Can birth control cause PCOS? Here are the facts

When you’re figuring out which birth control you’d like to use, there’s a lot to consider. It needs to fit with what’s going on in your life right now, along with your health history. You might also have a method in mind that you prefer.

The pill is an effective, convenient contraceptive method — and a popular choice for a lot of people. In fact, a 2020 report found the pill was the most used reversible contraception in the United States, with 14% of women taking it. But on the flip side, the pill can cause unwanted side effects for some, including headaches and irritability. 

“Post-pill PCOS” can also come up as a possible side effect when you’re doing your research. This is the unfounded idea that taking the pill could cause the condition polycystic ovary syndrome or PCOS. There isn’t any truth in this, but let’s break down where this medical myth comes from. Plus, we’ll discuss reasons you might experience symptoms like irregular periods when you stop taking the pill.

Key takeaways

• PCOS is a condition that affects how your ovaries work. It’s estimated that 8% to 13% of reproductive-age women have PCOS. 
• While you may have come across misinformation online, taking hormonal birth control does not cause PCOS.
• Some people experience symptoms associated with PCOS — like irregular periods — after stopping birth control. This is often because your body is adjusting to changing hormone levels and usually regulates itself within a few months.
• While hormonal birth control doesn’t cause PCOS, it can mask some symptoms by making your period appear regular. This can mean that when you stop taking birth control, PCOS symptoms can start or come back.

Can birth control cause PCOS?

The simple answer is no, it can’t. While some people worry that “pill-induced PCOS” is a thing, it isn’t a medical condition or something that doctors recognize. 

In fact, the opposite is true. Hormonal birth control is often used to “counteract some of the effects of PCOS,” explains Dr. Jenna Beckham, obstetrician, gynecologist, and complex family planning specialist, WakeMed Health and Hospitals, Planned Parenthood South Atlantic, North Carolina, US. 

That means your doctor may recommend the pill as a way to regulate your cycle if you have PCOS and don’t have regular periods. They may also prescribe it to help with another common PCOS symptom: acne. 

So why do some of us mistakenly think the pill can cause PCOS? It’s likely due to some people’s periods being unpredictable when they come off the pill. “Depending on their history and how long they’ve been on birth control pills, some patients will [notice a] change in their cycle,” Dr. Beckham explains.

This makes sense because the pill works by releasing hormones that suppress ovulation. So when you come off the pill, your body needs to readjust to the changing hormone levels. “It may take a little bit of time for it to regulate again,” Dr. Beckham says. Up to three months is normal. However, if you have any concerns or other symptoms, then schedule an appointment with your doctor.

What causes PCOS?

So, if the pill doesn’t cause PCOS, then what does? Frustratingly, the exact cause of PCOS isn’t totally understood, but it may be linked to an imbalance in your hormone levels. 

Here’s the science: Our cycle relies on lots of different hormones in order to stay in sync. Doctors think that PCOS occurs when your ovaries produce higher than normal levels of hormones known as androgens. The most commonly known androgen is testosterone. Sometimes androgens are considered “male hormones” because they are found in higher levels in men, but it is normal for both women and men to have androgens.

If you have high androgen levels as a result of PCOS, then it can cause changes to your cycle when you’re not using hormonal birth control, such as:

• Having an irregular cycle. That means your periods have a smaller (fewer than 21 days) or larger (35 days or more) than average gap between them. You might also experience heavier or lighter bleeding than usual or miss three or more periods in a row.
• Not ovulating or releasing an egg every cycle. This is why PCOS can sometimes make it harder to become pregnant. Please know that lots of people with PCOS go on to get pregnant and have healthy babies.

Another common feature of PCOS relates to how people’s ovaries can appear on ultrasound. PCOS gets its name from exactly this finding. The “cysts” in PCOS are actually lots of small fluid-filled sacs called follicles. 

These follicles contain immature eggs that are not developing or getting ready for ovulation as they normally do. While this might sound scary, the multiple follicles are not painful or dangerous and will not need to be surgically removed. These cysts are also caused by high levels of androgens, but not every person with PCOS has them. Doctors aren’t sure why this happens.

What they do know is that PCOS can develop any time after you’ve started puberty. Frustratingly, though, it can sometimes take up to 12 years to get a diagnosis. And while it’s hard to know why some people develop the condition, you may be more likely to have PCOS if other people in your family have been diagnosed with it.

Why “post-pill PCOS” doesn’t exist

So, let’s clear this up: Medical experts don’t recognize post-pill PCOS as a condition. But if you’ve heard about it from friends or online, then it’s helpful to unpack why this myth exists.

Whether you’ve been diagnosed with PCOS or not, you might recognize some of these symptoms, like an irregular cycle, from a time before you started taking hormonal birth control. It’s important to remember that PCOS isn’t the only reason why you might have an irregular cycle. 

Once you started taking hormonal birth control, your cycle might have become more regular, or you might not have had a bleed at all, even if you had PCOS. However, if you had irregular cycles before starting the pill, unfortunately, your cycles will probably go back to being irregular off of the pill. This might make it seem like the pill has caused PCOS when, in fact, your pill might have just masked some of the symptoms associated with PCOS. 

As hormonal birth control can regulate your cycle, it means you can’t be assessed for PCOS while you’re taking it. You may already have PCOS and just not know until you come off the contraceptive pill. Alternatively, you may come off the contraceptive pill and mistake your period not returning to a regular cycle for a few weeks or months as a sign of PCOS. 

Do post-pill symptoms go away?

Since it can take your body a few months to adjust to the change in hormones when you stop taking the pill, you may notice changes to your menstrual cycle and symptoms. 

That’s because, as Dr. Beckham explains, “a lot of hormonal birth controls can be beneficial in managing some other symptoms that are related to changes in hormones.” She says that includes “mood symptoms, cramping, and some of the premenstrual emotional symptoms.” 

So, you might find that your periods have become longer or shorter since coming off birth control. Or they might be heavier or more painful. Perhaps you’re having more mood swings or your premenstrual symptoms feel worse than they were before.

Rest assured that this is normal. However, these changes can sometimes be disruptive and uncomfortable, so go easy on yourself. If you’re worried about symptoms after coming off the pill, then talk to your doctor. Similarly, if your cycle hasn’t returned within three months after going off birth control, book an appointment with your health care provider. 

“Obviously, each individual can make their own decision, and if after one month, they’re feeling very stressed about it, or they’re having a lot of negative symptoms, it’s always worth having a conversation with their provider,” says Dr. Beckham. “But absolutely, if at the three-month mark, they’ve not had a return to regular cycles, or they’re still having a lot of other symptoms that they’re concerned about, I would absolutely recommend making an appointment and talking about it with their provider.”

How to tell if it’s PCOS

Now that you know that it can take some time before your cycle becomes regular after coming off hormonal birth control, here’s how to spot some of the signs that might point to PCOS. 

Signs of PCOS

Not everyone with PCOS has all of the symptoms, and they can vary in severity for each person. But some common signs include:

• Irregular periods or no periods
• Difficulty becoming pregnant 
• Dark, thick hair growth on areas like your face, chest, and back
• Weight gain, especially around your belly, and difficulty maintaining a weight that’s healthy for you
• Thinning hair and hair loss from your head
• Oily skin and acne
• Skin tags (excess pieces of skin on your neck and armpits)
• Skin that’s darker or thicker on your neck, armpit, and under your boobs

It’s hard to stay on top of multiple symptoms. Flo’s Symptom Checker feature can give you the information you need to have a confident conversation with your doctor about what’s going on inside your body.

PCOS diagnosis

If you recognize some of the symptoms above, then it’s time to reach out to your doctor.

What can you expect once you’re there? At the start of your appointment, they may ask you questions about what your cycle is usually like, any symptoms you’ve had or felt, and your family health history. This may feel personal, but this information can help you get the answers you need.

You might be referred for further tests and a follow-up appointment. They will use the following criteria to diagnose PCOS:

• Do you have irregular or infrequent periods?
• Do you have increased levels of androgens? This can be found by doing a blood test to check hormone levels. Some of the physical signs of PCOS, like hair growth on areas like your face or acne, can also be a sign that you have high levels of androgens.
• Does an ultrasound show that you have cysts on your ovaries? 

If you meet two of the three criteria, then they may diagnose you with PCOS.

Having a clear picture of any patterns in your cycles and symptoms can help you during these appointments. You may want to use Flo’s cycle report feature to get information you can easily share with your health care provider.

Final thoughts on hormonal birth control

Being unsure about changes in your cycle can be daunting. However, rest assured, if you’re worried about the pill impacting your longer-term fertility or health once you stop taking it, know that there isn’t any evidence of that happening.

“As long as you don’t have any medical [reasons why you shouldn’t be using] hormonal birth control, inherently they don’t have any risk,” Dr. Beckham explains, adding that this “ultimately does not itself impact the future success of fertility.”