In my experience, and the experience of the patients I see, little seems to be known about PCOS in the mainstream, first-contact point health system.
Many with PCOS are advised to take the oral contraceptive pill (the pill, or OCP) as it causes monthly bleeding (but not ovulation, so don’t be fooled into thinking it’s giving you a “normal” period), and can be helpful with problems like acne.
However, the OCP has never addressed, and never will, the underlying drivers of PCOS. In actual fact, it has been found to do the opposite.
Insulin resistance is present in the vast majority of folks with PCOS. Insulin resistance (IR) is a driver of PCOS symptoms. It causes changes like oestrogen dominance, and can change your hormonal balance and fertility. IR also puts you at future risk of deadly conditions like stroke, heart attack, and diabetes.
Oral contraceptive pills can alter how the hormone insulin works
Insulin resistance exacerbates PCOS, and the pill can increase insulin resistance. We’ve known this for decades, but it’s still rarely talked about before an oral contraceptive pill is prescribed.
How do birth control pills affect how your body handles sugar and insulin?
The oestrogen in the pill makes your cells less responsive to insulin, a condition known as insulin resistance. Think of it like your cells becoming a bit “deaf” to insulin’s signals.
The progestin in the pill (the synthetic progesterone) changes how long insulin stays in your bloodstream before your body breaks it down.
When researchers gave women on different birth control pills a glucose tolerance test (where you drink a sugary drink and they measure your blood sugar and insulin levels over time), the results varied depending on which pill they were taking. These differences come from the combined effects of both hormones working together—the oestrogen making insulin less effective, and the progestin changing how quickly insulin is cleared from the body.
This is why birth control pills can worsen insulin resistance in PCOS. The oestrogen component can actually make the underlying metabolic problems worse, which is particularly concerning for folks who already struggle with insulin resistance.
The oral contraceptive pill alters how the brain and reproductive organs “talk”
The pill suppresses the hypothalamic-pituitary-gonadal (HPG) axis, the communication system between the brain and the reproductive organs. When teens take the pill during their developmental years, their natural hormone cycles are replaced with synthetic ones.
For many, normal function returns within a few months of stopping. However, some people experience a more extended adjustment period with irregular cycles or absent periods (called post-pill amenorrhoea).
Troubling, also, is that the pill may mask underlying PCOS symptoms. Many people don’t realise they have PCOS until they stop the pill and try to conceive—only then do the irregular cycles, elevated androgens, and metabolic issues become apparent.
The oral contraceptive pill increases the risk of venous thromboembolism
Research has shown that PCOS increases the risk of venous thromboembolism. So does the pill. The risk is small, but if you are concerned, discuss it with your prescribing healthcare provider.
So, what should you do?
None of this means the oral contraceptive pill should never be used. For some people with PCOS, it provides tangible benefits—managing heavy bleeding, reducing painful acne, or providing reliable contraception.
But here’s what matters: you should know the whole picture before you decide.
The pill may be part of a PCOS management plan, but it shouldn’t be the entire plan. If you’re taking it or considering it, make sure you’re also:
- Addressing insulin resistance through diet and lifestyle
- Having your metabolic markers (insulin, glucose, lipids) monitored regularly
- Working with a healthcare provider who understands PCOS as a metabolic condition, not just a reproductive one
- Considering whether the pill is still serving you if you’ve been on it for years
And if your doctor dismisses your concerns about insulin resistance or suggests the pill is the only option, it may be time to seek a second opinion from someone who specialises in PCOS.
Your body, your choice—but that choice should be informed, not made in the dark.
From PCOS to perfect health, with love,
Dr. Rebecca Harwin
The PCOS Expert
Chiropractor & Bestselling Author of
Conquer Your PCOS Naturally
www.ConquerYourPCOSNaturally.com
P.S. Would you love to discover proven strategies for naturally managing your PCOS? We’ve created a range of PCOS-specific science-backed resources.
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