I'm 28 with PCOS. Can OCP worsen my insulin resistance?

Question

Hi doctor,

I am a 28-year-old woman currently using a combined oral contraceptive pill (Ethinyl estradiol 30 mcg and Levonorgestrel 150 mcg) for the past seven months to manage irregular periods and for birth control. I also have polycystic ovary syndrome (PCOS), diagnosed two years ago. My recent lab results showed total testosterone at 72 ng/dL, fasting insulin at 22 μIU/mL, and HOMA-IR of 4.9, indicating insulin resistance.

My cycles have become more regular, but I have been experiencing persistent bloating, mood swings, and occasional spotting between periods. My BMI is 30, and I have gained about 11 pounds since starting the pill. I am also on Metformin 500 milligrams twice daily.

I am concerned whether the birth control is worsening my insulin resistance or contributing to weight gain. Is it safe to continue this pill long-term with PCOS? Should I consider switching to a different formulation or method that is better for metabolic health? Also, is spotting a sign of hormonal imbalance?

Answer 1

Hi,

Welcome to icliniq.com

I am deeply concerned about your worries.

Women presenting with polycystic ovary syndrome (PCOS) who are overweight (body mass index [BMI] more than or equal to 55 pounds/m2 ) and women with PCOS who are not overweight (BMI less than 55 pounds/m2 ), but who have additional risk factors such as:

Advanced age (more than 40 years).
Personal history of gestational diabetes.
Family history of type II diabetes.

A two-hour post-75-gram oral glucose tolerance test should be performed.

In women with impaired fasting glucose (fasting plasma glucose level from 6.1 mmol/l to 6.9 mmol/l) or impaired glucose tolerance (plasma glucose of 7.8 mmol/l or more but less than 11.1 mmol/l after a 2-hour oral glucose tolerance test), an oral glucose tolerance test should be performed annually.

Women diagnosed with PCOS should be asked (or their partners asked) about snoring and daytime fatigue or somnolence, informed of the possible risk of sleep apnoea, and offered investigation and treatment when necessary.

Clinicians need to be aware that conventional cardiovascular risk calculators have not been validated in women with PCOS. All women with PCOS should be assessed for CVD risk by assessing individual CVD risk factors like:

Obesity.
Lack of physical activity.
Cigarette smoking.
Family history of type II diabetes.
Dyslipidaemia.
Hypertension.
Impaired glucose tolerance.
Type II diabetes.

The different ways to reduce risk in clinical practice include:

Exercise and weight control

It is recommended that lifestyle changes, including diet, exercise, and weight loss, be initiated as the first line of treatment for women with PCOS for improvement of long-term outcomes and should precede and/or accompany pharmacological treatment.

Drug Therapy

Insulin-sensitising agents have not been licensed for use in patients without diabetes. Although a body of evidence has accumulated demonstrating the safety of these drugs, there is currently no evidence that the use of insulin-sensitising agents confers any long-term benefit. Use of weight reduction drugs may be helpful in reducing hyperandrogenaemia.

Ovarian electrocautery

Ovarian electrocautery should be considered for selected anovulatory patients, especially those with a normal BMI, as an alternative to ovulation induction.

I will recommend you:

Start menstrual irregularity Tablet Dydrogesterone for 21 days, followed by a seven-day pill-free interval. Continue like that for three months.
Inomel-F (Myo-Inositol, Folic acid, Vitamin D3, and Melatonin) sachet at night for three months. Consult your specialist doctor, discuss with him or her, and take the medicines with their consent.

I hope this answers your query.