Post pill PCOS: symptoms, causes, and what to expect after stopping birth control

‍Polycystic ovarian syndrome (PCOS) is known as a hormonal condition affecting millions of women worldwide. The most common symptoms of PCOS include an irregular menstrual cycle, an excess amount of androgens in the body (known as hyperandrogenism), and cysts in the ovaries. Contraceptive pills are often prescribed to manage these symptoms, particularly to regulate periods and reduce androgen levels. 

However, some women develop symptoms that resemble PCOS after discontinuing contraception. This phenomenon, sometimes referred to as "post-pill PCOS" or post-birth-control hormonal withdrawal syndrome, is not officially recognized as a condition by medical experts. So, what is post-pill PCOS exactly? It refers to the temporary hormonal imbalance that may occur after discontinuing birth control pills taken for an extended period.

In a nutshell:

• Post-pill PCOS is temporary PCOS-like symptoms some women experience after stopping birth control.
• Common symptoms may include irregular periods, acne, and unwanted hair growth, which usually subside as hormones stabilize.
• Birth control pills don’t cause PCOS; however, some symptoms may resemble it.
• Symptoms typically resolve within a few months, but if they persist, it’s best to consult a healthcare provider.
• Lifestyle changes such as a balanced diet and regular exercise can help manage symptoms during this period.

So what happens when you have PCOS and go off birth control? Does birth control cause PCOS? Is there a link between stopping birth control and the onset of PCOS symptoms? When should a woman see a doctor if she is experiencing post-pill PCOS symptoms? Read on for answers to these questions and to gain a clearer perspective on this topic.

Getting off birth control with PCOS: What happens?

When women with PCOS stop taking contraceptives, symptoms like irregular periods, weight fluctuations, acne, and extra hair growth may return.

For women without PCOS, stopping the pill may still trigger symptoms similar to PCOS, but these are usually temporary. It may take several months for your body to reestablish its natural hormonal rhythm.

You can stop taking your birth control pills at any time, but medical experts recommend stopping the pill during your period or at the end of a pack to make the transition easier on your body

Is there a link between stopping contraceptives and post pill PCOS symptoms?

The short answer is yes and no. There is no scientific evidence that suggests that birth control pills cause PCOS. Contraceptive pills contain synthetic hormones, such as progestin and estrogen) that suppress ovulation and regulate the menstrual cycle. These pills manage PCOS symptoms but do not cause the syndrome.

Even if you are experiencing symptoms similar to PCOS after stopping birth control, it does not mean that you have this condition.Many symptoms such as acne, irregular periods, and hair growth are common in the months after discontinuing hormonal contraceptives. If these symptoms persist and meet the criteria for a PCOS diagnosis, it's possible that pre-existing PCOS, previously masked by birth control, is the cause. Sometimes, this condition develops in early adulthood and remains undiagnosed before a woman starts taking birth control pills. As a result, contraceptives reduce the symptoms, but they return once a woman stops taking pills. 

There is also a common concern: Can Plan B cause PCOS? The answer is no. It is actually generally safe to take Plan B, even if you already have PCOS. However, Plan B can worsen PCOS symptoms if you take it for a long time. 

Post pill PCOS symptoms

Here is a list of symptoms that many women experience after going off  birth control: 

• Amenorrhea. It is a condition in which you do not have your period for more than three months. According to some studies, some women experience a delay in the return of menstruation after coming off the pill. In most cases, it is temporary, and a cycle should return within several months. If it does not happen, it can be a sign of other conditions and health issues. It is good to see a doctor if you do not have your periods after six months or longer. 
• Irregular periods.  Many women also struggle with irregular periods after stopping contraceptives. Just like with amenorrhea, it might take three months for periods to get back to normal. Many women also experience spotting between periods. 
• Acne. Many women experience skin inflammation, breakouts, rosacea, and other skin problems after stopping pills. Why does this happen? This is how the body adjusts to the lack of hormones that it used to receive when a woman was on birth control. Acne often looks like skin inflammation, pimples, and an uptick in oil production. It is quite normal to have acne within the first six months after stopping contraceptives. 
• Unwanted and excessive hair growth. The condition in which a person has an excess of hair growth on their body is called hirsutism. Often, after stopping their birth control, women start having hair in unwanted and male pattern areas, such as their abdomen, face, or chest. New excessive hair usually looks thick and dark. 
• Depression and anxiety. When a woman stops taking contraceptives, hormone levels start fluctuating, and it takes time for them to settle down. These fluctuations can cause anxiety or even depression. 

It is important to note that not all women experience these symptoms. Some women have more symptoms than others. Research has shown that the development and severity of the above-listed symptoms are associated with the duration of use and the age at which she started taking birth control pills. Most symptoms should ease within several weeks to six months – this is the time the body needs to regulate hormone levels. 

Side effects of birth control pills

Many women also experience side effects while taking birth control pills, and it’s important to pay attention to them. In many cases, side effects will disappear after switching to a different type of pill. Paying attention to side effects and letting your healthcare provider know about them is important. Here is a list of the most common of them:

• Frequent mood changes
• Cramps
• Low libido
• Headaches
• Nausea that usually happens in the beginning but then goes away
• Enlarged and sore breasts 

Seek immediate medical help if you experience chest pain, leg swelling, or shortness of breath, as these could indicate blood clots. Discuss any family history of blood clots with your doctor before starting contraceptives.

Dealing with post pill PCOS

Most doctors recommend certain lifestyle changes to manage the symptoms and get back to a normal life. The changes include switching to a healthier diet and increasing activity levels. Most people return to normal within several days after taking the last pills. However, it can take up to several months, which is also considered normal. For example, it is common to have irregular menstrual cycles for several months after stopping birth control. 

If you are dealing with post pill PCOS, it is effective to address each symptom separately to help your body to readjust properly. For example:

• If you are dealing with anxiety and depression, you may try stress reduction techniques, including meditation or yoga exercises that help relax and control mood swings.
• If one of your concerns is weight gain, it is beneficial to add regular physical activities to your day and start eating a more balanced diet. 

When is the time to see your doctor with post pill PCOS?

If your post pill PCOS symptoms persist after several months of stopping birth control, it is a good idea to see a doctor and run some tests. You may also want to see your doctor earlier if you are trying to conceive. Here is what your healthcare provider may do: 

• Collect family history.  Research indicates that PCOS is a genetic condition, so your doctor may want to know if there are any relatives in your family who have PCOS. 
• Perform blood tests.  Certain blood tests can indicate PCOS by measuring hormone levels. With the help of these tests, your doctor will be able to exclude certain health issues that mimic PCOS. 
• Ultrasound.  During this procedure, a healthcare professional will examine the ovaries and uterus to see if there are any internal signs of PCOS, such as a thickened uterus lining or the presence of cysts in the ovaries. 

Final verdict 

Going off birth control can trigger certain symptoms that resemble PCOS. However, stopping contraceptives itself cannot cause the condition. If the symptoms persist, it may indicate underlying PCOS that was masked while on birth control, that will require further medical investigation.

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‍References: 

1. Mayo Clinic - "Polycystic ovary syndrome (PCOS)"

2. Raleigh Gynecology & Wellness, PA - "The Science Behind Hormonal Contraception"

3. NHS - "Polycystic ovary syndrome"

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