Hello everyone, Today I bring you a lovely conversation with Registered Dietitian Tara | PCOS Journal on the role of the contraceptive pill in managing PCOS and the importance of the cycle beyond pregnancy. Tara and I share many of the same principles for managing PCOS, and our conversations are always filled with passion, inspiration, and insights. We got so frustrated about the misinformation shared online about PCOS that this will be a 3-part series where we debunk and discuss some of the most common things we see on social media about PCOS. Today, we discuss the pill. We walk through: * The issues we have with the “just take the pill” approach * How the pill works * When it’s appropriate to take it * Why having a natural cycle is important beyond contraception This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below. The pill & the illusion of “fixing” PCOS When most women are diagnosed with PCOS, the first thing they’re offered is the contraceptive pill. At least that was my experience. The main issues I had, and I am seeing, is that it is often done without much explanation. Not because doctors are careless, but because it’s the standard first-line treatment. It regulates periods, reduces androgens, improves acne, and creates predictable cycles. On paper, it looks like it’s solving the problem. However, the pill doesn’t “fix” PCOS. It doesn’t restore ovulation. It doesn’t address insulin resistance. It doesn’t correct the underlying metabolic drivers. What it does is suppress the communication between your brain and your ovaries. Instead of your body producing its own cyclical hormones, you’re given synthetic ones in a steady, controlled dose. Your natural rhythm is paused. For some women, that pause can be relief. If you’re dealing with acne, irregular period, emotional overwhelm, or simply need contraception, the pill can be a helpful tool. There is no shame in using medication. The issue isn’t the pill itself. The issue is when women aren’t told what it’s actually doing, and that is something we have a bit of an issue with. It’s the false illusion that this will fix everything, which is not true. How the pill works In a natural cycle, there’s constant communication between your brain and your ovaries. Hormones rise and fall. Estrogen builds. Ovulation happens. Progesterone rises. Then everything resets and begins again. When we take the combined oral contraceptive pill, that communication is suppressed. Instead of your brain and ovaries leading the process, synthetic hormones take over. They flatten the fluctuations. Ovulation is paused. The “bleed” you get each month isn’t a true menstrual period; it’s a withdrawal bleed triggered by the hormone drop in the pill cycle. So, in PCOS, it gives the illusion of a cycle, and it does help manage some of our most annoying symptoms: * Increases sex hormone binding globulin (SHBG), which binds free testosterone. * Lowers circulating androgens. * Reduces acne and excess hair growth. * Creates predictable cycle patterns. The issue is that the underlying drivers have not been addressed, so once women come off it, PCOS returns. I have a more in-depth article on the mechanism behind the combined oral pill here: What happens when we come off Many women assume that after a few years on the pill, their PCOS will be “sorted”, that the break gave their bodies time to recalibrate. But PCOS is a syndrome. It’s a complex condition influenced by genetics, metabolism, and environment. When you remove the pill, your original physiology returns. Sometimes symptoms come back stronger.Sometimes they look different.Sometimes they were masked for years. And if no one explained that beforehand, it can feel quite a shock. A cycle is important beyond just pregnancy The other issues we have with being on the pill for a very long time are that it assumes that our cycles and hormones produced naturally are not important for other aspects of our lives. That is not true. Estrogen supports: * Bone density * Cardiovascular health * Brain function Progesterone supports: * Mood stability * Sleep quality * Nervous system regulation These functions only touch the tip of the iceberg. Our bodies are highly intelligent machines that have not been designed for any single use. In PCOS, restoring ovulation isn’t just about getting pregnant. It’s a barometer. It tells you insulin resistance is improving. It tells you the hormonal communication loop is functioning better, and it allows your hormones to do their thing in other parts of your body. When you suppress that loop, you lose a piece of feedback. That doesn’t automatically mean it’s wrong, but it does mean something important is different. Tara shared something really powerful - she only truly experienced a natural cycle consistently in her 40s. For much of her life, she was either on hormonal contraception, pregnant, or breastfeeding. When she finally lived with a regular, natural cycle, she started noticing patterns: * Libido rising before ovulation * Cervical mucus shifting. * Mood softening before bleeding. * Energy surges in the follicular phase. She described it as if she'd discovered a hidden rhythm she’d never been taught to listen to. However, we should NOT demonise it Two truths can exist simultaneously. Hormonal contraception has given women enormous autonomy. It has reduced unplanned pregnancies. It has allowed educational and career freedom. And at the same time, it suppresses a complex hormonal system that affects more than reproduction. If you take it, take it consciously. If you need it, use it without shame. But understand: * It manages symptoms. * It does not cure PCOS. * It pauses your natural cycle. * It doesn’t replace lifestyle and metabolic work if those are relevant. And perhaps most importantly, have a plan. Are you using it short-term for symptom relief?For contraception?While you stabilise something else in your life? That’s very different from assuming it has resolved the condition. Our conclusion Women deserve an explanation. Not just prescriptions. PCOS is complex. It requires time, nuance, and often a multidisciplinary approach. So the real message isn’t “Don’t take the pill” but know what you’re choosing, what is does and have a plan on how to come off it once you want to. See you Sunday, Francesca This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.thepcosnewsletter.com/subscribe
