Mirena coil? Combined Pill? Progesterone tablets? - Best treatment for PCOS. Absolutely stuck on which to go for.

[AC21]

Hi there. I'm 22 years old and have been recently diagnosed with PCOS. My symptoms are secondary amenorrhoea and cysts on my ovaries. I also suffer from acne. My gynaecologist has given me three options to manage the condition in order to help prevent endometrial cancer. These are the combined pill, progesterone tablets or the Mirena coil.

I have suffered from migraines in the past (I don't really suffer from them anymore) and have been told that the combined pill is not ideal for migraine sufferers as it can lead to increased risk of stroke (though I was on Dianette 2 years ago). Since I no longer get migraines I don't know if I still apply to this rule and thus whether I should still rule the pill out? While I don't need contraception now, I will want it again in the future and so don't know whether it would be better to choose either the pill or coil since this would mean I won't have to worry about this when the time comes in the future. But then I don't know whether progesterone tablets would be less invasive on my body and a better option? I was naturally swaying towards the coil however I've read about some horrible side effects (like puncturing the uterus and becoming embedded in the uterus). I really am stuck and would appreciate some advice, anybody else's experiences regarding how they manage their PCOS and how they have found certain treatments.

[Hols969]

I would go on the combined pill if possible (yasmin is a good one) as it will get your acne more under control. Everyone I know that has been on the coil has been very pleased with it. I would go for the added hormones as this is the easiest way to keep pcos at bay (I have been on and off the combined pill for 30 years and it keeps mine at bay generally) - it can take 3 months for the pill to settle, then take 2-3 months on the trot as this reduces the symptoms further, so as long as you have 4 periods a year to keep your uterus healthy then this is fine.

[AC21 in reply to Hols969]

Hi. Thank you so much for taking the time to share your advice with me. I feel so clueless at the moment and the opportunity to talk to somebody who actually has the same condition is so helpful and reassuring as nobody I know has it (as far as I'm aware). So you would say the combined pill would be your choice if you were in my situation? I know that PCOS can impact upon fertility which is worrying me a lot at the moment. Do you know if taking the combined pill on top of having PCOS is any more likely to make me infertile later in 10 or so years time?

[Hols969 in reply to AC21]

No taking the combined pill could actually make you conceive quicker as your body is less pcos. Our issue is ovulation, so generally we need help to ovulate. As often we have more cysts (which are follicles), they all think one of them will take the leap at ovulation time and none of them do. Cysts can come and go as well as they are only a symptom and not the cause. I would honestly not worry about conceiving for now, it is extremely rare not to conceive just because of pcos, 1/3 of fertility issues are now men as well. There is so much help out there though. I conceived aged 36 and Noah is now almost 11, it took me 3 years but not helped due to my hubbie having poor sperm as well. Our egg quality remains better for longer so we can conceive later than the norm as well.

As you are aware you have pcos when you do decide to try for a family you will be referred after 6 months anyway to get the ball rolling. It really is rare not to conceive so try not to worry about it. We also do not have an increased risk of miscarriage either (as there was a thought it may be the case but further research has shown that is incorrect).

I would get your diet as low GI as poss, so cut out all white carbs and as much sugar as poss as this will help along with the combined contraceptive.

[AC21 in reply to Hols969]

Thank you so much for your advice and sharing your knowledge and experience with me on this. This really has made me feel better about things. It is so daunting first being diagnosed with pcos and it feels like there is so much information to process and I want to be so careful to be fully informed in order to make the best decision for my body and my future self. I am glad that pcos didn't stop you from having children. Thanks again it's really really appreciated.

[Ailsa72 in reply to Hols969]

Totally agree. Never had problems conceiving. Went on the pill for a few months and low carb diet. Came off. First time with both children. If anything it assisted as I knew exactly when I was ovulating. Everyone I know with PCOS has been fine also.

[AC21 in reply to Ailsa72]

Hi Alisa. Thank you so much for taking the time to reply as well. This has also provided me with some much-needed reassurance that pcos doesn't have to mean the end of the world for fertility-related issues. I have now decided to go on the combined pill to regulate my "cycle" and have a bleed.