The Truth About PCOS Medications: The Ultimate Guide to 5 Conventional Treatments
If you’ve been diagnosed with PCOS at your doctor’s office, chances are you’ve been offered a handful of medications that promised to be the solution to your PCOS. Whether it’s dealing with symptoms of weight, blood sugar, infertility/irregular periods, or androgenic symptoms, maybe you’ve given some of these conventional treatments a go but ended up dealing with a ton of side effects. Or maybe you feel suspicious, confused, or overwhelmed by what these medications are doing for you. Either way, navigating the world of these conventional treatment options can be challenging, especially when you barely have enough time to seek the answers you need as you’re shipped in and out of your doctor's office.
So if you’re looking for clarity a one-stop-shop for the most common conventional treatments for PCOS, you’re in the right place. In the article we will be deep diving into the 5 most common prescriptions for a PCOS diagnosis:
Metformin
Birth Control Pills
Spironolactone
Ozempic
Provera
Metformin
Metformin, a drug that is traditionally used to treat Diabetes, is often prescribed for PCOS as a means of lowering insulin levels. In doing this, it can also reduce androgenic symptoms like unwanted hair growth, hair loss, and acne, promote regular menstrual cycles, and even support weight loss.
How It Works
Metformin works by decreasing the amount of sugar that is released by the liver and disrupting the amount of sugar your digestive system absorbs. This in turn lowers circulating blood sugar levels which lowers the need for the body to release excess insulin. 50-70% of women with PCOS experience insulin resistance, making insulin resistance and poor glucose tolerance the most common driver of PCOS symptoms.
Common Side Effects
The most common side effects of taking Metformin are digestive symptoms. Many women describe their stomach feeling like it’s in knots as they struggle with symptoms of bloating, loose stools, and nausea. Metformin can also disrupt the absorption of essential nutrients including B12, folate, and magnesium.
Considerations
Ironically, B12 and folate help increase insulin sensitivity, improve fertility, and support level mood and energy. It has also been shown that women with PCOS are already more susceptible to magnesium deficiencies. With magnesium being responsible for over 300 enzymatic reactions in the body, an exacerbated magnesium deficiency can drive symptoms of poor blood sugar control, poor sleep, and poor stress tolerance.
Now before you rush to take Metformin as a means of weight loss, it is important to know that it is not a magic pill for losing weight. In fact, for most women, it won’t result in weight loss alone. This is because weight is a complicated adaptation to many underlying drivers of PCOS, not just insulin resistance. Some of these other root causes include adrenal dysfunction, inflammation, sluggish thyroid, and other hormone imbalances. Finally, the sustainability of weight loss is essential to consider. Even with weight loss achieved through medication, there is a risk for rebound weight gain without addressing nutrition, lifestyle, and your overall relationship with food.
Looking for a root-cause approach to PCOS? Click HERE to download my free starter guide: Understanding the Language of Your Hormones to kick-start your healing journey.
Birth Control Pills
Birth Control Pills is most often prescribed for PCOS as a means of “regulating periods”. This statement is extremely problematic because 1) it is an inaccurate explanation of what the pill does to your hormones and 2) does not consider WHY you’re experiencing irregular periods in the first place.
Although the pill was originally developed as a form contraceptive, it is now commonly prescribed for a plethora of reasons including acne, PMS, and as mentioned above, irregular periods.
How It Works
The pill works to “regulate” your period by turning off the natural production of your hormones and then inducing a medically induced withdrawal bleed once a month. This is very different than a true period, as a true period follows ovulation. The pill prevents ovulation and thus simultaneously serves as a contraceptive.
This is also why the pill is prescribed for many other hormonal symptoms. By turning off your androgens, it can reduce symptoms of acne and by turning off your estrogen, it can reduce symptoms of heavy or painful periods.
Common Side Effects
So what’s the big deal if the pill turns off your hormones? Aren’t those pesky hormones the cause of all your PCOS woes?? Who needs them anyways??
Here’s the deal. Your hormones play a vital role in every aspect of your health! Not just your fertility, but your daily mood, appetite, and energy along with your long-term health including heart, bone, and brain health. In fact, the pill has even been shown to make certain PCOS symptoms worse, including an increase in anxiety/depression, chronic fatigue, and insulin resistance as well as depleting essential nutrients including B vitamins, vitamins C and E, magnesium, selenium, and zinc. Other side effects include an increased risk of blood clots and stroke, which is often not discussed with women who are prescribed the pill.
Finally, we must consider what happens when you get off the pill. Whether it’s for personal reasons or because you’re ready to try to conceive, if the root cause of your PCOS was never addressed i.e. poor blood sugar control, inflammation, cortisol imbalances, etc, those underlying drivers will still be there. The pill merely served to mask those symptoms all those years. In fact, many women experience what’s been coined “Post Birth Control Syndrome” where long-term suppression of hormones leads to a rebound of side effects after discontinuing the pill.
Considerations
The pill can help reduce certain PCOS symptoms, but it comes at a cost. The paradigm shift starts with the understanding that your hormones are an essential and necessary piece of your well-being– not something that should casually be disregarded and manipulated. I’m not here to demonize the pill as I’ve met many women who suffered from debilitating periods for years and found the pill to be the only solution for them to live a normal life. Rather, what I value the most in the prescription of the pill is Informed Consent, or the principle that you are given all the risks, benefits, and alternative options available so that you make the best decision for yourself.
When used to treat PCOS, the pill is merely a band-aid solution and in some cases, can make PCOS symptoms worse. If you’re looking to use birth control as a contraceptive, explore non-hormonal options. If you’re seeking to use birth control to manage symptoms, first ask WHY you’re experiencing those symptoms so that you can get to the root of your PCOS and start addressing the underlying metabolic imbalances.
Spironolactone
Spironolactone, originally prescribed for those with high blood pressure is another medication often prescribed for PCOS to address symptoms of high androgens. These symptoms include acne, hirsutism (unwanted hair growth), and hair loss.
How It Works
Spironolactone works by reducing the conversion of testosterone to DHT, an androgen metabolite that is 5x more androgenic than testosterone. It does this by blocking the activity of 5a-reductase, the enzyme that is in charge of this conversion process.
Common Side Effects
Unfortunately, Spironolactone comes with quite a laundry list of symptoms. For one, it is commonly understood that Spironolactone can cause irregular periods and frequent bleeding which is why it is often prescribed along with contraception. (Is it just me, or does that sound like a bandaid for another bandaid?) In fact, when women come to be looking to regulate their periods but are also on Spironolactone, one of the first things we do is collaborate on a treatment plan to discontinue this medication. This allows us to differentiate whether the symptoms of irregular periods are driven by PCOS or medically induced.
Spironolactone can also be harmful to the development of a baby, which is another reason why preventing pregnancy is considered when it is prescribed.
Another symptom of Spironolactone includes electrolyte imbalances due to sodium loss. Although sodium is often demonized in general health advice sodium, is essential in supporting optimal digestion, insulin sensitivity, and stress tolerance. Without enough sodium, you may notice an increase in symptoms of bloating, food cravings, headaches, dizziness, and brain fog. Women with PCOS who experience estrogen dominance are especially at risk for sodium loss as high estrogen levels increase the body’s need for sodium and taking Spironolactone will only make matters worse.
Could your symptoms be driven by estrogen dominance? Click HERE to get to know more about your unique estrogen balance.
Considerations
If you’re considering taking Spironolactone for your PCOS, understand that it is treating a SYMPTOM of PCOS and not the problem. The root cause of androgenic symptoms of acne, hirsutism, and hair loss is insulin resistance because elevated insulin levels increase androgen production in the ovaries. This is why many women will still experience persistent symptoms along with the added side effects when taking this medication. If you’re already taking Spironolactone, consider integrating nutrition and lifestyle strategies that can help naturally reduce insulin levels.
Ozempic
Ozempic, a diabetes medication that falls under the category of glucagon-like peptide-1 (GLP-1) receptor agonists (a mouth full, I know!), has recently gained attention in the PCOS world due to its impact on insulin. There is evidence that shows this medication can help increase insulin sensitivity while also regulating appetite and potentially lead to weight loss.
However the research around Ozempic for weight loss is still quite new, so there is no way of knowing whether it is effective for long-term use, especially for PCOS.
How It Works
Ozempic works by stimulating the pancreas to produce insulin which helps lower blood sugar levels. Its mechanism of action differs from Metformin, Metformin being in the drug class called a biguanide which, as mentioned earlier, decreases the release of sugar from the liver and absorption in the digestive system. Ozempic also slows digestion which can help reduce blood sugar spikes and help you feel fuller for longer.
Common Side Effects
Like any medication, Ozempic stops working when you stop taking it, which can lead to a reemergence of PCOS symptoms. Other side effects of being on Ozempic include nausea, constipation, low blood sugar, and headaches. There is also evidence of long-term side effects including kidney, pancreas, and gallbladder problems, vision changes, and thyroid tumors.
Considerations
In addition to the physical symptoms, Ozempic can be quite pricy if prescribed without Diabetes. Some estimate costs of over $1500 a month which can be a huge financial consideration, especially due to the fact that it is meant to be a long-term medication.
When used as an intervention for PCOS, understand that Ozempic isn’t going to address many other drivers of your symptoms such as poor adrenal health due to chronic stress. In fact, stressing about weight loss and/or losing too much weight too quickly can contribute to mental, emotional, and physical stress, which will only exacerbate PCOS symptoms.
Finally, if you struggle with an eating disorder or disordered eating, it is so important to invite alternative markers of progress for your PCOS outside of the number on the scale. When medications are prescribed solely for weight loss, it can perpetuate the obsession and micromanagement toward body size. It is not wrong to use Ozempic if you struggle with your relationship with food. However, any approach that disregards your mental and emotional health for a physical outcome will typically lack sustainability in the long term.
Provera
Provera is a synthetic form of progesterone that is typically prescribed to induce a period if your period has gone missing for more than 3 months. Women with PCOS who have infrequent or absent periods are at a higher risk of developing endometrial hyperplasia, a thickening of the uterine lining. Provera can help reduce this risk by promoting regular shedding of the uterine lining.
Provera can also be prescribed for The Provera Challenge. The Provera Challenge is performed to help investigate why you may not be having a period. For the Provera Challenge, you are typically instructed to take Provera for 5-10 days. Then one of two events may occur: Either you will have a withdrawal bleed (mimicking a period) or no bleed with occur.
If a withdrawal bleed occurs, it suggests that the uterus is functioning properly, and the cause of irregular periods is more likely related to underlying root causes of PCOS which disrupt regular ovulation.
If no withdrawal bleed occurs, it indicates that there might be a structural issue such as with a compromised outflow tract or scarring or in rare cases, an instance of premature ovarian failure.
How It Works
Provera works by mimicking the effects of progesterone. When you ovulate, progesterone is produced for 10-14 days. If no fertilization had occurred, progesterone will then drop which signals the body to shed the lining on your uterus which shows up as your period. Provera medically induces the same drop-off of progesterone in the absence of ovulation.
Common Side Effects
Although side effects of Provera are typically only temporary due to the way short phases in which it is used, some symptoms include acne, breast tenderness, and an increase in other PMS symptoms. It is also important to note that Provera is NOT a form of contraceptive and therefore not meant to be used to prevent pregnancy.
Considerations
Although Provera can serve as highly effective in protecting the health of the uterine lining, it is best used as a last resort for an absent period. Without addressing WHY you’re not having a regular period, Provera will merely serve to induce a bleed a do little to support ovulation and fertility. It also will not address other PCOS symptoms including acne and unwanted hair growth.
Final Thoughts
Conventional treatment options have their place in PCOS, and there are alternative and complementary approaches that treat the root cause of your PCOS and allow you to avoid the downsides and side effects of these medications. This is not about having to choose one or the other, but rather finding the right combination of treatments and strategies that work for you in your phase of healing.
At the end of the day, my job is to empower you with knowledge and instill confidence in your choices so that you can step into the driver's seat of reversing your PCOS. Whether it be medications, nutrition, lifestyle, supplements, etc. these are all tools that are available to you. The better you know how to use these tools to your advantage, the better you will feel the sooner you can put your PCOS in remission.
Looking for support with your hormone health? Here are a few ways I can help!
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