Can You Get Diagnosed With PCOS While on Birth Control?
It can be challenging to diagnose Polycystic Ovary Syndrome (PCOS) while on birth control, but it’s definitely possible under the right circumstances and with a thorough evaluation. Diagnostic criteria often need to be carefully considered in the context of hormonal birth control use.
Understanding PCOS and Its Diagnostic Criteria
PCOS is a complex hormonal disorder affecting women of reproductive age. It’s characterized by a combination of symptoms, and diagnosis relies on the Rotterdam criteria. To be diagnosed with PCOS, a woman needs to meet at least two out of the following three criteria:
- Irregular or absent periods (oligo-ovulation or anovulation): This reflects irregular or absent ovulation.
- Clinical or biochemical signs of hyperandrogenism: This means having high levels of male hormones (androgens), which can manifest as excess facial or body hair (hirsutism), acne, or male-pattern baldness. Biochemical signs are confirmed by blood tests.
- Polycystic ovaries on ultrasound: This refers to having 12 or more follicles in at least one ovary or an increased ovarian volume.
Importantly, other conditions that can mimic PCOS need to be ruled out before a diagnosis can be made.
The Influence of Birth Control on PCOS Diagnosis
Birth control pills, especially combined oral contraceptives (containing both estrogen and progestin), significantly impact hormone levels and menstrual cycles. This makes diagnosis more complicated because:
- They regulate periods: Birth control pills provide synthetic hormones that create regular withdrawal bleeds, masking underlying irregular ovulation.
- They suppress androgens: The estrogen component of combined pills can lower androgen levels, reducing or eliminating hyperandrogenic symptoms like acne and hirsutism.
- They can affect ovarian morphology: Long-term use of birth control can reduce the appearance of polycystic ovaries on ultrasound.
Therefore, while on birth control, some of the key diagnostic criteria for PCOS can be suppressed or masked.
The Process of Diagnosis While on Birth Control
Diagnosing Can You Get Diagnosed With PCOS While on Birth Control? relies heavily on a skilled clinician carefully interpreting symptoms and test results, accounting for the effects of hormonal contraception. Here’s a possible diagnostic approach:
- Detailed Medical History: The doctor will ask about your menstrual history before starting birth control, any symptoms you experienced prior to hormonal contraception (acne, hair growth, weight gain), and family history of PCOS.
- Physical Examination: This helps assess for physical signs of hyperandrogenism (hirsutism, acne, male-pattern baldness) or other related conditions.
- Hormone Testing: A blood test to measure androgen levels (testosterone, DHEAS), LH, FSH, and other hormones may be performed while still on birth control. Although values might be suppressed, elevated androgen levels even while on birth control can be suggestive.
- Pelvic Ultrasound: An ultrasound can be performed to examine the ovaries. While the presence of polycystic ovaries is helpful, their absence doesn’t rule out PCOS, especially with long-term birth control use.
- Trial Off Birth Control: This is often necessary. The doctor may recommend stopping birth control for a period of 2-3 months (or longer) to allow natural hormone cycles to resume and assess for irregular periods and hyperandrogenism. Hormone testing and ultrasound are typically repeated after this period. This will give a more accurate hormone level reading because your body isn’t artificially influenced by the birth control.
- Ruling Out Other Conditions: It’s crucial to rule out other conditions that can mimic PCOS symptoms, such as thyroid disorders, congenital adrenal hyperplasia (CAH), and hyperprolactinemia.
Common Pitfalls and Considerations
- Relying solely on ultrasound: The absence of polycystic ovaries on ultrasound while on birth control is not definitive evidence against PCOS.
- Ignoring historical symptoms: It’s vital to consider symptoms that were present before starting birth control.
- Insufficient washout period: If a trial off birth control is conducted, allowing enough time for natural cycles to resume is crucial. 2-3 months may not be sufficient for some women.
- Failure to rule out other conditions: Always consider other potential diagnoses that can mimic PCOS.
- Misinterpreting hormone levels: Understanding the expected impact of birth control on hormone levels is essential for accurate interpretation.
Important Note:
It’s absolutely crucial to consult with a qualified and experienced healthcare provider specializing in reproductive endocrinology for accurate diagnosis and management of PCOS, especially when Can You Get Diagnosed With PCOS While on Birth Control?
Frequently Asked Questions (FAQs)
1. Can I develop PCOS while on birth control, or did I likely have it before?
You likely had PCOS before starting birth control. Birth control pills don’t cause PCOS; they manage its symptoms. If you’re experiencing symptoms, it’s likely the underlying hormonal imbalance was present prior to hormonal contraception.
2. If I’m diagnosed with PCOS after stopping birth control, does that mean the birth control caused it?
No, the birth control didn’t cause PCOS. It’s more accurate to say that the birth control masked the symptoms of PCOS. Stopping birth control simply allows the underlying hormonal imbalances to become apparent again, leading to a diagnosis.
3. Can I still have PCOS even if my periods are regular on birth control?
Yes, absolutely. Birth control pills create artificial withdrawal bleeds, making your periods appear regular. This doesn’t mean you’re ovulating regularly, a key indicator of PCOS.
4. Are there specific types of birth control that make it harder to diagnose PCOS?
Combined oral contraceptives (pills with both estrogen and progestin) are most likely to mask PCOS symptoms because they suppress androgens and regulate periods. Progestin-only methods may have less impact, but can still affect menstrual regularity.
5. What if my doctor refuses to test me for PCOS while I’m on birth control?
If your doctor is hesitant, you can request a thorough discussion about your symptoms, a review of your medical history before starting birth control, and a potential trial off birth control for diagnostic purposes. You might also seek a second opinion from a reproductive endocrinologist.
6. Can I get an accurate ultrasound for PCOS while on birth control?
While an ultrasound can be performed, the results may be less informative while on birth control. Long-term use of birth control can reduce the appearance of polycystic ovaries.
7. What hormone tests are most important to request while on birth control if PCOS is suspected?
While on birth control, ask your doctor to test total testosterone, free testosterone, DHEAS, LH, FSH, SHBG (sex hormone-binding globulin), and AMH (Anti-Müllerian hormone). However, remember that these levels may be suppressed.
8. Is it safe to stop birth control just to get tested for PCOS?
For many women, it’s safe to stop birth control for a diagnostic trial, but it’s important to discuss the potential risks and benefits with your doctor. These risks could include unintended pregnancy or a resurgence of pre-existing symptoms, such as acne or hirsutism, but these are usually temporary.
9. How long should I be off birth control before getting tested for PCOS again?
Most doctors recommend being off birth control for at least 2-3 months before retesting, but some may suggest longer. This allows your hormone levels to return to their natural state. It’s important to track your menstrual cycles and any symptoms you experience during this time.
10. If I have PCOS, will I have to come off birth control entirely?
Not necessarily. Birth control is a common treatment for managing PCOS symptoms. If you’re diagnosed with PCOS, you and your doctor can discuss the best treatment plan for you, which may or may not involve staying on birth control.
11. Are there alternative treatments for PCOS besides birth control?
Yes, there are several alternative treatments for PCOS, including lifestyle modifications (diet and exercise), medications like metformin and spironolactone, and fertility treatments like clomiphene citrate or letrozole.
12. Can You Get Diagnosed With PCOS While on Birth Control? if my only symptom is weight gain?
Weight gain alone is not usually sufficient for a PCOS diagnosis. While weight gain can be associated with PCOS, it is not one of the diagnostic criteria. You need to meet at least two of the Rotterdam criteria. You would need to have irregular periods or signs of hyperandrogenism in addition to weight gain.