The Ultimate PCOS Handbook. Theresa Cheung

analysed the results of several studies published between 1980 and 2002. They determined that women using low-dose contraceptives have approximately twice the risk of stroke or heart disease.

      Women with polycystic ovary syndrome already have an increased risk of cardiovascular disease, Dr Nestler said, and are at an even greater risk if they are treated with low-dose contraceptives. He suggested that doctors consider alternatives. Long-term use of oral contraceptives may also increase this risk, Nestler said. But he said that for most women the risk is still very low.

      This study reinforces why we emphasize the importance of natural approaches for treating PCOS, such as a healthy diet, regular exercise, stress management and selected nutritional supplements and herbs. Hormone contraception is effective in preventing pregnancy, but should be chosen with a full understanding of the health risks involved. Always consider alternatives including barrier methods (diaphragm, cervical cap, IUD, condoms), which have the added benefit of protecting you against sexually-transmitted diseases (STDs).

      There are also health risks associated with being on the Pill if you’re overweight. Synthetic oestrogens in the Pill can increase the body’s drive towards insulin resistance, a precursor to diabetes. There’s also the increased risk of high blood pressure. So, for women with PCOS who have weight problems being on the Pill isn’t a good idea unless you’re following a healthy eating, healthy living plan and having regular check-ups for blood pressure, blood sugar and blood cholesterol levels.

      Finally, it’s important to stress that the pill is not a miracle cure, because although it results in monthly menstrual periods, this doesn’t mean your PCOS is ‘cured’. But if it’s the right option for you, having a healthy lifestyle is the key.

      Some studies⁴ also suggest that the Pill may actually leach valuable nutrients as well as alter your vitamin and mineral levels. Research indicates that the Pill lowers levels of B vitamins, folic acid, vitamin C and vitamin E. Levels of vitamin A and iron may also increase, as do levels of copper – which isn’t a good thing because copper levels that are higher than normal can increase the risk of high blood pressure. Zinc is perhaps the most important mineral that can be affected by the Pill. The Pill is thought to change a woman’s capacity to absorb zinc, and you need sufficient levels of zinc to maintain a healthy reproductive system and hormonal balance.

      If you’re on the Pill, on top of your healthy diet (which we’ll outline in Part 2) it might be a good idea to supplement extra vitamin B complex to help your liver break down synthetic hormones effectively. You might also consider taking a zinc supplement.

      We also know that the Pill can lower levels of good cholesterol (HDL) and increase levels of bad cholesterol (LDL), so you need to eat foods that promote good cholesterol to reduce your risk of heart disease. The Pill can also kill off friendly bacteria in your gut, which can lead to digestive problems. Live yoghurt which contains natural probiotics should be on your daily menu. If you’re dairy intolerant, you can buy fruit-based drinks with live bacterial cultures from health food stores.

      WHICH PILL IS BEST FOR PCOS?

      Oral contraceptives come in two types – ones containing both oestrogen and progesterone, and ones that contain only progesterone. The combined (oestrogen and progesterone) contraceptive is the most widely prescribed because it’s the most reliable. There are many different products available and they are divided into three groups depending on their oestrogen content:

      1 Low-dose brands such as Minulet, Ovran, Femodene, Loestrin and Ovranette

      2 Medium-dose brands such as Brevinor, Cilest, Norimin and Ovysmen

      3 High-dose brands such as Norinly-l, Ortho Novin 1/50 and Ovran.

      There are also pills that come in two or three groups, or phases, each phase containing a different proportion of oestrogen and progesterone, such as Triadene, TriMinulet, TriNordial and Tri Novum. (Please note brand names may differ outside the UK.)

      Progesterone-only pills are slightly less reliable and must be taken at exactly the same time each day. UK brand names include Femulen, Micoval, Norgeston and Noriday.

      You might think that progesterone-only pills are the best choice if you’ve got PCOS, but some women have found that progesterone-only pills or pills with low doses of oestrogen don’t properly suppress their PCOS symptoms, or even make them worse. One study⁵ found that the contraceptives with the greatest risk of triggering diabetes were progestin-only pills (progestin is a synthetic form of progesterone). However, a study from Harvard Medical School placed the blame for this increased risk not on the Pill but on excess weight. Of all the contraceptives studied, the combination pill containing norethindrome appeared to be the safest and did not increase the risk of diabetes.

      According to Dr Helen Mason, senior lecturer in Reproductive Endocrinology at St George’s Hospital Medical School, London, certain brands may make androgenic effects (hair growth or loss and other ‘masculinizing’ symptoms) worse:

      ‘Norethisterone found in Brevinor, Loestrin, Trinovum, is the most androgenic and should be avoided. The next most androgenic is levonorgestrel found in logynon, Microgynon, Ovran and then Desogestrel found in Marvelon. It seems that cyproterene acetate found in Dianette is the least androgenic and as a result is commonly prescribed for hirsutism, Dianette is probably your best choice.’

      Cilest is another brand to choose if excess body hair is a problem. If you’re prone to acne you need to go for contraceptive pills with the new progesterones such as Minulet, Femodene, Ovysmen, Brevinor or Yasmin.

      Weight gain tends to be more common with the higher-dose pills – which are now, thankfully, almost a thing of the past. Switching to lower-dose pills may help, but bear in mind that even lower-dose oestrogen pills can cause water retention, and that progesterone can still increase your appetite. If weight gain is a concern, go for the pills with the newest progesterones, such as Femodene, to reduce the risk, but always check with your doctor that it’s the right pill for you and your symptoms. If you’re on a low-dose pill there’s no reason why, with careful attention to your diet and regular exercise, you shouldn’t be able to manage your weight.

      It’s hard to say how long you should stay on the Pill, as every woman is different. You need to discuss this carefully with your doctor. The best advice is to monitor your health and your symptoms carefully. If you think the Pill is making things worse, tell your doctor. You may also find that after taking one brand of pill for several years your symptoms seem to be returning, perhaps as a result of increased insulin resistance. If you think your pill is triggering weight gain and your symptoms, ask your doctor for advice.

      EXCESS HAIR AND ACNE TREATMENTS

      Oral contraceptives such as Dianette and Yasmin decrease your body’s production of androgens, as do anti-androgen drugs such as spironolactone. Both treatments can lessen and slow hair growth. Oral contraceptives and anti-androgens can also reduce acne in women with PCOS, although some women may also need topical and/or oral antibiotics. Persistent cases of acne may require consultation with a dermatologist.

      Excess hair can be removed with local measures such as shaving, use of depilatories, electrolysis and laser therapy. Many women worry that these local measures make hair grow faster, but this isn’t true.

      Electrolysis is a permanent form of hair removal but it has several drawbacks. First, there are no standardized licensing guidelines for electrolysis, so finding an experienced, effective technician is difficult. Second, this method requires repeated treatments for up to 12 or 18 months. Finally, side-effects can include pain, infection, keloid (scar) formation (for people who are susceptible), hyperpigmentation (darker patches of skin), or hypopigmentation (lighter patches of skin).

      Studies⁶ show that laser treatment can be effective, though it can be expensive.

      Vaniqa is a prescription-only topical cream which many women have found to be particularly effective and suitable for unwanted hair growth associated with PCOS.

      Vaniqa is applied twice