PCOS: All Guides

PCOS (Polycystic Ovary Syndrome): General Information

Key Facts
  • PCOS is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne.
  • The cysts on the ovaries aren’t harmful and don’t need to be removed.
  • The treatment for PCOS is healthy nutrition, exercise, and medications.

PCOS icons

PCOS is a common problem among teens and young people. In fact, almost 1 out of 10 people have PCOS.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne. PCOS often begins during teenage years.

What are the symptoms of PCOS?

Some of the most common symptoms of PCOS include:

  • Irregular periods that come every few months, not at all, or too frequently
  • Extra hair on the face or other parts of the body, called hirsutism (her-suit-is-em)
  • Treatment-resistant acne
  • Weight gain and/or trouble losing weight
  • Patches of dark skin on the back of the neck and other areas, called acanthosis nigricans(“a-can-tho-sis ni-gri-cans”)

Could I have PCOS?

If you have some or all of the above symptoms, you might have PCOS. There can be other reasons why you might have these symptoms; however, only your health care provider can tell for sure.

What causes PCOS?

PCOS is caused by an imbalance in the hormones (chemical messengers) in your brain and your ovaries. PCOS usually happens when a hormone called LH (from the pituitary gland) or levels of insulin (from the pancreas) are too high, which then causes the ovaries to make extra amounts of testosterone.

For a more detailed explanation, take a look at the female reproductive anatomy image:

Female reproductive anatomy
Female reproductive anatomy
  1. The pituitary (pi-tu-i-tary) gland in your brain makes the hormones luteinizing (lu-tin-iz-ing) hormone (LH) and follicle (fall-i-call) stimulating hormone (FSH).
  2. After getting the signal from the hormones LH and FSH, the ovaries make estrogen (es-tro-gen) and progesterone (pro-ges-ter-own), the female sex hormones.
  3. All normal ovaries also make a little bit of the androgen testosterone (an-dro-gen tes-tos-ter-own), a male sex hormone. The pancreas (pang-cree-us) is an organ that makes insulin. High levels of insulin can also cause the ovaries to make more of the hormone testosterone.

Why are my periods so irregular?

Having PCOS means that your ovaries aren’t getting the right (hormonal) signals from your pituitary gland. Without these signals, you won’t ovulate (make eggs) every month. Your period may be irregular, or you may not have a period at all.

Let’s review a regular menstrual cycle.

  1. The menstrual cycle starts when the brain sends LH and FSH to the ovaries. A big surge of LH is the signal that causes the ovaries to ovulate, or release an egg.
  2. The egg travels down the fallopian tube and into the uterus. Progesterone from the ovary causes the lining of the uterus to thicken.
  3. If the egg isn’t fertilized, the lining of the uterus is shed. This is a menstrual period.
  4. After the menstrual period, the cycle begins all over again.
Regular vs. PCOS menstrual cycle
Regular menstrual cycle vs. PCOS menstrual cycle

The diagram on the left shows a regular menstrual cycle, and the diagram on the right shows a PCOS cycle with no ovulation.

Now, let’s look at what happens during a menstrual cycle with PCOS.

  1. With PCOS, LH levels are often high when the menstrual cycle starts. The levels of LH are also higher than FSH levels.
  2. Because the LH levels are already quite high, there is no LH surge. Without this LH surge, ovulation does not occur, and periods are irregular.

People with PCOS may ovulate occasionally or not at all, so periods may be too close together, or more commonly too far apart. Some may not get a period at all.

What types of tests will my health care provider do to diagnose PCOS?

Your health care provider will ask you a lot of questions about your menstrual cycle and your general health, and then do a complete physical examination. You will most likely need to have blood tests to check your hormone levels, and possibly your blood sugar and lipids (including cholesterol). Your health care provider may also want you to have an ultrasound test. This is a test that uses sound waves to make a picture of your reproductive organs (ovaries and uterus) and bladder (where your urine is stored). In people with PCOS, the ovaries may be enlarged and have multiple tiny cysts.

Does PCOS mean I have cysts on my ovaries?

The term “polycystic ovaries” means that there are lots of tiny cysts, or bumps, inside of the ovaries. Some young people with PCOS have these cysts; others only have a few. Sometimes these cysts are not seen on ultrasound. Even if there are not cysts seen on ultrasound, you may still have PCOS. If you do have polycystic ovaries, they’re not harmful and they don’t need to be removed.

Why do I get acne and/or extra hair on my body?

Acne and extra hair on your face and body can happen if your body is making too much testosterone. Everyone make testosterone, but if you have PCOS, your ovaries make a little bit more testosterone than they are supposed to. Skin cells and hair follicles can be extremely sensitive to the small increases in testosterone found in young people with PCOS.

Why do I have patches of dark skin?

Some adolescents with PCOS have higher levels of insulin in their blood. Higher levels of insulin can sometimes cause patches of darkened skin on the back of your neck, under your arms, and in your groin area (inside upper thighs).

Will PCOS affect my ability to have children some day?

People with PCOS have a normal uterus and healthy eggs. Many people with PCOS have trouble getting pregnant, but some people have no trouble at all. If you’re concerned about your fertility (ability to get pregnant) in the future, talk to your health care provider about all the new options available, including medications to lower your insulin levels or to help you ovulate each month.

What can I do about having PCOS?

The most important treatment for PCOS is working towards a healthy lifestyle that includes healthy eating and daily exercise. There are also excellent medications to help you manage irregular periods, hair growth, and acne. Ask your health care provider about the various treatment options.

What is the treatment for PCOS?

The most common form of treatment for PCOS is the birth control pill; however, other kinds of hormonal therapy may include the “vaginal ring” and “the patch”. Even if you’re not sexually active, birth control pills may be prescribed because they contain the hormones that your body needs to treat your PCOS. Birth control pills (either taken continuously or in cycles) can:

  • Correct the hormone imbalance
  • Lower the level of testosterone (which will improve acne and lessen hair growth)
  • Regulate your menstrual periods
  • Lower the risk of endometrial cancer (which is slightly higher in young people who don’t have periods regularly)
  • Prevent an unplanned pregnancy if you are sexually active

Is there any other medicine to treat PCOS?

A medicine which helps the body lower the insulin level is called Metformin. It’s particularly helpful in people who have high levels of insulin, or have pre-diabetes or Type 2 diabetes. Some people are treated with both Metformin and birth control pills at the same time.

Ask your health care provider about treating hair growth. Only you and your health care provider can decide which treatment is right for you. Options may include bleaching, waxing, depilatories, spironolactone (spi-ro-no-lac-tone), electrolysis, and laser treatment. Spironolactone is a prescription medicine that can lessen hair growth and make hair lighter and finer. However, it can take up to 6-8 months to see an improvement.

Ask your health care provider about treatment for acneThere are various ways to treat acne, including the birth control pill, topical creams, oral antibiotics, spironolactone, and other medications.

Ask your health care provider about a weight loss plan if you are overweight. If you’re overweight, losing weight may lessen some of the symptoms of PCOS. Talk to your health care provider or nutritionist about healthy ways to lose weight such as exercising more and following a nutrition plan that helps manage insulin levels. Healthy eating can also keep your heart healthy and lower your risk of developing diabetes.

Weight Management Tips:

  • Choose nutritious, high-fiber carbohydrates instead of sugary or refined carbohydrates
  • Balance carbohydrates with protein and healthy fats
  • Eat small meals and snacks throughout the day instead of large meals
  • Exercise regularly to help manage insulin levels and your weight

What if I have worries about having PCOS?

If you’ve been told you have PCOS, you may feel frustrated or sad. You may also feel relieved that at last there is a reason and treatment for the problems you have been having, especially if you have had a hard time keeping a healthy weight, or you have excess body hair, acne, or irregular periods. Having a diagnosis without an easy cure can be difficult. However, it’s important for people with PCOS to know they are not alone. Finding a health care provider who knows a lot about PCOS and is someone you feel comfortable talking to is very important. Keeping a positive attitude and working on a healthy lifestyle even when results seem to take a long time is very important, too! Many people with PCOS tell us that talking with a counselor about their concerns can be very helpful. Other people recommend online chats. The Center for Young Women’s Health offers a free and confidential monthly online chat for teens with PCOS.

What else do I need to know?

It’s important to follow-up regularly with your health care provider and make sure you take all the medications prescribed to regulate your periods and lessen your chance of getting diabetes or other health problems. Because you have a slightly higher chance of developing diabetes, your health care provider may suggest that you have your blood sugar tested once a year, or have a glucose challenge test every few years. Quitting smoking (or never starting) will also improve your overall health. Because you have a higher chance of developing diabetes, your health care provider may suggest having a:

  • Blood sugar test once a year
  • A1C test (a test that tells how high your blood sugar has been the past 2-3 months) once a year
  • Glucose tolerance test every few years

PCOS: Preparing for Your Oral Glucose Tolerance Test

Key Facts
  • PCOS is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne.
  • The cysts on the ovaries aren’t harmful and don’t need to be removed.
  • The treatment for PCOS is healthy nutrition, exercise, and medications.

PCOS iconsIf you have PCOS and you’re getting ready to have an oral glucose tolerance test, you may be wondering how to prepare for the test and what the results may mean. The test can help your health care provider figure out whether you have a high risk of developing diabetes and whether lifestyle changes and medications such as Metformin might be helpful in treating your PCOS.

What is Glucose?

Glucose is a type of sugar and the main source of energy used by your body. The glucose that your body uses for energy comes from many kinds of foods called carbohydrates, such as cereal, bread, rice, pasta, and other grains, not just sugary foods. Dairy products, fruits, and vegetables all contain carbohydrates as well. Your body uses the glucose it needs and then stores the rest as “glycogen” in your liver and muscles.

What is an Oral Glucose Tolerance Test (OGTT)?

An OGTT is a way to measure your body’s ability to use glucose. Your pancreas (a gland located behind the stomach) makes a hormone called insulin, which helps your body use the glucose in your blood. If your pancreas doesn’t make enough insulin or if your body is unable to use the insulin it makes, you may have a high blood glucose level. The OGTT involves fasting overnight and then having your blood checked early in the morning. You will then drink a special glucose drink and have your blood tested again after 2 hours. Sometimes blood sugar levels are also checked at other times such as 1 hour, 3 hours, or 4 hours after the glucose drink.

What if my blood glucose level is high?

If the OGTT shows that your blood glucose levels are higher than normal, your health care provider may tell you that you have “impaired glucose tolerance”. This often means that you are at risk for developing diabetes. Rarely, diabetes is diagnosed after an OGTT. Diabetes is an illness that can develop if your body does not make enough insulin, or when your body has trouble using the insulin that it does make. Your health care provider may suggest a fasting glucose level, an A1C, or an oral glucose test (especially if you are overweight). Depending on the results, these tests are often repeated yearly or every few years.

What do I need to do before the OGTT?

Your health care provider will most likely give you either a glucose drink to take home or a prescription to bring to your pharmacy or the lab. Some tests are done in a health care provider’s office, but most often the test is done in a lab at a hospital or clinic. The test takes several hours (most of it is waiting between blood tests), so you’ll need to plan on being at the lab or your HCP’s office for most of the morning. If you need to fill a prescription, be sure you call your pharmacy ahead of time to see if they have the glucose drink in stock, because some pharmacies may not carry this item, or they may need to order it.

Do I need to eat anything special before the test?

3 DAYS BEFORE THE OGTT: Plan on eating three healthy meals and snacks for 3 days before the test. You do not need to buy special food, but you do need to make sure you have healthy foods to eat. Your meals should be balanced with plenty of carbohydrates.

Foods containing carbohydrates include:

  • Fruits
  • Breads
  • Cereal
  • Pasta
  • Rice
  • Crackers
  • Starchy vegetables (corn/peas/carrots)

12 HOURS BEFORE THE OGTT: DO NOT eat, smoke, or participate in heavy exercise 12 hours before the test. (For example: If your test is scheduled for first thing in the morning, i.e.: at 8 AM—Do not eat, smoke, or participate in heavy exercise after 8pm the night before). You may drink plain, NOT flavored, water.

What happens on the morning of the test?

When you are ready to leave your home to have your test done, be sure to remember to bring:

  • Your laboratory slips
  • Your glucose drink (unless the lab provides it)
  • Reading material/book/magazine
  • Earbuds if you want to listen to music while you’re waiting (optional)
VERY IMPORTANT! DO NOT DRINK the glucose drink until you arrive at the lab. The lab technician will tell you when to drink the glucose drink.



First: A fasting blood glucose test is done. This is a simple blood test that checks your blood sugar before you drink the glucose drink.

Next: The lab technician will tell you to drink the glucose drink. It will taste very sweet. It’s important to drink the whole amount fairly quickly.

Waiting: After you finish drinking all of the glucose drink, you’ll be asked to sit until it’s time for your next blood test (about 2 hours later). You may read, listen to music, talk, or do another quiet activity while you are waiting.

VERY IMPORTANT! DO NOT EAT or DRINK anything except plain water while you’re waiting.


AFTER THE OGTT: Once your tests are done and the lab technician gives you permission to leave, you may go about your normal daily activities. You can go back to school or work, eat, drink, and do the regular exercise that you normally do.

When can I expect to get my test results?

The lab will usually send your results to your health care provider within a few days. You may already have a follow–up appointment scheduled or your health care provider may call you to review your results and let you know if there are any concerns.

What do the results mean?

The first test or “baseline” glucose test is your blood glucose level before you drank the glucose drink. Normal fasting blood glucose levels are less than 100 mg/dl. Your health care provider may also check your insulin level. A high level of insulin means that your body does not use insulin well (even if your glucose levels are normal). The second result of your 2–hour blood glucose test measures your glucose two hours after you drank the glucose drink. This level should be less than 140mg/dl. Normal levels of glucose mean that your body is able to use glucose the way it’s supposed to. High levels of glucose mean you are at high risk of diabetes or meet the diagnosis for diabetes. This means that your body has a hard time using glucose, and puts you at risk for developing diabetes. If your glucose levels continue to be very high, it could mean that you have diabetes.

What is the connection between impaired glucose tolerance (IGT) and PCOS?

Health care providers have known for some time that many of the symptoms of PCOS are caused by too much of the hormone testosterone. With PCOS, the ovaries make too much of this hormone which can result in extra facial and body hair and menstrual problems. Many young people with PCOS also have high levels of insulin that can stimulate the ovaries to make testosterone. The high levels of insulin also increase the chance of getting diabetes. Your HCP will look at your OGTT results along with other test results to figure out the best treatment for you including exercise, weight loss (if you’re overweight), and sometimes, medication.

Understanding how to prepare for an OGTT test and what the results mean can help you take charge of your PCOS. Making healthy food choices, exercising, and talking about your medication options with your health care provider are the best ways to keep your body healthy.

PCOS: The Oral Contraceptive Pill

Key Facts
  • PCOS is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne.
  • The cysts on the ovaries aren’t harmful and don’t need to be removed.
  • The treatment for PCOS is healthy nutrition, exercise, and medications.

PCOS icons

Adolescents and young people are frequently prescribed oral contraceptive pills (also called the “Pill”) for Polycystic Ovary Syndrome and for other problems like irregular or absent menstrual periods, menstrual cramps, acne, PMS, and endometriosis. Oral contraceptive pills lower hormone levels in people with PCOS and regulate their menstrual periods. Hormone patches (Ortho-Evra, Xulane) and vaginal hormone ring (NuvaRing) can also help lower the hormone levels in people with PCOS.

What are oral contraceptive pills?

Oral contraceptive pills contain two types of synthetic female hormones, progestin and estrogen. Similar hormones are made by the ovaries. There are many different kinds of oral contraceptives.

What are some of the possible medical benefits of oral contraceptive pills for young people with PCOS?

  • Regular and Lighter Periods: Oral contraceptive pills can help to regulate your menstrual cycle so your period comes about every 28 days or less often on extended pill cycles. The Pill usually causes lighter periods, too. This is important because not having your periods may result in excess growth of the lining inside your uterus, called the endometrium. Excess growth can lead to prolonged and heavy periods, or eventually a condition called endometrial hyperplasia. This is a precursor to endometrial cancer, therefore it is very important to ensure the endometrium is being shed in a daily or cyclic fashion.
  • Less Unwanted Hair: Oral contraceptive pills can lower androgen hormone levels and lessen the amount of excess hair growth (also called “hirsutism”). It can take 6 months before there’s a decrease in unwanted hair on the face, chest, back, and stomach.
  • Clearer Skin: Oral contraceptive pills can improve acne. The hormones in most types of the Pill can help stop acne from forming. Be patient though, it can take a few months to see an improvement.
  • Fewer or Milder Cramps, or No Cramps: Oral contraceptive pills can help to lessen menstrual cramps.
  • Other Medical Benefits: Because there is less menstrual bleeding with the use of oral contraceptive pills, people taking the Pill are less likely to become anemic. Oral contraceptive pills also decrease your chance of getting endometrial (lining of the uterus) cancer, ovarian cancer, and ovarian cysts.

What are the possible side effects of the oral contraceptive pill?

Most people have no side effects when taking the oral contraceptive pill, but it’s possible to have irregular periods, nausea, headaches, or weight change. Each type of oral contraceptive pill can affect a young people differently.

  • Spotting (you usually don’t need to use a regular pad, just a panty shield) or very light bleeding: This may occur during the first 1–3 weeks of starting the Pill, or if you miss a pill. If the bleeding becomes heavier or lasts more than a few days or the bleeding happens after you have been on the pill for a few months, you should talk with your health care provider.
  • Nausea (or feeling like you need to throw up): Nausea occasionally occurs when you first start taking the Pill and will often go away in a few days. It is less likely to occur if the Pill is taken after dinner or with a bedtime snack.
  • Headaches: Headaches may occur because of stress at school or home, too little sleep, sinus infections, or migraines. The Pill can make headaches better or worse. If your health care provider thinks your headaches are related to the Pill, he/she may prescribe an oral contraceptive pill with a lower amount of estrogen or have you stop the Pill for a short time. If you have migraine headaches, talk to your health care provider about whether the Pill is right for you.
  • Mood changes: Feeling up and down emotionally can sometimes happen to anyone and is unlikely to be caused by the Pill. Exercising regularly and following a healthy diet may help along with talking to a counselor. Make sure you let your health care provider know how you are feeling.
  • Sore or enlarged breasts: Sometimes, your breasts may become tender and/ or get larger, but usually they will stay the same.
  • Weight change: Some teens gain weight and some teens lose weight while on the Pill, but most stay exactly the same. Remember to choose healthy foods, watch your portion sizes, drink lots of water, and get plenty of exercise.
  • Blood clots: A blood clot in your leg or lung is a very rare, but a serious side–effect. If you suddenly have pain or swelling in your leg, or shortness of breath and chest pain, see your health care provider right away. If you have a history of blood clots, you should not take the Pill. Tell your health care provider if any of your relatives have ever had blood clots, especially when they were young. Blood clots are more likely to develop if you are a smoker, overweight, having surgery, have a family history, or sitting on a plane for a long time. To lessen your chance of blood clots, don’t smoke, and if you’re on a long plane trip, get up, walk around, and drink lots of water. If you have a family history of blood clots, talk to your HCP. If you’re scheduled for surgery, talk to your health care provider about stopping the Pill for 3–4 weeks before surgery and after the surgery until you have recovered.
If side effects from the Pill occur, they’re usually mild and go away in the first three to four cycles. If you do have side effects, talk with your health care provider. If the side effects are uncomfortable or if they don’t go away, your health care provider may switch you to a different kind of oral contraceptive pill.

Are there any reasons why I shouldn’t take the oral contraceptive pill?

Most teens can take the oral contraceptive pill for PCOS, but for some, taking the combined Pill (with both estrogen and progestin) is not an option because of certain medical conditions, called “contraindications.” If you can’t use the combined Pill, your health care provider will talk to you about other medications to treat your PCOS.

Reasons why you should NOT take combined oral contraceptives:

  • History of blood clots
  • Migraine headaches with aura (spots and flashing lights or difficulty seeing 5 to 30 minutes before the headache starts), or neurological symptoms (numbness, loss of speech)
  • Certain kinds of heart disease
  • High blood pressure
  • Active hepatitis (liver disease)
  • Jaundice (yellowing of your skin or eyes during a previous pregnancy)

Taking the Oral Contraceptive Pill

The most common pill packs come with 21 active hormone pills and seven placebo pills, but some packs have 24, 26, or even 28 active pills. The example shown is for a 28–day pill pack in which you take 21 active hormone pills, and then seven placebo pills that contain no active hormones. These last seven pills are just “reminder” pills in most pill brands. They are taken during the fourth week, including during your period. With packages that have 24 active pills, the last 4 are “reminder” pills. There are also pill packages that have 84 active pills for extended continuous hormones and 7 “reminder” pills. Your health care provider will tell you whether you will be taking the active pills continuously or in cycles as shown below.


How to take birth control pills
How to take birth control pills
  1. To take the oral contraceptive pill, follow the instructions on the package. Your health care provider will explain how to use your pill pack. You will be told to start taking the oral contraceptive pill on a Sunday, on the first day of your menstrual period, or the day you are seen by your health care provider.
  2. You should take one oral contraceptive pill each day, at the same time of day until you finish the pack. Take the Pill at the same time as something that you do regularly so you don’t forget. For example, you could keep them near your toothbrush, or set your cell phone alarm as a reminder. The best time is ½ an hour after a complete meal such as dinner, or at bedtime. You may have slight nausea the first month, but this usually goes away with time. Some teens who take the Pill first thing in the morning find that they are more likely to have nausea, especially if they skip breakfast, so taking the pill after dinner or at bedtime may cure this symptom.
  3. After completing a 28–day pack, you should immediately start a new packet of pills the next day. During your fourth week on the pill cycle, you should get your menstrual period. Your menstrual period should stop once you begin the new packet of pills.

If your hormone levels continue to be high or your excess hair growth doesn’t improve, your health care provider may re–check your hormone levels, or may suggest that you take the Pill continuously. This means that you would take just the “active pills” for 3–4 months or longer. You would not have a menstrual period until you stop taking the active hormone pills. Some people may have spotting while taking the Pill continuously.

The Oral Contraceptive Pill & PCOS FAQs

Do I need a pelvic exam before going on the oral contraceptive pill?

No. Although it’s important for teens to have checkups as part of their general health care, a pelvic exam is not needed for people with PCOS just to start oral contraceptive pills. People with PCOS may have an external genital examination or a pelvic exam as part of their first visit for PCOS, and/or they may have a pelvic ultrasound to look at their ovaries.

Is there any trouble getting pregnant after using the oral contraceptive pill?

There is no change in fertility with the use of the oral contraceptive pill. However, if you have PCOS and your periods were irregular before you started taking the Pill, it is likely that your periods will be irregular again when you stop taking it.

Does the oral contraceptive pill cause birth defects?

No, the Pill does not cause birth defects or affect the health of future children.

Does the oral contraceptive pill cause cancer?

No. The Pill actually protects against cancer of the ovaries and cancer of the lining of the uterus. A woman is half as likely to get cancer of the uterus or ovaries if she takes the Pill. Most experts believe that taking oral contraceptive pills does not cause any increased risk of developing breast cancer. Even people with a family history of breast cancer can take the Pill.

How long can I be on oral contraceptives?

It’s safe for you to be on the Pill for years, whether to regulate your menstrual cycle, treat your cramps, or as hormone replacement or birth control.

Do I need to take a break from the Pill?

There’s no medical reason that you need to take a “break” from the Pill.

What if I am also using the oral contraceptive pill for birth control?

If you’re also taking the oral contraceptive pill for birth control, you should know that oral contraceptive pills do not protect you from sexually transmitted infections. Condoms help to prevent most sexually transmitted infections and they are also an important backup method of birth control if you miss more than one pill in a row, or if you are sick (vomiting). All of these things can lower the effectiveness of the birth control pill. Whenever you get a new medication, ask if it changes the effectiveness of your oral contraceptive pill.

What if my period is very light while I’m taking the oral contraceptive pill?

Your period may be so light when you are on the oral contraceptive pill that you may have only a brown smudge on a tampon, pad, panty shield, or underwear. The amount of hormones in the pills is very low. This means that the lining of your uterus doesn’t become very thick, so very little blood needs to come out each month.

What if I forget to take one or more combined oral contraceptive pills?

  • If you miss 1 Pill, take the pill as soon as possible and then continue taking your pills at the usual time. You may take 2 pills on the same day (one at the moment you remember and the other at the regular time) or even 2 at the same time.
  • If you miss 2 or more active pills in a row, take the most recently missed Pill as soon as possible and then continue taking your pills at the usual time. You may take 2 pills on the same day (one at the moment you remember and the other at the regular time). If you are sexually active, use a backup method of birth control, such as condoms, or do not have sexual contact until you have taken the active hormone pills for 7 days (1 pill every day for 7 days in a row.)
  • If you missed the active pills in the third week, don’t take the inactive (hormone free pills). Instead, finish the current active hormone pills and then start a new pack right away. If you can’t start a new pill pack right away and you are sexually active, use a backup method of birth control (such as condoms) or do not have sexual contact until you have taken active pills for 7 days (1 pill every day for 7 days in a row).
  • Talk to your health care provider about whether you should use emergency contraception, especially if you missed pills in the first week of the package, or had unprotected sex anytime during the past 5 days.

Emergency contraception is recommended if you’ve had unprotected intercourse during the time you missed your pills.

  1. The first “morning–after” emergency contraception pill methods approved in the United States are: Plan B One–Step™, Next Choice®, and MyWay®. These products contain one kind of hormone, a progestin, and come as 1 or 2 pills. EC works best if taken within 3 days (72 hours) of unprotected sex, but can be taken up to 5 days but the earlier it is taken the more effective it is. No prescription is needed. Anyone can buy it without needing to show an ID. It prevents ovulation; it does not affect pregnancy or work after ovulation. It might be less effective in overweight people.
  2. Ella™ (ulipristal acetate or UPA) is an emergency contraceptive that works by stopping or delaying ovulation. It’s one pill (one dose) that can be taken up to 5 days or 120 hours after unprotected intercourse. A prescription is needed. It’s best to check a pregnancy test first.
  3. Another type of emergency contraception uses regular birth control pills, which contain two hormones, estrogen and progestin. There are 2 doses. The first dose may be 2, 4, or 5 pills depending on the brand of birth control pills used, and is taken within 120 hours (5 days) of unprotected sex. The second dose is taken 12 hours after the first dose. A health care provider must prescribe how many pills should be taken for this kind of emergency contraception. This method is less effective than the other two, and is more likely to cause nausea. So you are unlikely to use this medication.

Are there any serious side effects that I should be worried about?

Most people who take the oral contraceptive pill have few or no problems. If you do have any of the following problems, call your health care provider right away.

Remember: ACHES

  • Abdominal or stomach pain (severe)
  • Chest pain (severe), cough, shortness of breath
  • Headache (severe), dizziness, weakness, or numbness
  • Eye problems (vision loss or blurring), speech problems
  • Severe leg pain (calf or thigh)

The oral contraceptive pill is much more than a birth control pill. Many teenagers are frequently prescribed the oral contraceptive pill just for its medical benefits. It’s a very safe and effective treatment for many medical problems, including PCOS, irregular menstrual periods, menstrual cramps, acne, PMS, and endometriosis.

PCOS: Insulin and Metformin

Key Facts
  • PCOS is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne.
  • The tiny cysts on the ovaries aren’t harmful and don’t need to be removed.
  • The treatment for PCOS is healthy nutrition, exercise, and medications.

PCOS icons

Teens with PCOS may have elevated insulin levels and are more likely to develop diabetes. Metformin is a medication often prescribed for people with PCOS to help prevent or treat diabetes. A lifestyle that includes healthy nutrition and daily exercise is an important part of a PCOS treatment plan.

What is insulin?

Insulin is a hormone made by an organ in the body called the pancreas. The food you eat is broken down into simple sugar (glucose) during digestion. Glucose is absorbed into the blood after you eat. Insulin helps glucose enter the cells of the body to be used as energy. If there’s not enough insulin in the body, or if the body can’t use the insulin, sugar levels in the blood become higher.

What is insulin resistance?

If your body is resistant to insulin, it means you need high levels of insulin to keep your blood sugar normal. Certain medical conditions such as being overweight or having PCOS can cause insulin resistance. Insulin resistance tends to run in families.

What can insulin resistance do to me?

High insulin levels can cause thickening and darkening of the skin (acanthosis nigricans) on the back of the neck, axilla (under the arms), and groin area. In teens with PCOS, high insulin levels can cause the ovaries to make more androgen hormones such as testosterone. This can cause increased body hair, acne, and irregular or few periods. Having insulin resistance can increase your risk of developing diabetes.

How can I lower my insulin levels?

You can help lower your insulin levels naturally by eating fewer starches and sugars, and more foods that are high in fiber and low in refined carbohydrates. Low glycemic foods, on the other hand, don’t raise your blood sugar or insulin levels as much as foods that are high in sugar or refined carbohydrates. Exercising is another way to improve your PCOS. Fitting in 60 minutes of exercise each day is recommended, but any amount of exercise you do will help manage your PCOS. Exercise decreases insulin resistance.

What else will lower my insulin level?

Metformin (also known as Glucophage®) helps to regulate the amount of glucose (sugar) in your blood. It makes your body more sensitive to insulin, and decreases the amount of glucose your liver releases. Young people with high insulin who take Metformin are less likely to develop type 2 diabetes than those who don’t take a medication that lowers insulin. Research studies have shown that young people with PCOS who are overweight and who were treated with Metformin and a healthy lifestyle (healthy nutrition and regular exercise) were able to lose weight and lower their fasting blood sugar. Taking Metformin and maintaining a healthy weight also improves cholesterol levels. Metformin is not approved by the FDA (Food and Drug Administration) for PCOS, but it is commonly prescribed for adolescents with impaired glucose tolerance.

How do I take Metformin?

Metformin is available as a pill or liquid. It is usually taken 2–3 times a day with your meals (usually breakfast and dinner). Your health care provider will tell you to begin at a very low dose and slowly increase the amount of medicine you take over a few months—”start low, go slow.” Your health care provider may prescribe once a day long acting (XR–extended release) Metformin instead. It’s important that you take this medication exactly as prescribed by your health care provider. Do not break, chew, or crush the pills. Be sure to swallow the whole pill(s).

How do I store Metformin?

Keep your Metformin tightly closed, in the same bottle it came in. Do not remove the label on the bottle. Store it at room temperature away from high temperatures and any moisture. Do not store Metformin in the bathroom. Be sure to keep your medicine away from young children.

Are there any reasons not to take Metformin?

People with kidney or liver problems should not take Metformin. Your health care provider will check your blood to make sure that you do not have blood, kidney or liver problems before you start Metformin and then usually once a year after that. If you get sick and throw up or have diarrhea, call your health care provider and stop your Metformin until you feel completely well. It’s very important not to be dehydrated (not having enough fluids in your body) while taking Metformin. You should not binge drink alcohol and take Metformin. Also, if you’re going to have surgery or a medical or dental procedure where you can’t have anything to eat or drink, talk to your health care provider about stopping the Metformin for 48 hours before the procedure. If you’re scheduled for an X–ray that includes a “contrast material” (a dye that helps the radiologist see the images better), you should talk to your health care provider about stopping your Metformin for up to 48 hours before and after the test. Getting dehydrated, having kidney problems, or having a serious infection can cause the rare condition called “lactic acidosis”, so it’s important to talk to your health care provider about any of these problems.

Does Metformin have any side effects?

In general, healthy young people don’t experience many side effects. About a third of people who take Metformin have stomach upset such as nausea, diarrhea, gas, and loss of appetite. Some people may complain of a metallic taste. If the side effects are a problem for you, it’s important to talk with your health care provider. You may be able to lower your dose for a few days and slowly build back up to your regular dose.

What if I miss a dose of my Metformin?

When you first start taking Metformin, it’s a good idea to ask your health care provider what to do if you miss a dose. Write down the answer so you will have a plan if it happens. In general, you will probably be told NOT to take the pills that you missed, especially if it’s almost time for your next dose. Never double up on pills to make up for a missed dose.

Can I get pregnant while taking Metformin?

Yes. If you’re sexually active and you’re not taking oral contraceptive pills or using another method of birth control, it’s possible that you’ll have menstrual cycles and ovulate (release an egg). If your egg is fertilized (sperm from a male comes together with an egg of a female), you could become pregnant. People with PCOS are more likely to get pregnant while taking Metformin. You should talk with your health care provider about a method of birth control that’s right for you.

Important things to remember when taking Metformin:

  • If you’re prescribed Metformin for PCOS, be sure to tell your health care provider and pharmacist about all the prescription medications and over–the–counter medicines that you’re taking.
  • If you’re having surgery, including dental surgery, tell your health care provider or dentist that you’re taking Metformin for PCOS. Ask when you should stop taking it before the procedure.
  • Metformin can lower your body’s ability to absorb certain vitamins (B12 and folate), so it’s a good idea to take a multivitamin (with B vitamins).
  • Alcohol can be dangerous while taking Metformin. You’re more likely to get dehydrated or develop liver problems. If you have 3–4 drinks at a time, Metformin is not a good treatment option for your PCOS. Ask your health care provider about other treatment options or decrease your use of alcohol.
  • If you’re sexually active, be sure to talk with your health care provider about taking the oral contraceptive pill or about using another reliable birth control method.
  • Talk to a dietitian about planning meals and snacks that are PCOS–friendly.
  • Try to fit in about 60 minutes of exercise every day.
  • Keep all of your medical appointments and be sure to go for any lab tests that your health care provider might order.

Talk to your health care provider about the pros and cons of taking Metformin. Remember that Metformin will not cure PCOS or help you lose weight. Choosing foods that have a low glycemic index (lower in sugar and higher in fiber and protein) and exercising at least 60 minutes every day will most effectively help you manage your PCOS and lose weight.

PCOS: Spironolactone

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Spironolactone (pronounced: spi–ro–no–lac–tone) is a diuretic or “water pill” that’s prescribed for people who have high blood pressure and for those who have swelling due to extra fluid, but it also has other benefits. Spironolactone is often prescribed for young people with PCOS who are taking oral contraceptive pills and are “hirsute” (have extra hair in unwanted places).

How does Spironolactone work?

Spironolactone, the generic name for Aldactone®, works by blocking the effects of androgen. Androgens are hormones that both males and females have, but males have higher levels of them. Androgens such as testosterone are responsible for hair growth on the face, chest, and stomach that some young people with PCOS have. Androgens can also cause acne. Spironolactone may work by lowering the level of androgens, which lessens hair growth and improves acne.

How effective is Spironolactone?

Spironolactone is very effective in lessening hair growth and improving acne for young women, especially those who have not seen desirable results with oral contraceptive pills. Most young people taking spironolactone medication will see positive results; however, it can take up to 6 months to see an improvement in.

Are there any side effects?

Most young people who take spironolactone have few or no side effects. The side effects are only temporary and will go away when spironolactone is stopped. Spironolactone should be prescribed along with contraception to prevent pregnancy as the drug can be harmful to a developing baby.

Possible side effects may include:

  • Irregular menstrual bleeding (if not taking the Pill)
  • Frequent
  • Rash
  • Dry mouth, thirst
  • Loose bowel movements
  • Nausea
  • Tiredness
  • Headache

Other things to know about Spironolactone:

  • Before taking Spironolactone, tell your health care provider if you have liver or kidney problems
  • Depending on the level of spironolactone you are on, your health care provider may want to repeat blood tests to monitor your potassium levels
  • Your health care provider may suggest you to take spironolactone during the daytime so that frequent urination is not disrupting your sleep
  • Don’t take spironolactone if you’re pregnant or might become pregnant
  • It’s best to take both spironolactone and contraception together
  • Don’t take potassium supplements while taking spironolactone

PCOS: Quiz

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Young people with PCOS usually have certain symptoms. The following quiz was created to help you figure out if you might have PCOS. This quiz is designed as an educational tool and is not a substitute for medical advice by your health care provider.

If you answer “yes” to 3 or more of these questions, you should make an appointment with your health care provider. Your health care provider will be able to tell if you have PCOS or whether your symptoms are caused by another condition.

  1. My periods come about every 2-3 months or less often.
  2. I get my period every 2-3 weeks.
  3. My acne is pretty bad.
  4. I have darker patches of skin on the back of my neck, under my arms, or in my groin area.
  5. The hair on my head feels like it’s getting thin.
  6. I have dark hair above my lip,
  7. No matter what I try, I have a hard time getting down to a normal weight.
  8. I have a relative with PCOS.
  9. I have diabetes.
  10. Diabetes runs in my family.