAMs Educator) and Menstrual Cycle Educator with over a decade of experience, I am here to tell you that hormonal birth control is NOT the only answer. In fact, I don’t think it’s a solution to PCOS at all (keep reading for more on that!). And, in my experience analyzing thousands of cycle tracking charts from women around the world, many of whom were told that they had PCOS, it’s even likely that you don’t have PCOS at all. I know, I said what I said.
That’s why in today’s article, we will cover…
What is PCOS?
Do you actually have PCOS?
Does birth control fix PCOS?
Why do doctors recommend birth control for PCOS?
How to manage PCOS naturally?
Let’s get started!
What is PCOS?
PCOS stands for polycystic ovarian syndrome. It is a hormonal and metabolic condition that causes an excess of male-type hormones (like testosterone) called androgens and very often inhibits regular ovulation, and therefore creates irregular or absent periods. Some folks with PCOS have random period bleeds throughout the year, others have no periods at all.
If there is one, most important thing that I wish everyone understood about PCOS it’s that PCOS is not a lifelong condition or diagnosis. Instead, PCOS is a temporary condition. Once androgen excess is reversed and regular ovulation is restored, a woman no longer has PCOS.
PCOS & irregular cycles are not lifelong diagnoses. They are temporary states of androgen excess and compromised ovulation.
However, if you choose to cover up the cause of PCOS and simply shut down the menstrual cycle with hormonal birth control to manage the symptoms of PCOS, then - yes, PCOS becomes a lifelong condition of indefinite length.
You will often hear that PCOS is diagnosed by cysts on the ovaries that can be seen via ultrasound and the presence of irregular or absent periods. This is an old, outdated way of thinking about, and diagnosing, PCOS. Modern, holistic PCOS research tells us that PCOS is instead a state of androgen excess that results from several different factors. Androgen excess causes symptoms like facial hair growth, dark hairs on chest/chin/belly/etc, jawline acne, and hair loss.
Modern, holistic PCOS research also shows that there are likely four different types of PCOS, all caused by different triggers and some of which don’t involve the presence of ovarian cysts or irregular cycles at all.
This means that some doctors are using outdated parameters to diagnose PCOS, which leads us to an important question… Do you actually have PCOS?
Do you actually have PCOS?
In order to determine if you have PCOS, you must first understand the four different types of PCOS and what triggers them.
The 4 Types of PCOS
To get a full, in-depth, doctor reported look at the four types of PCOS, please read Dr. Lara Briden’s article here. I will do my best to give a very broad overview here based on my understanding as a menstrual cycle and FAM Educator.
Insulin-Resistant PCOS
Insulin-resistant PCOS is the most common type of PCOS. It is characterized by androgen excess in the presence of insulin resistance. It is diagnosed by the presence of androgen excess on a blood test or demonstrating persistent symptoms of androgen excess, and the presence of insulin resistance as determined by appropriate testing (which Dr. Lara Briden shares is to measure triglycerides, ALT, or the hormone insulin). As Dr. Briden reports, normal glucose tests and/or continuous glucose monitoring cannot diagnose insulin resistance. Folks with insulin-resistant PCOS often have irregular or missing periods and may or may not have cysts on their ovaries during an ultrasound. It is very common for folks with insulin-resistant PCOS to struggle with weight loss and to carry excess weight around their mid-section due to the metabolic nature of insulin resistance.
Post-Birth Control PCOS
Post-birth control PCOS is a state of androgen excess that occurs, for some, after going off of certain hormonal birth control methods. Irregular and/or missing periods are common, but insulin resistance is not present. Ovarian cysts may or may not be present. This type of PCOS is a response to coming off of hormonal birth control and usually quite temporary. If you had an irregular cycle prior to beginning hormonal birth control it is unlikely that discontinuing hormonal birth control is the driving factor of your PCOS and/or irregular cycles.
Inflammatory PCOS
Chronic inflammation plays a role in all types of PCOS, however with inflammatory PCOS it is the main trigger given that insulin resistance is not present and a recent discontinuation of hormonal birth control has not occurred. Folks with this type of PCOS show the common signs of PCOS (irregular cycles, acne, dark hair growth, etc) AND very likely show signs of chronic inflammation as well like IBS, chronic fatigue, eczema, psoriasis, and autoimmune diseases.
Adrenal PCOS
This is the most uncommon type of PCOS and one that I very likely experienced in my late twenties. This is a funky type of PCOS where menstrual cycles are usually regular, meaning there are no irregular or missing periods. Testosterone, the usually elevated androgenic hormone of the other PCOS types, tends to be within normal range. However, the adrenal androgenic hormone DHEA-S tends to be elevated. Adrenal PCOS is not triggered by insulin resistance, chronic inflammation, or transitioning off of hormonal birth control. While I can only speak for myself, I experienced this symptomatically as major dysregulation in my stress response system that led to debilitating periods with chronically elevated cortisol and DHEA-S.
Okay, now that you have a brief overview of the four types of PCOS, it’s important to reflect on your symptoms, advocate for appropriate diagnostic testing, and ask yourself - Do I even have PCOS?
In my experience as a FAM Educator who has analyzed thousands of cycle tracking charts over the past 10 years from women all around the world, many MANY women have come to me saying that they had been told that they have PCOS. However, upon looking at their cycle tracking charts and asking them simple PCOS-related questions it was obvious that they did not have the diagnostic markers for PCOS. Most of them simply came to me with long menstrual cycles and ovarian cysts that were visible on an ultrasound. Their long menstrual cycles were misinterpreted by medical providers as “irregular cycles” because they didn’t fit the acceptable 28-day cycle length, when in fact many of these women were ovulating and bleeding regularly and predictably it just occurred later in the cycle than is generally considered “ideal”.
What this means is that these women that came to me having been told that they had PCOS actually were just experiencing late ovulation and, therefore, delayed periods.
I’m not saying that this is the case for everyone, rather that it’s an important distinction to be aware of. I have worked with many women who do, in fact, have a diagnosable type of PCOS, but it’s important to differentiate between true PCOS and long menstrual cycles.
Why?
Because true PCOS requires understanding which of the four types is present and appropriately treating the underlying cause of the androgen excess and ovulation suppression with tailored food, supplements, and lifestyle shifts.
Long menstrual cycles, on the other hand, simply require tailored ovulation support again through food, supplements, and lifestyle shifts but they are very specific to boosting & nourishing ovulation itself rather than an underlying cause of androgen excess and outright suppression of ovulation.
Does hormonal birth control fix PCOS?
If you’ve ever discussed PCOS with a doctor or even done an internet search about PCOS you’ve likely been told that hormonal birth control is the primary, if not only, treatment for PCOS. I highly disagree. In fact, I don’t believe that hormonal birth control is a treatment for PCOS at all. Here’s why…
A treatment for a medical condition should address the cause of the condition and actively work to fix and resolve the condition. Hormonal birth control use for PCOS does neither. Hormonal birth control suppresses ovulation - aka shuts it down - and replaces your natural period bleed, or lack thereof, with a fake chemical bleed. PCOS is already a condition of suppressed ovulation, so how is further suppressing ovulation fixing the problem? It’s not.
Hormonal birth control helps restore a regular, monthly bleed in folks with PCOS, which some folks misinterpret as “regulating their cycle”. This is misguided because the bleed that occurs on hormonal birth control does not happen as a response to ovulation as one aims for with a healthy, regular menstrual cycle. Rather, the bleed that occurs on most hormonal birth control methods occurs as a withdrawal bleed. It is simply a response to switching to sugar pills or changing out a vaginal ring and removing the constant presence of the synthetic birth control hormones.
To make matters worse, most types of hormonal birth control contain progestins - synthetic progesterone hormones that can create or increase androgen excess symptoms like jawline acne, dark hair growth, hair loss, and more. Though for some folks with PCOS combined oral contraceptives may help lower androgens and improve symptoms of androgen excess. I’ve seen it go both ways.
All this leads us to the next question that often comes up… If hormonal birth control doesn’t reverse androgen excess or restore regular ovulation, why do doctors recommend birth control for PCOS?
Why do doctors recommend birth control for PCOS?
The answer is two-fold. Firstly, doctors recommend birth control for PCOS because it does restore the regular release of the uterine lining, which is often not occurring for folks with PCOS. Regular release of the uterine lining, aka having a period bleed, is good for your health for many reasons. One of the most important being that it lowers the risk of endometrial cancers for folks with PCOS. (Source)
If you’ve ever read the stat that endometrial cancer risk (cancer of the uterine lining) is higher for those with PCOS it is because they are not experiencing a regular growth and release of the uterine lining due to a constant state of unopposed estrogen - aka lack of progesterone because we only make progesterone AFTER ovulation. (Source)Hormonal birth control can help mimic this process that would be occurring naturally in a healthy, regular menstrual cycle by triggering a cyclical period-like bleed.
Secondly, many doctors recommend birth control as the ONLY option for PCOS because it is often the only tool that they have in their toolkit to manage the symptoms & risks of PCOS. Our medical system here in the US relies almost entirely on pharmaceuticals and that approach is what is taught in our medical schools. For this reason, most conventional doctors have not been taught much about the food, supplements, and lifestyle approaches to reversing - as opposed to managing - PCOS.
And, truly this is what hormonal birth control does. It manages PCOS, it does not fix it.
Hormonal birth control simply manages some, not all, of the symptoms of PCOS, but it does not fix the root cause or reverse the condition.
Which brings me to my finally big question of the day… If you don’t want to simply manage PCOS and you want to actually fix and reverse the condition - getting rid of it for good - then what the heck do you do?
How to manage PCOS naturally without birth control
First off, I would argue that with natural approaches to PCOS we are not managing PCOS, we are truly working to reverse and eliminate the presence of the condition. To do so, there are 3 steps that I recommend for the natural treatment of PCOS.
3 Steps for Natural Treatment of PCOS
Step 1. Identify IF you even have PCOS. If so, clarify which type of PCOS may be present using the guidelines presented above and in Dr. Lara Briden’s article here
Step 2. Work with a naturopathic doctor and other holistic providers to create a food, supplement, and lifestyle plan that nourishes your specific cycle needs and addresses the type of PCOS that is present. For example - working to reverse insulin resistance in insulin-resistant PCOS, healing chronic inflammation in inflammatory PCOS, nourishing adrenal health in adrenal PCOS, and appropriately supporting the cycle after coming off of hormonal birth control with post-birth control PCOS.
Step 3. Learn how to track your cycle using cervical fluid, basal body temperature, and FAMs rules to understand how your cycle is responding to your natural healing protocol, to identify when & if ovulation is occurring, and to have a reliable birth control method that doesn’t suppress ovulation.
Curious about the science behind the FAMs Method for birth control and how it’s scientifically proven to be up to 99.6% effective(that’s the same as the pill!)? I wrote a whole article about that here.
And, YES you CAN use fertility awareness methods (FAM Method) even with PCOS. The same fertility signs that folks with regular, predictable cycles track each month are still present in folks with PCOS, they just occur less frequently - only as frequently as they are ovulating or trying to ovulate.
Curious about how to use FAMs safely and effectively with PCOS and irregular cycles? I wrote a whole article on that here.
Ready to ditch hormonal birth control and stop just managing PCOS so that you can actually heal your hormones and revive your regular, monthly cycle? I have a thing that can help!
Join me for one of my monthly Cycle Wisdom FAMs Classes.
These classes are perfect for folks who are beginners and/or totally new to fertility awareness methods and cycle tracking. In each class I teach the full FAMs method - how to track cervical fluid, how to track basal body temperature, and how to use the rules of the method for birth control & pregnancy achievement. It’s the perfect opportunity to experience the method before diving all the way in. You can learn more about the Cycle Wisdom FAMs Classes here.
For folks who are like f*ck it, I’m ready to dive all the way in, my Monthly FAMs Support Membership was made for you.
In the Monthly FAMs Support Membership you get access to:
> Self-paced teaching modules to learn the full FAMs method(including how to use it as birth control, for pregnancy achievement, and for greater cycle awareness)
> 24/7 on-demand voice & text messaging with me to answer all your cycle-related questions
> Unlimited cycle chart reviews to get my expert FAM Educator support with analyzing your personal cycle tracking charts to help you open & close your fertile window, identify ovulation, and spot potential underlying cycle imbalances
> Access to my extensive practice chart library so that you can practice using the rules of the method BEFORE you need to use them in your own cycle
> Unlimited access to my menstrual wellness masterclass training vault with self-paced classes specific to transitioning off of hormonal birth control, perimenopause, postpartum cycles, natural menstrual cycle support, and more
> Exclusive access to 1:1 Deep-Dive Sessions with me for more intensive, in-depth, personalized support with your cycle needs (available only to members!)
You can learn all about the Monthly FAMs Support Membership here.
Disclaimer: Brandy Oswald, Sauvage Wellness LLC, and her employees are not doctors, nurses, physicians, psychotherapists, or in anyway licensed medical practitioners and information presented here is to serve as an educational resource and not to be interpreted as: (1) medical advice or parameters for diagnosing medical conditions; (2) a 100% effective birth control or pregnancy achievement options or (3) nutrition or health guidelines. By reading this you acknowledge that you understand that as a specialized form of consulting, fertility awareness education is not the same as professional or licensed therapy or medical advice and intervention; and recognize that it is your responsibility to seek such services from a licensed professional. Brandy Oswald is not a medical provider and cannot give medical advice. All information provided by Sauvage Wellness LLC and Brandy Oswald is of a general nature and is intended only for educational purposes to help with your personal health improvement goals and should not be relied on as medical advice. Always consult a physician with any health concerns and prior to changing your diet, lifestyle, supplements, birth control, fitness, or prescription medicine routine. Should you choose to take action based on the information provided by Brandy Oswald it is of your own volition and you recognize that neither Brandy nor Sauvage Wellness LLC is not held liable for any intended or unintended outcomes. All readers hereby WAIVE AND RELEASE Brandy Oswald and Sauvage Wellness LLC from any claim, demand, cause of action of any kind resulting from or related to reading educational articles, and/or participation in classes, workshops, and all service offerings provided by Brandy and Sauvage Wellness. As a reader you hereby acknowledge that you are fully responsible for any and all risks, injuries, or damages, known or unknown, which might occur as a result of your participation.
