Birth Control and PCOS: An Interview with Dr. Giada Frontino

By The SABI Collective

PCOS is now the world’s most common reproductive ailment affecting women today. It can have far-reaching consequences on overall quality of life and can be plaguing to live with, including symptoms that are life-disrupting such as unwanted facial hair growth, acne, low mood, irregular periods, struggles seeking a pregnancy, weight issues, and the list goes on…. 

While we lack definitive reasons as to why PCOS is so widespread, if you have been diagnosed with PCOS, you may have heard that birth control is a commonly prescribed tool to help manage symptoms. But how does it actually work? What are the benefits and risks? And, what else can you do to support your health, improve your fertility and manage your symptoms? 

In this article, we delve into these topics with Dr. Giada Frontino, an esteemed expert in women's health. Dr. Frontino brings a wealth of knowledge, having trained extensively across the globe and now practising in the UK. Her expertise in women's health encompasses everything from contraception, irregular periods and PCOS management to fertility challenges, Endometriosis, Uterine Fibroids and preventative care. For women with PCOS, Dr. Frontino offers not only a deep understanding of the condition but also valuable guidance on managing its symptoms, including how to optimise fertility. 

Dr. Frontino, let's start with birth control. It's a valuable tool, but how exactly does it prevent pregnancy?

Dr. Frontino: Hormonal birth control works by preventing your ovaries from releasing eggs (ovulation). Most birth control pills contain synthetic versions of oestrogen and progesterone. The low dose hormones contained in hormonal contraception put your ovaries on a temporary break, preventing them from ovulating. With no mature egg available for fertilisation, pregnancy is effectively prevented.

Beyond preventing pregnancy, women often use it to control other hormonal issues and symptoms, which ones and what are the benefits?

Dr. Frontino: Birth control offers a range of advantages for women. It can be highly effective in managing:

• Painful or heavy periods: studies have shown birth control can significantly reduce cramps and reduce the amount of bleeding during the period
• PMS symptoms: it can help  mood swings, bloating, and other PMS symptoms by giving you a balanced amount of hormones.
• Hormonal Acne: by lowering androgen production and sebum levels, birth control can be a powerful tool in preventing breakouts.

What about the potential downsides of birth control? Can you address these concerns?

Dr. Frontino: there are some potential downsides and side effects to consider when making the decision to use birth control. If you are experiencing any changes or are worried about any of the below, sit down with your doctor and talk through the options available, and what is best for you and your body. 

A breakdown of some of the common concerns:

• Physical and Emotional changes: in some women birth control may cause side effects like headaches, breast tenderness, and low mood. These are usually mild and temporary, often improving within the first two months of use. If the symptoms continue, it is worth sitting down with your doctor to discuss alternative options available to you.
• Blood Clot Risk: certain types of birth control, particularly those containing combined oestrogen and progestin, increases the risk of blood clots. However, this risk is still very low for most women. Smoking, being overweight or a history of clotting all increase the chances of developing blood clots and will be a reason to avoid certain types of hormonal contraception. If you have a personal or family history of blood clots, it is important to discuss this with your doctor.
• Weight Gain: some women experience weight gain while on birth control. Research shows that this weight gain is often minimal and is actually due to increased cravings caused by these hormones in some women. Maintaining a healthy diet and regular exercise is known to prevent weight gain.
• Reduced Libido: a small percentage of women experience a decrease in libido with some types of hormones. Your doctor will be able to guide you on which combinations will not cause this side effect to occur.
• Cancer: The combined pill has shown to reduce the chances of developing bowel, womb and ovarian cancer. 
• Research has already shown that combined hormonal contraception increases the risk of breast cancer only slightly. This increased chance is small and only lasts while you take the pill; when you stop taking the pill, the increase in risk gradually disappears. 

As there are many different types of birth control available, your healthcare provider will help you find one that meets your needs and improves your quality of life, while minimising potential downsides. Don't hesitate to discuss your concerns and preferences with your doctor, be your own best advocate! Your provider can guide you through the safest and most effective hormonal contraceptive options and clarify your concerns.

Let's shift gears and talk about PCOS. What exactly is this condition? How is it diagnosed?

Dr. Frontino: PCOS, or Polycystic Ovary Syndrome, is a common hormonal and metabolic disorder affecting up to approximately 26% women across the globe. Despite the name suggesting cysts on the ovaries, PCOS has nothing to do with ovarian cysts at all. Iin some women,PCOS has many immature eggs (follicles, not cysts) that can be detected on ultrasound which are called polycystic ovary morphology.  However, having polycystic ovaries on a scan does not mean you have PCOS. 

PCOS is considered a syndrome because it can cause a variety of symptoms which may be present with different patterns and combinations, including but not only:

• Irregular periods
• Acne
• Excessive facial hair
• Insulin resistance
• Low or unstable mood

While an ultrasound might reveal polycystic ovaries, it alone doesn't diagnose PCOS. Doctors diagnose PCOS when at least two out of three symptoms are present: irregular or absent periods, excess body or facial hair (sometimes confirmed by blood tests showing high testosterone), and the presence of polycystic ovaries on an ultrasound scan or raised AMH. In adolescents, ultrasound or AMH are unreliable and cannot be used to diagnose PCOS. These symptoms can vary from woman to woman. 

We talk often at The SABI about the interconnectedness of hormonal ailments, especially in relation to metabolic health. Can you address PCOS in that context?

Dr. Frontino: Yes, PCOS also often (but not always) presents with insulin resistance. Many women have heard about insulin resistance, but I'd like to expand on what it is. It’s a condition where your body's cells become less responsive to the hormone insulin. Insulin is like a key that unlocks your cells, allowing them to absorb sugar (glucose) from your bloodstream and use it for energy. When your cells are insulin resistant, the key doesn't work as well, fumbling at the lock and missing its opportunity to go through the door. Resulting in sugar building in your blood instead. If left untreated, this can lead to several health problems, including type 2 diabetes.

This condition explains why PCOS is strongly linked to metabolic health.  Many women with PCOS, regardless of weight (slim or overweight), experience insulin resistance.  It further disrupts your hormone balance, impacting how you feel overall. Leaving PCOS untreated, increases the chance of not ovulating regularly. Studies show that around 70% of women with anovulation have PCOS, highlighting the impact PCOS can have on fertility. Treating PCOS can reestablish regular ovulation and optimise fertility. 

How can birth control help manage PCOS?

Dr. Frontino: First of all it is important for women with PCOS to be aware that PCOS does not mean they cannot have a healthy pregnancy nor that they don’t need any birth control in place. Many women with PCOS will conceive naturally and others will see their fertility significantly improve by addressing the underlying causes to their PCOS symptoms and by optimising their lifestyle. 

Here's where it's important to understand PCOS as a metabolic issue. Birth control can be of temporary help for managing many PCOS symptoms by improving acne, excess hair growth, mood and by making periods appear monthly. However, it doesn't address the root causes of PCOS.

So, then is Birth Control Right for PCOS?

Dr. Frontino: while hormonal birth control can be helpful in some cases, particularly for managing bothersome symptoms that significantly impact your quality of life, it is not the answer to taking care of PCOS as it does not improve the underlying health risks, hence should never be the only approach for dealing with PCOS.

Scientific studies show that leaving PCOS untreated increases the chances of developing cardiovascular disease, diabetes, endometrial (the womb lining) cancer. After all, PCOS is more than just a hormone imbalance. It's a complex condition with several contributing factors, including:

• Chronic Low-Grade Inflammation: women with PCOS often have elevated levels of inflammatory markers, which can worsen symptoms.
• Elevated Cortisol Levels: chronic stress can lead to high cortisol levels, further disrupting hormone balance in PCOS.
• Metabolic Disorders: with insulin resistance making it difficult for the body to regulate blood sugar.

What other lifestyle changes do you recommend in addition to, or beyond birth control for women living with PCOS?

Dr. Frontino: a holistic approach that addresses the root causes of PCOS is crucial for long-term management. Because PCOS is a syndrome which manifests in a multitude of ways in each woman, it always necessarily requires an approach that is tailored to the individual patient. Here are some key areas to focus on:

• Maintain a regular eating schedule: don't skip meals. Aim for three balanced meals daily, especially after exercise, to regulate energy levels and reduce cravings.
• Focus on high-fibre carbohydrates: choose whole grains and oats to improve insulin resistance and hormonal balance. Grains such as wholegrain bread contain high amounts of inositols, which are micronutrients that regulate glucose and insulin metabolism and support ovaries to produce a balanced amount of estrogens and progesterone.
• Include protein and healthy fats: poultry, eggs, tofu, pulses, and healthy fats are essential for overall health.
• Eat plenty of fruits and vegetables: these provide antioxidants that help reduce inflammation associated with PCOS.
• Cut sugary foods and drinks and limit processed foods. 
• Regular exercise: light to moderate exercise is beneficial. Avoid intense workouts that can worsen symptoms. Consider activities like strength training, LIIT (low-intensity interval training) yoga, pilates, barre, walking or hiking. 
• Prioritise sleep: adequate sleep is crucial for managing insulin resistance, mood, and hormonal balance.

What other lifestyle aspects might be impacting my PCOS symptoms?

Dr. Frontino: exposure to environmental toxins and endocrine disruptors can worsen PCOS symptoms. Reducing exposure to these toxins are thought to be beneficial. These toxins can be found in a pesticide heavy diet or personal care products that contain Endocrine Disruptors, such as hair products, facial care, makeup and nail polish. 

Additionally, a healthy gut microbiome is essential for overall health, and research increasingly suggests it may play a role in PCOS. Maintaining a healthy gut through a nutrient-rich balanced diet is the most effective way of achieving a balanced gut microbiota and is believed to support in reducing PCOS symptoms. 

Thank you Dr. Frontino!

This conversation sheds light on both birth control as a tool and PCOS as a complex health concern. While birth control can offer temporary relief from some PCOS symptoms, it doesn't fully address the root causes.

The key takeaway? A holistic approach is vital for managing PCOS effectively. By prioritising nutritious dietary changes, regular exercise, adequate sleep, and stress management, you can create a foundation for optimal wellbeing. Additionally,  maintaining a healthy gut microbiome through eating a variety of whole foods can provide further support.

Knowledge is power. Always discuss your individual needs and concerns with a qualified healthcare professional who can build a personalised plan with you to manage PCOS and substantially improve your health and wellbeing.

ABOUT DR. FRONTINO

Dr Giada Frontino undertook her Obstetrics and Gynaecology training in Milan, Hong Kong and Louvain, and completed a Specialty degree in Obstetrics and Gynaecology, focusing on Paediatric and Adolescent Gynaecology, Endometriosis, Adenomyosis and Ultrasound. Dr Frontino joined the prestigious Obstetrics and Gynaecology unit at Clinica Mangiagalli in Milan in 2008, managing benign gynaecology, adolescent gynaecology and high-risk pregnancy cases, and later carried on as a tertiary referral centre specialist and clinical researcher for diffuse uterine adenomyosis until 2015, when she relocated to London. Dr Frontino is currently collaborating with the University of Roehampton in London in research on Polycystic Ovary Syndrome and Menopause. Dr Frontino is an active member of the IMS International Menopause Society, ISGE International Society of Gynecological Endocrinology, BMA British Medical Association, RCOG Royal College of Obstetricians and Gynaecologists, ISUOG International Society of Ultrasound in Obstetrics and Gynaecology.

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