Research
How Birth Control Reduces Androgen Symptoms in PCOS
Learn how birth control effectively manages androgen symptoms in PCOS by balancing hormones, reducing acne, and regulating menstrual cycles.
July 6, 2025
·
12
Learn how birth control effectively manages androgen symptoms in PCOS by balancing hormones, reducing acne, and regulating menstrual cycles.
Birth control is one of the most effective treatments for managing androgen symptoms in women with PCOS. It works by balancing hormones, reducing androgen levels, and alleviating symptoms like acne, irregular periods, and unwanted hair growth. Here’s how it helps:
Benefits include:
For optimal results, consult your doctor to choose the right birth control type, considering your symptoms and health history. Pairing birth control with lifestyle changes like a balanced diet and exercise can further improve PCOS management.
PCOS throws off the body's hormonal balance, leading to disruptions in menstrual cycles, skin issues, and unusual hair growth patterns. Let’s break down what androgens are and how their excess contributes to these symptoms.
Androgens are hormones like testosterone, androstenedione, and DHEA-S. While both men and women produce androgens, women typically have much lower levels - only about one-twelfth of what men produce. In women, these hormones are made in the ovaries, adrenal glands, and fat cells, playing key roles in maintaining bone strength, muscle tone, and sexual health. But when their levels rise too high, these hormones can cause disruptions in menstrual cycles, skin health, and hair growth.
One of the main drivers of androgen excess is insulin resistance. When insulin levels climb, they stimulate the ovaries to produce more androgens. At the same time, lower levels of sex hormone-binding globulin (SHBG) allow more free and active androgens to circulate in the bloodstream.
The numbers paint a clear picture of the connection between PCOS and androgen imbalance. Around 80% to 90% of women with hyperandrogenism are diagnosed with PCOS. Overall, hyperandrogenism affects 5% to 10% of women of reproductive age, and between 60% and 80% of women with PCOS experience this hormonal imbalance.
When androgen levels spike, they can trigger a variety of symptoms, affecting the menstrual cycle, skin, and hair.
Irregular menstrual cycles are one of the most common signs. Elevated androgen levels can disrupt ovulation, leading to irregular, infrequent, or even completely absent periods.
Hirsutism, or excessive hair growth in areas where men typically grow hair, is another hallmark symptom. This affects 65%–75% of women with PCOS, compared to just 4%–11% in the general population.
Acne and oily skin often occur because androgens overactivate the oil glands, leading to persistent acne that can be resistant to standard treatments.
Male-pattern baldness, including thinning hair around the temples and crown, is another potential outcome of high androgen levels.
Excess androgens also contribute to weight-related changes. They encourage fat buildup around the abdomen, which may explain why 38% to 88% of women with PCOS are overweight or obese. This abdominal fat, in turn, worsens insulin resistance, creating a cycle where insulin resistance fuels further androgen production.
The emotional toll of these symptoms can’t be ignored. Persistent acne, unwanted hair growth, and weight fluctuations can deeply affect self-esteem and overall well-being. Recognizing that these symptoms stem from a treatable hormonal imbalance is an important step toward finding effective solutions. Addressing these imbalances is key to managing PCOS and reducing androgen levels.
Hormonal birth control helps reduce androgen symptoms through three key processes, targeting the hormonal imbalances often seen in PCOS. Combined oral contraceptives (COCs) are the most common choice for managing PCOS because they directly address these imbalances.
One way birth control lowers androgen levels is by reducing their production in the ovaries. The progestin in COCs suppresses gonadotropin-releasing hormone (GnRH) and prevents the luteinizing hormone (LH) surge that triggers ovulation. With less LH stimulating the ovaries, androgen production decreases.
The estradiol in birth control pills boosts the production of sex hormone-binding globulin (SHBG), a protein that binds to free testosterone and other androgens in the bloodstream. Women with PCOS often have lower SHBG levels, leaving more androgens active in the body. By increasing SHBG levels, birth control reduces the amount of free, active androgens. Additionally, some progestins block androgens from binding to their receptors or inhibit the enzyme 5-α reductase, which converts testosterone into a stronger form.
Birth control also helps create a more stable hormonal environment. A consistent daily dose of synthetic hormones reduces the fluctuations associated with PCOS, leading to more regular menstrual cycles and lower androgen secretion.
Hormonal birth control doesn't just regulate menstrual cycles - it also offers relief from several symptoms linked to androgen imbalances.
One of the standout benefits of hormonal birth control is its ability to combat acne. It achieves this by lowering androgen levels and increasing sex hormone-binding globulin (SHBG), which reduces sebum (oil) production. Certain progestins, like drospirenone and dienogest, are particularly effective in addressing stubborn acne issues.
For those dealing with hirsutism (excessive hair growth in areas like the face or body), birth control can be a helpful solution. By boosting SHBG levels, it decreases the amount of free testosterone in the body, which can gradually reduce hair growth. However, this improvement takes time, as hair cycles need several months to complete. Hirsutism affects around 70% of women with polycystic ovary syndrome (PCOS), and combinations like drospirenone and ethinyl estradiol have shown promising results in managing this condition. It’s worth noting that progestin-only pills aren’t ideal for treating hirsutism, as they can sometimes exacerbate androgen-related symptoms.
Beyond addressing androgen symptoms, birth control offers a range of other health benefits:
These benefits make hormonal birth control a versatile option for managing both androgen-related symptoms and broader health concerns.
When it comes to managing PCOS symptoms, especially those related to androgens, choosing the right birth control is a big step. The type of hormonal contraception you use can make a huge difference in how effectively symptoms like acne, unwanted hair growth, and irregular periods are controlled. It's not a one-size-fits-all decision - working with your healthcare provider to find the best fit for your needs is key.
Combined oral contraceptives (COCs) are often the first choice for managing PCOS, particularly for those not planning to get pregnant. These pills work by reducing androgen symptoms through a dual mechanism: lowering luteinizing hormone (LH) levels and increasing sex hormone-binding globulin (SHBG). This combination reduces both ovarian androgen production and the free androgens circulating in your body.
However, not all COCs are created equal when it comes to addressing androgen-related issues. Some progestins, like drospirenone (DRSP), dienogest (DNG), nomegestrol acetate (NOMAC), and norgestimate (NGM), have anti-androgenic properties that are particularly effective. Healthcare providers often recommend COCs with 20–30 µg of ethinylestradiol (or a similar compound) because they strike a balance between managing symptoms and minimizing metabolic risks. Ethinylestradiol-based COCs are often preferred over those with natural estrogens, as they more effectively increase SHBG levels.
If swallowing a pill every day isn’t your thing, there are other hormonal options like vaginal rings, patches, and IUDs. However, these are generally less effective at treating acne, hirsutism, and seborrhea.
Progestin-containing intrauterine devices (IUDs) are a solid choice for long-term contraception. They can help regulate menstrual bleeding and lower the risk of endometrial cancer. That said, most progestin-only methods, including many progestin-only pills (POPs), don’t have much impact on hyperandrogenism. The exception? Certain formulations, like a DRSP-only pill, do offer anti-androgenic benefits. This variety highlights the importance of tailoring your choice to your specific needs.
Selecting the right birth control for PCOS isn’t just about controlling symptoms - it’s about finding what works for your lifestyle and health goals. Here are some key factors to discuss with your healthcare provider:
| Factor | Key Considerations |
|---|---|
| Medical History | Age, smoking status, obesity, high blood pressure, history of stroke, diabetes, and blood clotting disorders |
| Symptom Severity | Acne, unwanted hair growth (hirsutism), menstrual irregularity, and other androgen-related symptoms |
| Ease of Use | Daily pills vs. weekly patches, monthly rings, or long-term IUDs |
| Side Effects | Nausea, mood changes, breast tenderness, and potential weight fluctuations |
| Cost | Insurance coverage, out-of-pocket expenses, and patient assistance programs |
| Treatment Goals | Contraception, symptom management, and reducing cancer risks |
For those dealing with severe acne or hirsutism, COCs with anti-androgenic progestins are often the go-to option. Keep in mind that it usually takes at least six months to see noticeable results.
Ultimately, the right birth control is one that manages your symptoms effectively and fits your lifestyle. For more in-depth and expert-backed advice on PCOS, check out PCOSHelp.
Managing PCOS often requires a well-rounded approach that goes beyond hormonal birth control. A complete treatment plan typically includes medical advice, specific medications, and lifestyle changes. While birth control is effective for addressing androgen-related symptoms, it’s just one piece of the puzzle. Collaborating with healthcare professionals can help create a personalized strategy that targets your symptoms and aligns with your health goals.
Navigating PCOS treatment starts with finding the right healthcare provider. Your doctor will assess factors like your symptoms, health history, and personal goals to recommend the most suitable hormonal birth control option. Beyond prescribing birth control, they can help design a broader treatment plan that addresses other aspects of PCOS management. In more complex cases, they might refer you to a specialist with expertise in hormonal conditions. Staying in regular contact with your healthcare provider is essential to monitor progress and adjust your treatment as needed. This collaborative approach can also open the door to exploring additional therapies.
For some, hormonal birth control alone may not fully manage androgen-related symptoms. In such cases, additional medications can be used to improve results. Anti-androgen drugs like spironolactone, flutamide, and finasteride are often prescribed to reduce symptoms caused by high androgen levels. These medications work in various ways - blocking androgen receptors, reducing androgen production, or inhibiting enzymes like 5-α-reductase, which converts testosterone into its more active form, DHT.
Spironolactone, a commonly used anti-androgen, is particularly effective for managing acne and excessive hair growth. However, women taking this medication need reliable contraception due to the risk of feminization in male fetuses. For facial hair, topical treatments like eflornithine cream can slow hair growth by targeting specific enzymes involved in the process. Additionally, topical agents such as benzoyl peroxide, tretinoin, and clindamycin can help address acne. Research has also shown that flutamide, an androgen receptor blocker, can significantly reduce hirsutism and acne symptoms in women with PCOS. Combining these treatments often leads to better symptom management.
Medications aside, lifestyle changes are a cornerstone of PCOS treatment. Adjustments in diet and exercise can help manage symptoms and reduce the risk of complications. These changes are particularly effective in lowering insulin and androgen levels.
Weight management plays a key role, as losing even 5% of body weight can improve insulin sensitivity, reduce androgen levels, and potentially restore ovulation. Regular physical activity, such as walking for 20–30 minutes after meals or engaging in HIIT workouts, helps reduce insulin resistance and lowers testosterone levels [33, 34]. For stress relief, activities like yoga, Pilates, or tai chi can also be beneficial.
When it comes to diet, focusing on managing insulin levels is crucial. A low-carb, high-fiber diet is often recommended. This can include reducing sugar and simple carbs, choosing foods with a low glycemic index, and opting for complex carbohydrates. Limiting added sugar intake to 24 grams per day or less may also be helpful [33, 34].
To effectively manage androgen symptoms in PCOS, it’s important to combine the right birth control with additional strategies. While birth control is a well-established method for addressing androgen-related issues, its success depends on understanding how to use it properly. Combined oral contraceptives (COCs) are widely regarded as a "first-line medical treatment" for managing PCOS symptoms.
COCs that contain anti-androgenic progestins, such as drospirenone, norgestimate, or dienogest, can help reduce acne, slow excessive hair growth, and regulate menstrual cycles within just a few months. However, as Dr. Jenna Rayachoti, a Naturopathic Doctor, points out, this approach primarily focuses on symptom relief rather than addressing the underlying causes of PCOS.
"Birth control does not fix your hormones or the underlying causes of PCOS – it acts as a bandaid over the symptoms."
For the best results, hormonal birth control should be paired with natural strategies to lower androgen levels. Studies suggest that drinking two cups of spearmint tea daily can significantly reduce total and free testosterone levels, with noticeable improvements in hair growth within 30 days. Adding 30 grams of ground flaxseeds to your diet and eating omega-3–rich fish like salmon or mackerel twice a week can also support hormone balance. These dietary adjustments work well alongside lifestyle changes and regular medical care.
It’s essential to consult your doctor throughout this process. They can assess factors like smoking, obesity, high blood pressure, or diabetes before recommending the most suitable birth control option. In some cases, additional treatments such as spironolactone or alternatives like vaginal rings or patches may be necessary. Combining these measures with prescribed birth control and routine medical check-ups creates a more comprehensive plan for managing PCOS.
Birth control pills, particularly combined oral contraceptives (COCs), are often used to help women with PCOS manage androgen-related symptoms by targeting hormonal imbalances. The progestin component works by suppressing luteinizing hormone (LH), which in turn reduces androgen production from both the ovaries and adrenal glands. On the other hand, the estrogen component increases levels of sex hormone-binding globulin (SHBG). This protein binds to free androgens in the bloodstream, limiting their activity.
Together, these effects can relieve common PCOS symptoms like acne and excessive hair growth, making COCs a common treatment choice for addressing androgen-related issues.
Using birth control to address PCOS symptoms can be helpful, but it’s important to weigh the potential side effects and other factors. For instance, some birth control pills might lead to weight gain or increase the risk of insulin resistance - an issue already common among people with PCOS. Additionally, hormonal birth control can sometimes hide PCOS symptoms, which might delay diagnosis or make it harder to track your condition accurately.
Another consideration is the slightly increased risk of blood clots (venous thromboembolism) associated with certain types of hormonal birth control, particularly those with higher estrogen levels. Although these risks are generally low, it’s crucial to discuss them with your healthcare provider to find the safest and most suitable option for you.
Your doctor can help you navigate these choices by reviewing your medical history, lifestyle, and specific PCOS symptoms to create a treatment plan that works best for your needs.
To boost the effectiveness of birth control in managing PCOS symptoms, making some lifestyle adjustments can play a key role. Start by focusing on maintaining a healthy weight through a combination of balanced eating and regular physical activity. This can help reduce insulin and androgen levels, which are often linked to PCOS symptoms. Aim to cut back on processed foods and refined sugars, and instead, fill your meals with whole foods, fiber, lean proteins, and healthy fats to help support hormone regulation.
Incorporating regular exercise into your routine is another important step. Activities like walking, strength training, or yoga can improve insulin sensitivity and may help alleviate symptoms such as acne and excess hair growth. These steady, manageable changes can work alongside birth control to provide better symptom control and overall well-being.
