Hormonal Treatment for PCOS: Guide to Oral Contraceptives and Progesterone Therapy

Role of Hormonal Treatment in PCOS

If you’ve been diagnosed with Polycystic Ovary Syndrome (PCOS), you’ve likely heard about hormonal medications—especially oral contraceptive pills (OCPs)—as a mainstay in managing symptoms. For many young girls and women, these pills become the first and most effective treatment option.

As a gynecologist, I often reassure my patients that these medications aren’t just about regulating periods—they help control deeper hormonal imbalances that drive PCOS symptoms.

Let me explain exactly how these work, who they’re meant for, and what you should realistically expect from them.

PCOS is primarily a hormonal condition. Most women with PCOS struggle with:

• Irregular ovulation (or no ovulation at all)
  
• Elevated luteinizing hormone (LH) levels
• Excess testosterone in circulation

Oral contraceptive pills (OCPs) act like a reset button for your hormones. They:

• Temporarily suppress ovulation to control the disease process

• Regulate menstrual cycles and prevent the uterine lining from thickening, which lowers the risk of endometrial cancer, a long-term complication associated with PCOS.

• Increase SHBG (Sex Hormone Binding Globulin), which binds to extra testosterone

• Reduce the symptoms of androgen excess, like acne, hair growth, and oily skin

This is why oral contraceptives are considered the treatment of choice for adolescents and young women with PCOS who are not actively trying to conceive.

The best oral contraceptive for PCOS is usually one that contains:

• Ethinyl estradiol (~30 µg)
• A third- or fourth-generation progestin with anti-androgenic properties

Commonly Preferred Progestins:

• Cyproterone acetate—very effective in reducing excess androgen symptoms
• Drospirenone has anti-androgenic and mild diuretic properties
  

These combinations are not only safe but have also shown long-term benefits in managing PCOS symptoms and preventing complications like endometrial hyperplasia.

You should take oral contraceptive pills for:

• A minimum of 9 to 12 cycles
• Following the 21-day on, 7-day off routine

After this, we typically give a 3-month break to assess your body’s response. Many patients continue the therapy for up to 4 to 5 years, especially if symptoms persist.

⚠️ But remember: These pills are not a standalone treatment. They must be combined with:

• Consistent exercise
• Focused weight management
• Nutritional therapy

In India, a lot of young girls are already occupied with work, and then they are unable to concentrate on healing their disease completely, as a result of which the therapists are left pretty much incomplete.

For women above 25–30 years or those who’ve completed childbearing, our hormonal approach changes.

We switch from OCPs to cyclical progesterone-only therapy, such as

• Medroxyprogesterone acetate
• Norethisterone acetate

These are typically given:

• Day 15 to Day 25 of the menstrual cycle
• Or sometimes Day 5 to Day 25, depending on the clinical situation

Even this therapy is continued for at least 9 to 12 cycles to ensure symptom control and menstrual regularity.

Yes! In many cases, we combine hormonal pills with metformin, a medication that improves insulin sensitivity.

This combination:

• Helps regulate periods
• Aids in weight loss
• Supports overall hormonal balance

But again, medication alone is not enough. Your diet, exercise routine, and lifestyle remain the cornerstone of PCOS management.

This is a completely different treatment path.

Hormonal contraceptives are not used for women who are actively trying for a baby. Instead, we focus on:

• Ovulation induction (Letrozole is usually first-line)
• Addressing insulin resistance
• Monitoring hormone levels and follicular development closely

Many young women feel scared about taking hormonal pills—especially due to misinformation on social media. It’s important to understand:

✅ OCPs are safe when taken under medical supervision
✅ They significantly reduce the risk of endometrial cancer
✅ They offer long-term hormonal control and symptom relief

Not sure which PCOS medication is right for you?

Book a consultation with Dr. Jay Mehta, a leading PCOS specialist and fertility expert in Mumbai. Get personalized guidance, clear answers, and a treatment plan tailored to your needs—without the confusion or stress.

👉 Take the first step toward better hormonal health. Schedule your consultation today at  1800-268-4000