What birth control is best for polycystic ovaries (PCOS)?

Finding the right birth control when you have polycystic ovary syndrome (PCOS) can take a little trial and error. 

PCOS often brings symptoms like irregular periods, acne, and unwanted hair growth, which can make managing your health feel like a bit of an uphill battle. Birth control pills, especially combination pills with both estrogen and progestin, are commonly recommended because they help regulate your cycle, lower androgen levels, and improve skin concerns.

But birth control pills aren’t your only option. Hormonal IUDs and implants can also help manage PCOS symptoms by regulating hormones over a longer period, which might be a good fit if you prefer a low-maintenance approach.

Since everyone’s body reacts differently, working with a healthcare provider is key to finding a birth control method that fits your unique needs. Together, you can weigh the benefits and possible side effects, ensuring your choice supports your overall health and helps you feel your best.

How Birth Control Helps with PCOS Symptoms

Birth control can be a powerful tool for managing the tricky symptoms of polycystic ovary syndrome (PCOS). When you have PCOS, your body often produces higher levels of androgens—male hormones that can cause irregular periods, acne, excess hair growth, and other frustrating issues.

Hormonal birth control helps by balancing these hormones, mainly through combined oral contraceptive pills containing both estrogen and progestin. Brands like Nikkii® or Tri-Sprintec® are often recommended because they effectively reduce androgen production, helping your body find a more natural rhythm.

Here’s how birth control can support you with PCOS symptoms:

• Balances hormone levels: Estrogen lowers excess male hormones, while progestin regulates your menstrual cycle.
• Regulates periods: Helps make your cycle more regular and predictable, easing heavy or irregular bleeding.
• Reduces acne and oily skin: Lowers sebum production to calm breakouts and reduce shine.
• Targets excess hair growth: Some pills include anti-androgenic progestins that help reduce unwanted hair.

You might think of your hormones like an orchestra that can sometimes get out of tune—birth control can act as the conductor, helping everything come back into harmony.

Your healthcare provider can recommend the best options for your unique symptoms. Finding the right fit is key to managing PCOS effectively, and having a trusted provider by your side makes all the difference.

Types of Birth Control for Polycystic Ovaries

Not all birth control methods work the same when it comes to managing PCOS. Different options target symptoms in various ways, and what works well for one person might not be the best fit for you. 

Popular choices include combination pills, progestin-only options, hormonal IUDs, implants, patches, and vaginal rings. Each has its own benefits and considerations, especially when managing insulin resistance and other PCOS-related challenges.

Combined oral contraceptives

Combined oral contraceptives (COCs) are often the frontline choice for managing PCOS—and for good reason. These pills contain both estrogen and progestin, helping regulate hormones by reducing ovarian androgen production and increasing sex hormone-binding globulin (SHBG), which lowers free male hormones in your system.

Popular pill options like Sprintec® offer different formulations, some with anti-androgenic progestins that specifically help with acne and excess hair growth. Beyond symptom relief, combination pills may also prevent new ovarian cysts.

Keep in mind that COCs aren’t for everyone. Smoking, high blood pressure, a history of blood clots and other health conditions, and age may affect whether this option is safe for you.

Progestin-only pills (mini pills)

Progestin-only pills (POPs), also called mini pills, are a great option for those who can’t or prefer not to take estrogen. Brands like Slynd® work mainly by thickening cervical mucus and thinning the uterine lining, and some newer versions can suppress ovulation.

These pills can help regulate periods and reduce PCOS symptoms with fewer side effects linked to estrogen. They require daily use, so consistency is key to effectiveness.

Vaginal rings and patches

For those who prefer alternatives to daily pills, hormonal vaginal rings and patches provide another way to get combination hormones. Options like NuvaRing® (vaginal ring) and Twirla® (patch) deliver estrogen and progestin steadily, offering similar benefits to COCs in regulating PCOS symptoms.

These methods can be more convenient if remembering a daily pill is challenging, but they share similar risks and considerations with oral contraceptives.

Long-acting options

If you prefer less frequent maintenance, long-acting methods offer convenience and steady symptom management.

The Depo-Provera® shot is a progestin injection you get every three months. 

The Nexplanon® implant is a small rod placed under the skin that lasts up to three years.

Hormonal IUDs like Mirena® and Skyla® release low-dose progestin directly into the uterus. Many appreciate their “set it and forget it” ease, and they’re especially effective at lightening or stopping heavy periods.

While these options are effective, keep in mind they might not address acne or excess hair growth as well as combination pills. Irregular spotting is also common at first.

Birth control and hair growth

Unwanted hair growth—known as hirsutism—is one of the more frustrating symptoms of PCOS. It happens because higher androgen levels stimulate hair follicles in areas where you might rather not have extra hair.

Birth control can help manage this, but it’s not an instant fix. Combination methods like the pill, ring, or patch are especially effective because they lower androgen levels and increase sex hormone-binding globulin (SHBG), which binds free testosterone. This dual effect slows new hair growth and can make existing hair finer and less noticeable over time.

Patience is key. Hair growth cycles are slow, so it usually takes 6 to 12 months of consistent use before you see meaningful changes. Some women notice continued improvement even after a year or more.

Certain formulations work better for this symptom. Pills with anti-androgenic progestins like drospirenone, desogestrel, or cyproterone acetate tend to be more effective. Sometimes, combining birth control with medications like spironolactone can provide extra help.

Birth control and weight management

Managing weight with PCOS can feel like an uphill climb, and it’s normal to wonder if birth control might help—or make things harder. The truth is, the connection between birth control, PCOS, and weight is complex and varies from person to person.

Here’s what you need to know: birth control isn’t a weight loss solution on its own. Some people notice weight gain when starting hormonal birth control, while others don’t see much change—or might even lose a bit. The type of birth control matters, too. Some formulations tend to be more weight-neutral, and your healthcare provider can help find options less likely to affect your weight.

What birth control can do is help balance the hormones that often make weight loss harder with PCOS. By lowering androgen levels and sometimes improving insulin sensitivity, some find it easier to manage their weight once those hormonal roadblocks ease up. Think of it as clearing one obstacle on your path—it still takes effort, but it can make a difference.

Often, insulin resistance plays a bigger role in weight challenges with PCOS. Birth control can address some hormone-related issues, but you might also need extra support for your metabolism.

Side effects and risks to consider

Hormonal birth control is a powerful tool for managing PCOS and preventing pregnancy, but like any medication, it comes with potential risks and side effects. Understanding these helps you make informed choices and know when to reach out for support.

Common side effects often improve within the first few months as your body adjusts. These may include:

• Nausea
• Breast tenderness
• Mood changes
• Spotting between periods
• Headaches
• Changes in libido
• Vaginal dryness

Starting with a lower-dose option or trying different formulations can often reduce these side effects while still helping control PCOS symptoms.

More serious risks are rare but important to be aware of:

• Blood clots
• Stroke
• Heart problems

Your risk increases if you:

• Smoke
• Are over 35
• Have high blood pressure
• Have migraines with aura
• Have a personal or family history of clotting disorders

Because women with PCOS often face additional risk factors like obesity, insulin resistance, or metabolic syndrome, healthcare providers will need to carefully consider these factors to find a birth control method that balances benefits and risks for you.

When to seek immediate in-person medical attention

• Severe headaches or migraines
• Vision changes or loss
• Chest pain or shortness of breath
• Swelling or pain in your legs

Remember, it’s normal to have concerns, but don’t let fear stop you from getting the care you deserve. Regularly reaching out to your provider to check-in ensures your birth control remains safe and effective as your health needs change.

How to choose the right birth control for PCOS

Choosing the best birth control for your PCOS isn’t one-size-fits-all. Think of it like finding the perfect pair of jeans—what fits and feels great for someone else might not be the right match for you.

Identify your main concerns

What PCOS symptoms are you facing? Are irregular periods the biggest challenge? Is acne taking a toll on your confidence? Or maybe it’s the extra hair growth that feels frustrating. Combination methods often help tackle multiple symptoms at once, but if estrogen isn’t an option for you, progestin-only choices like the Depo-Provera® shot or Nexplanon® implant can be great alternatives. Sharing your unique symptoms will help your to find the best fit for you.

Consider your lifestyle and preferences

Your lifestyle and preferences matter, too. If remembering a daily pill feels tough, long-acting options might be easier to manage. If mood changes worry you, some birth control formulations are gentler on emotional well-being. 

Review your medical history

Your medical history is important here. Conditions like migraines with aura, high blood pressure, or a history of blood clots can affect which options are safe. Age, smoking, and other medications also come into play. Being open and honest with your healthcare provider about your health helps keep you safe and supported.

Think about your future plans

Don’t forget your future plans. Managing PCOS symptoms now is key, but thinking about your long-term reproductive goals helps too. Some birth control methods are easily reversible, while others might take a bit longer for fertility to return. Having a clear, open conversation with your provider ensures you find the right balance for your body and your life.

Finding confidence in using birth control for PCOS

Managing PCOS with birth control is about more than just preventing pregnancy—it’s about reclaiming control over your body and your symptoms. The right hormonal contraception can improve your quality of life by regulating periods, easing acne, managing unwanted hair growth, and helping bring those stubborn hormones back into balance.

Figuring out what birth control is best for polycystic ovaries is personal, and can take time and patience. What works well for someone else might not be the perfect fit for you—and that’s okay. The most important part is keeping an open, honest conversation with your healthcare provider about what’s working and what’s not.

At Nurx, we make it easy to access expert care and find the treatment that fits your unique needs. You deserve personalized support every step of the way—and we’re here to help you take control of your PCOS journey.

Ready to find the right birth control for you? Connect with a Nurx healthcare provider today and start your personalized care plan with ease.

Frequently Asked Questions (FAQ)

What is the most effective birth control for PCOS?

Combination oral contraceptives (COCs) are often the most effective option for managing PCOS symptoms, including irregular periods and excessive hair growth. That said, what is most effective for you will depend on your health history and symptoms. 

What type of pill is best for PCOS?

COCs containing both estrogen and progestin are commonly recommended. Some formulations can help reduce excessive hair growth associated with PCOS. The right option for you will always depend on your health history and symptoms. 

What is the first line of birth control for PCOS?

Combined oral contraceptives are typically the first-line treatment to regulate menstrual cycles and manage common PCOS symptoms. The best treatment for you will depend on various factors, including your health history and symptoms, and so it’s best to share that information directly with your provider. 

Is an IUD better than the pill for PCOS?

The choice between an IUD and the pill depends on your health needs and preferences. Hormonal contraceptives like the Kyleena® or Liletta® IUD can regulate periods but may affect symptoms differently than pills. Discuss options with your healthcare provider to find what suits you best.

The information provided is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon this content for medical advice. If you have any questions or concerns, please talk to a medical professional.

Services not offered in every state. Medications prescribed only if clinically appropriate, based on completion of required consultation. Not all options discussed here are available through Nurx. Individual results may vary. Costs apply. See Nurx.com for details.

Nikki® (drospirenone 3mg and ethinyl estradiol 0.02mg tablets), Rx only, is an oral contraceptive used to prevent pregnancy. This drug may cause side effects, including headaches, irregular and/or heavy uterine bleeding, dysmenorrhea, nausea and/or vomiting and back pain. If you would like to learn more, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH/default.htm or call 1-800-FDA-1088.

Tri-Sprintec® (norgestimate 0.25mg/0.215mg/0.18mg and ethinyl estradiol 0.035mg tablets), Rx only, is an oral contraceptive used to prevent pregnancy. This drug may cause side effects, including headaches, irregular and/or heavy uterine bleeding, dysmenorrhea, nausea and/or vomiting and back pain. If you would like to learn more, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH/default.htm or call 1-800-FDA-1088.

Sprintec® (norgestimate 0.25mg and ethinyl estradiol 0.035mg tablets), Rx only, is an oral contraceptive used to prevent pregnancy. This drug may cause side effects, including headaches, irregular and/or heavy uterine bleeding, dysmenorrhea, nausea and/or vomiting and back pain. If you would like to learn more, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH/default.htm or call 1-800-FDA-1088.

​​NuvaRing® (etonogestrel 0.12mg and ethinyl estradiol 0.015mg vaginal ring), Rx only, is used as contraception to prevent pregnancy. This drug may cause side effects, including irregular uterine bleeding, nausea, breast tenderness, headache, and increased or unusual vaginal discharge. If you would like to learn more, see full prescribing information, here. You are encouraged to report negative side effects to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Twirla® (levonorgestrel 0.12mg ethinyl estradiol 0.03mg patch), Rx only, is an oral contraceptive used to prevent pregnancy. This drug may cause side effects, including headaches, irregular and/or heavy uterine bleeding, dysmenorrhea, nausea and/or vomiting and back pain. If you would like to learn more, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH/default.htm or call 1-800-FDA-1088.

Depo-SubQ Provera® 104 may be prescribed by a Nurx affiliated provider but is not fulfilled through a Nurx pharmacy. Learn more about Depo-SubQ Provera® here. 

Slynd® (drospirenone tablets 4mg), Rx only, is used to as contraception to prevent pregnancy. Slynd® may cause side effects, the most common is irregular bleeding. Other less common side effects may include headache, breast pain and tenderness, weight gain, menstrual cramps, nausea, severe vaginal bleeding, less sexual desire. If you would like to learn more about Slynd®, please see the full prescription information, here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH or call 1-800-FDA-1088.

Nexplanon® is not available through Nurx. Learn more about Nexplanon® including risks and side effects here. All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx. 

Mirena® is not available through Nurx. Learn more about Mirena® including risks and side effects here. All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx.

Skyla® is not available through Nurx. Learn more about Skyla® including risks and side effects here. All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx.

Kyleena® is not available through Nurx. Learn more about Kyleena® including risks and side effects here. All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx.

Liletta® is not available through Nurx. Learn more about Liletta® including risks and side effects here. All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx. 

All product names, manufacturer or distributor names, logos, trademarks, and registered marks (“Product Marks”) are the property of their owners and are for identification purposes only. Product Marks do not imply any affiliation, endorsement, connection, or sponsorship by their owner(s) with Nurx.