Oral contraceptives that contain a very small amount of estrogen may not be the best choice when these are symptoms of concern. Low-estrogen contraceptives include Alesse, Estrostep, Levlen, Loestrin, Norlestin, and Ovral. It's important to know that these brands are not the cause of acne or hirsutism (excessive hair growth) in women who have PCOS, they just will not help acne or excessive hair growth. Then it is possible to choose among the best oral contraceptives for particular symptoms of concern. Acne is relieved when the oral contraceptive contains more estrogen with a lower potential for creating androgens masculinizing sex hormones such as androstenedione and testosterone. (Even women who have PCOS need tiny amounts of these hormones for normal sexual health.)
Break-through bleeding is treated with brands of the Pill that contain more estrogen and more progestin but don't stimulate masculine sex hormones. These brands include Desogen, Estrostep Fe, Ovcon, Yasmin, and Zovia. Breast soreness is minimized by formulations of the Pill that offer more estrogen and less progestin, such as Alesse, Levlite, Loestrin, Ortho Evra, or Yasmin. If you have other symptoms in addition to breast soreness, your doctor may just prescribe a Pill with less estrogen than the brand you are now taking. When depression or mood swings is an issue, lower progestin is preferred. Brands of the Pill with lower amounts of progestin include Alesse, Brevicon, Modicon, Necon, Ortho-Cyclen, Ortho-TriCyclen, Ortho Evra, Tri-Levlen, Triphasil, and Trivora. Headaches may be less frequent when the Pill contains both lower estrogen and lower progestin. Appropriate brands of the Pill include Alesse, Levite, and Ortho Evra. The Pill will not stop premenstrual migraines.
Light menstrual flow or no menstruation at all is treated with brands of the Pill that have more estrogen and a longer-acting form of progestin. These brands include Brevicon, Modicon, Necon, Norinyl, Ortho-Cyclen, Ortho-Novum, and Ovcon. Severe menstrual cramping is treated with pills of higher progestin potency, such as Demulen, Desogen, Loestrin, Mircette, Yasmin, and Zovia. Weight gain is addressed with less estrogen and a more potent form of progestin, offered by Alesse, Levlite, Loestrin, Ortho Evra, and Yasmin. If you have other symptoms, your doctor may just put you on a different brand of the Pill with less estrogen than you are taking now. There are many, many choices among oral contraceptives. Don't hesitate to ask your doctor why the brand prescribed is the best for managing your PCOS.