Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder involving hormonal imbalances that can lead to various physical and metabolic concerns. Individuals often wonder if they can be diagnosed with PCOS while using hormonal birth control. Understanding how PCOS is typically identified and how birth control influences its indicators is helpful.
Understanding PCOS and Its Diagnosis
PCOS is characterized by hormonal disruptions that affect the ovaries. Women with this condition often experience irregular menstrual cycles, signs of elevated androgen levels, and changes in ovarian structure. These characteristics can manifest as unpredictable periods, acne, or excess hair growth.
For a diagnosis of PCOS, healthcare providers commonly use the Rotterdam criteria, requiring at least two out of three key features. These include irregular or absent periods (oligo-ovulation or anovulation), elevated androgen levels (hyperandrogenism), and polycystic ovaries on an ultrasound. Hyperandrogenism can be observed clinically (hirsutism, excess body hair, or acne) or confirmed biochemically. The presence of polycystic ovaries is typically identified by 12 or more small follicles in at least one ovary or an increased ovarian volume. It is important to note that a PCOS diagnosis does not necessarily mean an individual will have cysts on their ovaries.
Birth Control’s Impact on PCOS Indicators
Hormonal birth control, particularly combined oral contraceptives (COCs), complicates PCOS diagnosis by altering the indicators used to identify the condition. COCs contain synthetic hormones that suppress natural hormone production, preventing ovulation and regulating the menstrual cycle.
By regulating periods, COCs mask irregular cycles, a common PCOS symptom. They also suppress ovarian activity, potentially reducing the appearance of polycystic ovaries on ultrasound. Hormonal birth control can also lower androgen levels, alleviating symptoms like acne and excessive hair growth, thereby masking hyperandrogenism. While birth control manages PCOS symptoms, it can obscure the underlying signs needed for diagnosis.
Diagnosing PCOS While on Birth Control
Diagnosing PCOS while on birth control is challenging, as the medication can mask key indicators. However, a diagnosis can still be made through assessing persistent symptoms and medical history. Clinical symptoms like acne, hirsutism, and hair loss, if noticeable despite birth control use, can still point towards PCOS. Weight gain or difficulty losing weight may also be indicative.
Testing androgen levels while on birth control is possible, but results require careful interpretation. Hormonal contraceptives increase sex hormone-binding globulin (SHBG), which binds to androgens, leading to lower free testosterone and making true androgen levels difficult to determine. An ultrasound may still be performed, though the polycystic appearance of ovaries might be altered due to birth control’s suppressive effect. In some cases, a healthcare provider might suggest temporarily discontinuing birth control (3-12 months) to allow natural hormone levels to return for more accurate testing. However, this is not always necessary; diagnosis can often be based on a comprehensive evaluation of symptoms, medical history, and test results interpreted within the context of birth control use.
Next Steps: Consulting Your Doctor
If PCOS is suspected while on birth control, consult a healthcare provider. An OB/GYN or endocrinologist can evaluate symptoms and guide the diagnostic process. Share current symptoms, family medical history, and the specific type of birth control being used. The doctor will consider your individual circumstances, including birth control duration and symptom severity. They may order blood tests and a pelvic ultrasound to assess ovarian appearance.
While birth control can influence these results, a skilled clinician can interpret them alongside a thorough clinical picture. If a temporary break from birth control is recommended for diagnostic clarity, the doctor will discuss the benefits and risks. A PCOS diagnosis is possible even while on birth control, and a healthcare provider can help navigate diagnostic challenges to develop an appropriate management plan.