PCOS and Birth Control Yasmin

[Rowlie]

I have diagnosed pcos but conceived naturally four years ago, not planning to have anymore.
Pre-pregnancy, I was on Yasmin which greatly alleviated my pcos symptoms, which are mainly bad hormonal spots on chin and jaw line, thinning hair on head and excess hair elsewhere. My skin completely cleared up on Yasmin.
After the birth of my dd, I chose not to go back onto Yasmin due to the revelations about increased cancer risks on the pill. However, my skin is getting worse and worse and I am very tempted to go back on it as I’m fed up of acne at aged 35.
Does anyone else have any thoughts on using Yasmin or another pill to manage pcos given the increased cancer risks? Is it different in the case of pcos if the pill is being used to manage other symptoms of the hormonal imbalance caused by pcos?
I want to go back on Yasmin desperately to help my skin but not at the risk of potentially increasing my cancer risk :(

My understanding is that while there may be a slightly increased risk of breast cancer, there’s a decreased risk of ovarian and womb cancer. Afaik the former is generally more detectable/treatable than the latter two, but I don’t know exactly what the balance of risk v benefit is.
https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk

PCOS itself can have associated health issues apart from skin and hair especially insulin resistance.

I’m not a doctor; my own decision was to continue with a combined pill after I’d had my DD until menopause, in my case Marvelon. 64 now and ok so far.

Yes I'd get back on Yasmin, it was working helping with your hair, acne etc.

Also since you haven't been treated for a while for PCOS, book a GP appointment and get them to do a whole set of bloods, and also some other hormones, again cholesterol and insulin tests, as well.Blood test wise I'd probably ask for:• Total testosterone• Sex Hormone Binding Globulin• Free Androgen index• Fasting glucose + insulin• Lipid panel (cholesterol, triglycerides)• Vitamin D• Thyroid panel (TSH, free T4)
Hirtuism blood panel as well. I'd also use vitamin B6 and D supplements as they can be helpful with energy, also for periods.

Then you do need to start some form of contraception because you need uterine protections especially as with PCOS it can be a 2-5 x higher risk of uterine cancer, so it is so important to protect from that.
This video explains it in quite a lot of detail but very understandable as well, definitely have a watch https://www.instagram.com/reel/DPRWvOkEeGJ/?igsh=dDJlMjc4dGxmbHh5

The stats on increased BC risk for women aged 35-39 it was 265 cases per 100,000 users. So quite small. Also there are tons of other factors that also contribute to the chance of getting breast cancer.

The increased breast cancer risk does declines after stopping hormonal contraception, it isn't long-term. Contraception lowers the risk of ovarian cancer, at average 30% but can be up to around 50%. The decreased risk of ovarian cancer can also last for up to 30 years after a woman stops using contraception.

https://www.mdanderson.org/cancerwise/the-pill-and-cancer-is-there-a-link.h00-159779601.html

Contraception lowers endometrial cancer risk by at least 30%, with larger reductions with longer use. Your risk is reduced by roughly 24% per 5 years of being on contraception.

Try and see if your GP surgery has anyone with a special interest in women's health or endocrinology.

I almost died on yasmin. It ruined my health. Its not just linked to cancer but blood clots too. It took me 10 years of detoxing to get all the toxic estrogen out of my system after it.

You've got acne because of a hormone imbalance. You need to treat that rather than mask and make the issue worse long term by taking more synthetic hormones

@Superfoodie123 how would you suggest I treat the hormonal imbalance

You cannot cure PCOS, nor is PCOS simply 'hormonal imbalance' - that is not a medical term, your hormones in non-PCOS patients and PCOS patients are meant to be imbalanced. They fall and rise in response to changes in the body e.g insulin being released when you eat or FSH being released when you have your period to stimulate a follicile to grow, or T3+T4 being released when your body temp drops to increase heat production and metabolism.

PCOS is medically defined as hormonal deregulation - a different thing, so it is not using the hormones it has (which are in the right amounts) properly. So insulin resistance is common in PCOS because your body procedures insulin but doesn't respond to it correctly, the same for androgens etc. PCOS is more about bio-chemistry and genetics which you cannot fix, lifestyle changes, hormonal meds etc can help to managae it and get your body to regulate and respond and flucatate hormones properly. You need to fight bio-chemistry with bio-chemistry; meds.

The pill is there to protect you, to treat the symptoms, it treats PCOS, if anything it is the best for the PCOS, that is the point. It is a treatment for acne, it treates heavy periods, missed periods, irregular periods, it treats hirsutism, it treats the risk of uterine cancer. Saying that it 'masks' PCOS is like saying 1. PCOS symptoms are normal, which they are not, and like insulin masks diabetes.
The pill is not a diagnostic tool, when you already have a diagnosis, the condition can be further managed, with things for insulin resistance, hair excessive growth or hair thinning. It can be managed but not cured - managed with interdisciplinary care of endocrinologist, dietitians, gynaecologists etc.

Now there are other things apart from contraception that can help in PCOS management not curing it, so something like inositol (naturally made in your kidneys), PCOS patients have an improper balance of inositols but non-PCOS patients have a balance of 40:1, of myo-inositol v dechiro-inositol. So taking something like inositol alongside the pill, meds for hair growth, metformin etc you can bring your inositol levels back into the range of non-PCOS patients. It increases chances of helping with levels of testosterone, glucose control etc. Try and find the one with the 40:1 ratio. However I should say this has not been completely proven as a link, the evidence so far is positive, but not conclusive enough to be necessary for a PCOS patient, it can have a side effect of heavy periods in some people so is not right for everyone but you can try it as it can help.

Oestrogen is a natural hormone, it is not 'toxic' and linked to cancer only when it is not regulated by progesterone. Oestrogen in a menstrual cycle, when your period is over it is released to build the uterine lining back up, progesterone near to ovulation is released and suppresses oestrogen to be released. That means that the uterine lining does not get too thick - known as hyperplasia which over time can lead to more cancer cells etc. The issue with PCOS is when you are not having a period regularly or ovulating then the uterus lining every month is not being shed, so it builds up that is why PCOS has a 2-5x higher rate of uterine cancer, and many women from their 30s, 40s etc with PCOS are being diagnosed with that.

UK summary found that PCOS patients had a 3x endometrial cancer risk. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancer/risk-factors

A large Taiwanese study found a hazard ratio of around 17 for getting endometrial cancer in women with PCOS vs without. https://journals.lww.com/md-journal/fulltext/2018/09280/association_between_polycystic_ovarian_syndrome.98.aspx

But with some form of progesterone, not having a period is not the same because that happens because it thins your uterus lining and so it is quite thin, that there is not much or anything really to shed, but in that case your uterus is protected from hyperplasia and thus uterine cancer.

https://vm.tiktok.com/ZNdcGc57y/

https://vm.tiktok.com/ZNdcGbNr7/

Depending on your issues, you could ask your GP to refer you to see an an endocrinologist, and a dietitian as well. But you should also ask for the bloods I mentioned earlier because then they can see how your PCOS is progressing, whether your risk of diabetes is increasing, you have worsened insulin resistance, how your androgens are being managed etc - from there you can make a plan about what referrals you need with your GP.

That’s useful info, @TheLivelyViper , thanks!
re blood clotting, my gp did some blood tests on me for some sort of clotting factors before prescribing Marvelon. So that might be relevant to ask for too.

@TheLivelyViper thank you for this very helpful info. I am fortunate enough to have private health care so hoping to seek professional help via this route.
I believe my pcos to be mild/moderate, as I have a regular period every month and was able to conceive naturally. I am not overweight, it is mainly the acne that is causing issues. When I had a scan of my ovaries 10 years ago there were a couple of follicles on one ovary only.
As you say, it would be useful to see how this has progressed and how it can be best managed.

Yes I'd definitely still have the bloods, and maybe a scan to check things.

With PCOS even at a healthy weight you can still be insulin resistant, or have elevated androgens (even without excessive hair etc). This is the case for around 20-30% of women with PCOS, so definitely get the bloods to see as there are a range of different treatments for lots of the potential symptoms of PCOS which is why it is known as a syndrome.

Through your private healthcare, would it still be the process of seeing a GP first, and then from your bloods and perhaps a pelvic and/or transvaginal scan, deciding on whether you need to see endocrinology, gyne etc? As that's likely the clearest route depending on what results show. It sounds like you've had goof management so trying to keep that is the best route, reducing risk as much as you can for diabetes, other conditions as well and stopping symptoms disrupting your life.

I had exactly the same issue, Yasmin worked brilliantly for me / also helped keep weight and blood sugars ok. But after babies and breastfeeding doctor wouldn’t prescribe it anymore due to blood clot risk. I tried an alternative but I bled every day on it. Gutted.