Research by by Molly Thompson, PCOS thriver, recipe developer, and mom of 3. Reviewed by functional medical provider.
The Two-Minute Answer
Combined hormonal birth-control pills (and other estrogen-plus-progestin contraceptives) lower free testosterone, lighten heavy bleeding, and create clock-work “withdrawal” bleeds within 2–3 months—so they’re great at masking the most frustrating Polycystic Ovary Syndrome (PCOS) symptoms.
But they don’t fix the root drivers of PCOS—insulin resistance, systemic inflammation, and HPA-axis stress—and those underlying issues usually return the moment you stop the pill. Think of birth control as a symptom band-aid, not a cure. Long-term metabolic healing still comes from nutrition, movement, targeted supplements, and (sometimes) medications like Metformin.
Please note: This is my experience! This is not meant to be medical advice. Dr Brighten has so many articles on birth control that I recommend you read as well.
What the Research Says—Symptom by Symptom
- Cycle regulation: Combined oral contraceptives (COCs) suppress the LH surge and create a predictable 28-day withdrawal bleed—effective symptom control but no spontaneous ovulation. Source: e-enm.org
- Androgen-driven acne & hirsutism: Estrogen raises SHBG; one RCT on EE 30 µg + drospirenone cut free testosterone by ≈ 50 % in 12 weeks, improving acne and excess hair. Source: pmc.ncbi.nlm.nih.gov
- Ovarian cysts / pelvic pain: Lack of ovulation and steady progestin keep most functional cysts from forming, easing pain in many users.Source: e-enm.org
- Insulin resistance & weight: Multiple reviews show little to no change in HOMA-IR or weight after 6 months on COCs—so metabolic root causes persist. Source: pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov
- Inflammation markers: Data are mixed; some progestins may slightly raise CRP, while drospirenone appears neutral. (Narrative review) Source: e-enm.org
Why I Chose to Quit: My Root-Cause Framework
I wanted my cycle to be my marker for my overall health. Your cycle tells you so much about your hormones and health and my cycle was telling me something was off and I didn’t want to ignore that. I worked really hard to reverse my symptoms naturally so we could conceive our daughter on the first try.
- Labs told the real story: On the pill my SHBG was high (great for acne), but fasting insulin and hs-CRP stayed elevated—root issues untouched.
- Mask-then-rebound cycle: Four months post-pill my periods vanished and acne spiked, proving symptom suppression only lasted while medicated.
- Nutrient depletion worry: Long-term COC use can lower B-vitamins and magnesium—nutrients already crucial for insulin sensitivity. Source: e-enm.org
- Personal goal shift: I wanted natural ovulation for future fertility and a true read on my hormone status, so I traded a quick fix for a root-cause plan (see next section).
Alternatives to Birth Control for PCOS (Evidence-Based)
- Myo- & D-Chiro Inositol (40 : 1 blend): Restores ovulation and lowers insulin in many trials—typical dose 2 g : 50 mg, twice daily. pmc.ncbi.nlm.nih.gov
- Omega-3 EPA/DHA: 1–2 g/day can reduce triglycerides and inflammatory markers in PCOS. pmc.ncbi.nlm.nih.gov
- Strength or HIIT training: 3 sessions per week improves insulin sensitivity and may lower androgens better than moderate cardio. pubmed.ncbi.nlm.nih.gov
- Metformin (Rx): Targets insulin resistance directly; often paired with inositols or lifestyle change for additive benefit (discuss dose with your doctor). e-enm.org
- Stress & sleep hygiene: 7+ hours of sleep and daily mindfulness reduce cortisol spikes that can worsen androgen excess—low-tech but powerful.
- Spearmint tea / Spironolactone: Two cups of spearmint tea daily or 50–100 mg spironolactone (by prescription) help block excess androgens. e-enm.org
Ready more about my PCOS story.
Should You Use Birth Control for PCOS?
Questions to Ask Your Doctor
- Am I mainly treating acne / heavy periods or aiming for fertility soon?
- Do I have clot risks (family history, smoking, migraines w/ aura)?
- Which pill formulas have the best androgen profile (e.g., drospirenone, desogestrel)?
- Can we try Metformin or inositol first or pair it with the pill to address metabolism underneath?
- What’s the exit plan? How will we monitor cycles and hormones when I stop?
- Can we dig deeper with a full lab panel to understand my metabolic profile and inflammatory markers first? (see which PCOS labs I tested!)
Bring labs and this checklist to your appointment!
Here is a great article about birth control side affects from Dr. Brighten. If you choose to use HBC and are experiencing side affects she has awesome options to help minimize them too!
Ready to dig deeper? Check out my medical provider approved PCOS Planner—complete with deep dives on how to heal naturally, weekly meal plans and grocery lists, and daily task trackers.
FAQs
No. It controls symptoms while you’re on it; underlying insulin resistance & androgen production resume once you stop.
Large reviews show no consistent weight gain, but fluid retention and appetite changes vary individually.
Most people ovulate within 3–6 months after stopping; see a reproductive endocrinologist or functional medical provider if cycles stay missing past 12 months.
Many OB-GYNs pair them to cover symptoms and insulin resistance.
Takeaways & Next Steps
Birth control can be a helpful short-term tool—especially for teens overwhelmed by heavy periods or adults battling cystic acne—but it’s not a root-cause therapy. Pair (or replace) it with nutrition, movement, targeted supplements, and stress regulation for lasting PCOS relief.
What if You Don’t Want the Pill, But Aren’t Ready to Start a Family?
If you aren’t ready to start a family and use HBC to prevent pregnancy, I recommend reading this comprehensive guide to contraception and make the best choice for you (birth control or not)! And here’s a great post about the Fertility Awareness Method.
A Great Resource to Learn More:
If you want more information about the pill and how to come off birth control, I highly recommend the book, “Beyond the Pill,” by Dr. Jolene Brighten.
I also want to note, if you are on birth control right now, please don’t worry, feel guilty or stressed. I recommend you read up on the impacts and make the best decision for you.
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Hi Molly! Thank you for this article and really for this whole site. I am starting my journey of getting off the pill after 10 years. I am trying to understand PCOS and transition to taking charge of my hormones, as you say. It’s really scary (I don’t want the hair to come back), especially cuz I have felt pretty good on birth control and spironolactone. Your website is going to be my survival guide through this journey, so thank you!
You’re so welcome!! Be sure to sign up for my weekly PCOS newsletter too! It’s my best resource! https://whatmollymade.com/pcos-newsletter/
This is amazing. What your thoughts are on getting off HBC but not wanting to start a family. I have PCOS and have a Kyleena. I want to get off of it due to the terrible side effects but I am 20 years old and not ready to start a family. Do you have any advice for me?
Ty for posting this! Ive been taking birth control for 3 yrs and I needed some advice if it was a good thing to stop or not. I think you worded it best when you wrote “Facing my PCOS symptoms head on was less scary than the birth control side affects…” I love how online it says stuff like “you’ll get used to it after 2 to 3 months.” Like gurl, I’ve been taking it for 3 yrs and those side effects still havent gone away. In fact, it just kept getting worst. I hate knowing im gonna cry everytime i start the package again and the 3rd week is when im gonna be stressed. -.- I felt like a robot with no control over thay stuff. I think your right tho, we gotta just listen to our bodies and take care of it one step at a time. Even if it may be hard.