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By Julia

Birth control pills or oral contraceptive pills are often prescribed for women who are suffering from polycystic ovarian syndrome or women who tend to have hyperandrogenism, which is an excess of male hormones. All women typically have male hormones, such as testosterone, naturally, but in deficient concentrations.

Because of this excess of male hormones, a series of symptoms and complications of PCOS can occur. Treating hyperandrogenism with birth control can alleviate some of the most uncomfortable symptoms of Polycystic Ovarian Syndrome (PCOS) or Polycystic Ovarian Diseases (PCOD.)

Combined Hormonal Contraceptives

By supplying combined hormonal contraceptive pills, the problems of hyperandrogenism are reduced because the pills help in a number of ways:

● By introducing estrogen, the production in the liver of sex steroid transport globulin (SHBG) increases, thereby decreasing the amount of free testosterone.
● On the other hand, the hypothalamus reduces the release of gonadotropin-releasing hormone (GnRH), decreasing the levels of LH which in turn causes the ovary to stop producing androgens.

For these reasons, the administration of hormonal contraceptives is one of the first therapeutic options for women with a polycystic ovarian syndrome.

Choosing the Right Pill for PCOS

Choosing the right contraceptive pill for PCOS can be a challenge because the variety of contraceptive pills available may seem overwhelming. Fortunately, they can be classified into just a few categories, which make it easier to evaluate your options. The choice of the most appropriate contraceptive depends mainly on the general health of the woman, her age, and her doctor’s decision.

There are two main types of birth control pills: combined contraceptive pills, which contain estrogen and progesterone, and the mini-pill, which only contains progestin. Combination contraceptive pills are also classified according to whether the hormone dose remains the same or varies:

● Single-phase: In this type of combination contraceptive pill, each active pill contains the same amount of estrogen and progestin.
● Multiphasic: In this type of combination contraceptive pill, the amount of hormones in active pills varies.
Also, combined oral contraceptives can also be classified according to the concentration of estrogen, with ethinylestradiol being the most widely used estrogen today. The combined oral contraceptives are subdivided into two groups: high dose and low dose.
● The high doses are also called macrodoses and are those in which the concentration of ethinylestradiol is higher than 50 ugs in each tablet.
● Those of low dose are subdivided into microdoses if the ethinylestradiol concentration is between 30 and 35 ugs per tablet.

High doses vs. low doses

It is essential to keep in mind that even the lowest dose of estrogen can be effective in preventing pregnancy and is less likely to cause side effects such as bloating, weight gain and mood swings. On the contrary, high doses increase the risk of irregular periods instead of reducing it. On the other hand, low and very low levels of estrogen are associated with a risk of intermenstrual bleeding that can cause some women to stop taking it.

Progestin-Only Options

The progestin-only pill is often called a “minipill.” It may be prescribed for young and adult women experiencing abnormal menstruation, who can’t take estrogen due to an underlying medical condition. Although progestin-only pills can produce side effects, particularly bleeding or spotting between periods, the side effects often improve or disappear after a few months.

The Bottom Line

PCOS can be treated using a variety of options. If you suspect you’re dealing with PCOS or are desperate to figure out how to manage PCOS, you should see a medical doctor as soon as possible. The longer you leave your PCOS untreated, the worse it will become.

You can see all of Julia’s posts here.

Spironolactone (Aldactone) for the treatment of PCOS

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by Jesse

DID YOU KNOW? PCOS is a disorder of hormone (dis)regulation. Insulin and male hormones are often seen in much higher levels in women with PCOS than without the disease. The medicinal one-two-punch for this is typically a cocktail of Metformin and Spironolactone. Metformin helps to keep insulin low by limited blood sugar creation in the liver and sensitizing your body to sugars in the blood. Spironolactone, on the other hand, limits the creation of male hormones (androgens) so fewer of them are circulating in your system.

Do you have PCOS? This means you may have hair growth in funny places, painful acne, oily skin (seborrhea), androgenetic alopecia, obesity and, less frequently, acanthosis nigricans (an area of thickened skin, typically behind the neck, that is darkened in appearance and fuzzy soft to the touch).

Spironolactone is the androgen blocking powerhouse pill that can lessen these masculinizing issues for women with PCOS and excessive blood androgen levels.

DID YOU KNOW? Benign cysts that form in the ovaries – often referred to as the PCOS “sting of pearls”- are capable of affecting the production of hormones, such as the androgens Spironolactone is designed to suppress.

Cystic Acne
As if unwanted facial hair wasn’t hard enough to deal with, Mother Nature often throws PCOS patients the potentially disfiguring complication called cystic acne. This isn’t the same as annoying adolescent pimples or outbreaks. Proactiv won’t do anything to get rid of it. This is something much more irritating (literally).

Cystic acne is much more likely to leave scars because the infection often occurs many layers below the skin surface. This is also why topical cleansers and treatments do so little to ease the condition. Treatment has to start below the skin, not on top of it.

Heather from CysterWigs has experienced this symptom her entire adult life. It requires diligence to keeping your skin clean, exfoliated, and well moisturized. In her case, it also required the use of Spironolactone to decrease the hormones responsible for her break outs. She considers this pill her not-so-secret weapon for keeping the dreaded “beard of acne” away!

Androgenic Alopecia
We need to be very specific and state up front that Spironolactone is not a miracle cure for hair loss. It will not make hair grow back if that follicle is already dead. However, this pill can slow or even stop excessive hair shedding in women with high androgen levels. We will discuss testosterone and its role in female hair loss in a later, more detailed installation of this blog series.


DID YOU KNOW? Hirsutism is defined as the excessive growth of body hair in women. It is classified as mild, moderate and severe and is measured by a chart very similar to this one.

The symptoms of hirsutism include excessive growth of hair on the face of a woman or unwanted growth all around the body, especially in the chest and in the back. The hair is usually dark and thick as opposed to the “peach fuzz” one might expect.

Polycystic ovarian syndrome (PCOS) is known to be a frequent cause of hirsutism. According to American Family Physician, PCOS is responsible for three out of four cases of hirsutism.

Spironolactone treatment
What exactly is this pill we’re talking about? It’s another classic example of a medical oops turning into a medical win.

Since its discovery in the 1950s, Spironolactone has demonstrated that it has a curious side effect: it lowers testosterone levels in the people who take it.

DID YOU KNOW? Spironolactone is one of the most common medications prescribed for trans women when they first begin their transitioning process. Spironolactone is either prescribed in combination with estrogen therapy or as a way to suppress androgens before adding more hormones to the mix.

Spironolactone (Aldactone) is actually a diuretic (water pill), normally prescribed to people who have high blood pressure or those who experience swelling due to excess fluids in some areas of their bodies (edema). Most women who this medication to suppress androgen production will get positive results, although it may take up to 6 months to see an improvement in symptoms.

How does Spironolactone work?
Androgens, such as testosterone, are responsible for the growth of hair on the face, chest and stomach that occurs in some women who have PCOS. Spironolactone, when taken, does a great job in decreasing androgen levels in the body, which in turn neutralizes the effect of androgen on the skin, while also improving acne.

Possible side effects may include:

  • Increased urine frequency (remember this is a diuretic)
  • Weight loss (mostly water weight)
  • Nausea (this generally goes away after a while)
  • Clear skin and easing of other androgen-related issues

Important things to note:

  • In case of liver or kidney problems, inform your doctor before you start taking Spironolactone.
  • Do not take it if you are pregnant or you could get pregnant
  • Spironolactone is best taken along with oral contraceptive pills
  • VERY IMPORTANT: Avoid taking potassium supplements while using Spironolactone! This medication can cause of build-up of potassium in the liver, which can damage the liver over time

Stay tuned for next week’s installment: Birth Control Pills and PCOS

Legal Disclaimer

This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!


You can see all of Jesse’s posts here.


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Losing between 50 to 100 strands of hair per day is normal. But what does it mean when when you’re losing much more? About a third of women experience hair loss (alopecia) at some point in their lives. Among postmenopausal women, approximately two-thirds suffer from thinning hair or baldness. The loss often has a greater impact on women than on men. Alopecia can also severely affect a woman’s emotional well-being and quality of life. But understanding hair loss caused by androgens can help you get it under control and ease away the stress it gives you.

Trigger Factor: Androgens
For women, the female sex hormones, estrogen and progesterone, are the main factors in the development of their hair. But in case of constitutive predisposition, it is the small amount of their androgens, secreted by their adrenal glands (at 60%) and by their ovaries (at 40%), which can negatively affect the normal renewal of their hair. The negative action of androgens accelerate the life cycle of some hair. This abnormal acceleration imposes on hair follicles and roots a rate of infernal production, forcing the production of shorter strands of hair. In the end, when exhausted, the follicles shrink and end up producing nothing at all.

Androgenetic Alopecia
Over time, many women will develop some degree of hair loss or female pattern baldness. This condition can start at any time after the onset of puberty, but women tend to notice it around menopause when hair loss usually increases. The risk increases with age and is higher in women with a family history of hair loss.

As the name suggests, androgenetic (or androgenic) alopecia involves the action of hormones called androgens which are essential for normal male sexual development and other vital functions in both sexes, including sexual desire and the regulation of hair growth. This condition can be inherited and involve several genes. It can also result from an underlying endocrine condition, such as the overproduction of androgens or an androgen-secreting tumor in the ovary, pituitary gland or adrenal gland.

In either case, alopecia is probably related to increased androgen activity in the body. But unlike androgenetic alopecia in men, the precise role of androgens is more challenging to determine in women. On the off chance that an androgen-secreting tumor is involved, it is essential to measure androgen levels in women who have significant hair loss.

In any sex, hair loss due to androgenetic alopecia occurs because of a genetically determined shortening of the anagen phase, the growth phase of hair, and a prolongation of the time between the “detachment” of hair and the beginning of a new anagen phase. This means that the hair needs more time to start growing again. Because hair loss from androgenetic alopecia is an abnormality of the hair growth cycle, it is theoretically reversible; however, advanced androgenetic alopecia will not respond to treatment because the inflammation surrounding the bulging area of ​​the follicle could irremediably damage the follicular stem cell.

Causes of Hair Loss in Women

Genetic Factors
The fact is that more than 90% of hair loss is attributable to genetic factors. Although lifestyle factors may affect hair thickness. Before blaming your diet or hair dryer, you might want to find out if heredity is a factor. Hereditary hair loss, also known as androgenetic alopecia, is a genetic condition that decreases active hair growth time. Androgenetic alopecia causes narrowing of hair follicles. Gradually, thinner and lighter hair, called “down”, replaces the thicker, darker hair. Women with inherited hair loss have a general thinning of their hair, with the most substantial loss occurring on the top of the head and around the hairline.

Stress increases the secretion of androgens and is the most constant aggravating factor. Androgenetic hair loss in women can thus be reinforced by stress in general. Stress, generated especially by a new lifestyle, contributes to the increasing number of cases of female alopecia and their increased severity.

Poor diet can cause hair loss in women by keeping the hair follicles in the resting phase. Furthermore, diets low in nutrients, such as iron and protein, can also lead to hair loss in women. The hair can start to grow again when nutrient deficiencies are corrected, but it can take a few months.

Thyroid Disorders
Hormonal fluctuations can cause hair loss in women. The thyroid gland regulates hormone levels. For example, people with thyroid conditions may have hair loss. In most cases, hair regrows when the thyroid condition is treated.

Hormonal fluctuations can cause hair loss in women. A drop in the level of estrogen causes more hair follicles to remain in the rest phase. Known as postpartum alopecia, this type of hair loss is usually short-lived. Women who lose a lot of hair after childbirth observe a return to normal after six to 12 months.

Alopecia Areata
Alopecia areata is another cause of non-hereditary hair loss. This autoimmune disease usually leaves patches and rounded areas of the scalp. It can occur quickly and cause total hair loss. If you don’t have a history of baldness and have this type of hair loss, see your doctor right away. The sooner you seek treatment, the better.

How is Alopecia Diagnosed?
Alopecia can be diagnosed through your medical history and a physical examination. Your doctor will ask you questions about your hair loss, which is why you should observe the pattern of your hair loss, and examine your scalp.

The doctor can perform some other tests to check if there is a disease that could be the cause of your hair loss is if the source is not apparent. These tests consist of:

● Hair analysis: A sample of your hair will be taken and examined under a microscope. Furthermore, a scalp tissue sample will also be taken.
● Blood tests: Your doctor will test for a specific condition, such as hyperthyroidism or hypothyroidism.
Hair Loss Solutions
If you decide not to wait for your hair to grow back (which usually takes upto a year) you can choose to follow the following:
● Wear Wigs: The wigs are made of human or synthetic hair that they implant in nylon net. Some wigs can be attached to the scalp with glue, metal staples, or ribbons. You can even use extensions: sew or braid longer pieces of hair in your existing hair. However, we do not recommend it as it could cause permanent hair loss.
● Use specific hair care products and design techniques: You can buy hair care products. Using dyes can help you “color” the scalp. However, the continuous use of dyes can lead to more significant hair loss.
● Corticosteroids: The most common treatment for hair loss in patches is injections of corticosteroids on the scalp or skin, about 1 cm (0.4 in.) Away, every 4 to 6 weeks.
● Minoxidil: Minoxidil affects the hair follicle in three ways: it increases the time follicles spend in the anagen stage, “awakens” the follicles that are in the catagen, and enlarges the actual follicles.
● Anthralin: Anthralin is ointments that can help hair grow back. Treatment with anthralin, a nonspecific immunomodulator, is safe and effective, particularly in patients with generalized alopecia areata. Anthralin is available in creams of 0.1, 0.25, 0.5 and 1.0% and can be applied once a day at home for progressively more extended periods, starting with five minutes to one hour. After each application period, the scalp should be rinsed with cold to lukewarm water and then cleaned with soap. The new hair growth becomes apparent in two or three months.

If you’re worried about hair loss, talk to your doctor. Treatment of an underlying disease or deficiency may be enough to restore your hair’s former glory. If you’re taking medication for a chronic illness, mention hair loss to your pharmacist or doctor. Doing this could help them pinpoint medications that cause excessive hair loss.

You can see all of Julia’s posts here.

Metformin for the treatment of PCOS

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DID YOU KNOW? Most people don’t need sugars in their diet to maintain a healthy blood glucose level (unless you are hypoglycemic or diabetic). This is because your liver can create glucose on its own to be released in the blood to keep you healthy. Understanding this concept is essential for understanding the role Metformin plays in your PCOS treatment.

Metformin, also known as Glucophage, is a medication commonly used in the treatment of type II diabetes and blood sugar regulation disorders, such as Polycystic Ovary Syndrome. It inhibits the production of glucose in the liver (glucose = a kind of sugar and the fuel of all your body’s cells) and increases insulin sensitivity (insulin = the hormone that tells your body to open up an accept the fuel; if that fuel can’t be used, this hormone is also responsible for fat storage). Metformin is of great utility in non-diabetic women who have PCOS and has demonstrated long-term improvements in weight loss, ovulation, period regularity, hair loss, and body hair growth. Metformin is also effective at helping ease the intense sugar cravings associated with disorders of insulin resistance, such as PCOS and type II diabetes.

DID YOU KNOW? Contrary to popular belief, Metformin DOES NOT lower the impact foods you eat have on your blood sugar. Instead, Metformin tells your liver to stop making sugar (glucogenesis) in response to your body’s signals related to its insulin resistance. This means that you cannot get away with eating more sugar just because you’re on this pill; taking more of it in response to poor dietary choices will probably only make you feel sicker.

A glucose tolerance test is done before you start metformin. In most patients over 17 years old, the usual starting dose is 500 mg a day, which is increased to twice a day and then increased to 850 mg, twice a day. The first dose is taken in the morning after breakfast and the second at night, after dinner. Doses increase until you reach the maximum dose of 2500 mg per day.

DID YOU KNOW? 2000 mg – 2500 mg a day is considered a prophylactic dosage – meaning it will help prevent PCOS from progressing rather than curing it. This often exceeds the dose given to type II diabetics!

Side effects
Metformin is a modern wonder drug but the side effects can be daunting, particularly when you first start taking it. This is medication women with PCOS stop taking on their own against their doctor’s advice because it is not a pill you can feel working instantly. It is not psychoreactive (there’s no high associated with it) and it prevents the onset of worsened disease rather than curing something. This means that the positive effects are not always obvious to the person taking it, making it often difficult to justify enduring the side effects.

DID YOU KNOW? You need to build up a tolerance to this medication in your liver before the side effects will diminish. If you start and stop only to start again, you will be met head on at every false start with the full impact of these side effects!

The most common side effect that patients experience when they start metformin are stomach upset and diarrhea. These symptoms are most acute when you begin your Metformin regimen and they generally subside when you achieve tolerance to the medication. Tolerance usually sets in about a month after you’ve reached the full prophylactic dosage.

You may experience a relapse of these negative side effects if you eat a meal high in simple sugars or fructose. This is similar to the “dumping syndrome” experienced by bariatric weight loss surgery patients. Believe it or not, this is a signal that your Metformin is doing a good job of sensitizing your liver to the sugars in the food you eat. These foods may also begin to change flavor – and certain hyper sweet foods may even start to taste bad to you!

DID YOU KNOW? Dietary changes are a MUST whenever you start a Metformin regimen to best avoid digestive problems. A low carbohydrate diet low in processed convenience foods, in combination with your Metformin, is generally your best bet for defeating sugar cravings and getting your health back on track.

Other side effects are headache, weakness, intestinal gas and abdominal pain. These symptoms can be relieved by taking the medication with a meal. Talk to your doctor about switching to the time released version of this medication if the symptoms persist after tolerance is reached. The time released version is called Metformin ER and it is often much easier on your digestion than the instant release pill form.

Metformin with other treatments
Metformin can be used successfully in combination with other. Spironolactone (Aldactone) is another medication commonly prescribed in combination with Metformin for the treatment of PCOS. The success of metformin treatment increases when patients follow a healthy diet. Since obesity is a common symptom of polycystic ovarian syndrome, many doctors pair their patients with a nutritionist. Regular exercise helps lose weight and improves overall health because it helps the Metformin do a better job of sensitizing your body to glucose in the blood.

In conclusion, Metformin constitutes a fundamental, almost universally accepted treatment in patients with PCOS in any clinical presentation. Metformin regulates the menstrual cycle and induces spontaneous ovulation, thereby increasing fertility and overall health in the process.

DID YOU KNOW? Metformin presents benefits for improving metabolic syndrome, blood glucose levels, total cholesterol, LDL (bad cholesterol), and blood triglycerides. While you may not see or feel it working for you, you are reducing your heightened risk of cardiovascular diseases and other PCOS complications by taking this pill.

Do you have questions about Metformin or PCOS? We highly recommend talking to your doctor or an Endocrinologist (hormone specialist) to discuss possible diagnosis and treatment options. PCOS is often a diagnosis of exclusion because its symptoms mirror so many other possible conditions – such as Cushing’s Syndrome, hypothyroidism and Hashimoto’s Disease. Working closely with a doctor you trust is an essential part of achieving a correct diagnosis. Your doctor will probably want to rule out these other conditions first before prescribing Metformin or any other treatment to you.

Stay tuned for next week’s installment: Spironolactone

Legal Disclaimer

This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!

You can see all of Jesse’s posts here.

Medication-induced hair loss

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Medication is designed to treat a variety of health conditions, but sometimes they can have unwanted side effects – including changes to your hair. Certain medicines can contribute to excess hair growth, changes in hair color or texture, or even hair loss.


Medication-induced hair loss, like any other type of hair loss, can have a real effect on your self-esteem. The good news is that in most cases, it’s reversible once you stop taking the medication.

How do drugs cause hair loss?

Medicines cause hair loss by interfering with the normal cycle of hair growth. This growth cycle has three phases:

  • During the anagen phase, which lasts for around three to four years, the hair grows.
  • During the catagen (transitional) phase, which lasts two to three weeks, the hair prepares for the telogen phase.
  • During the telogen phase, which lasts about three months, the hair rests and older hairs are shed and replaced by newer hairs.

Medications can lead to two types of hair loss:

Telogen effluvium is the most common form of medication-induced hair loss. It usually appears within two to four months after taking the medication. This condition causes the hair follicles to go into their resting phase (telogen) and fall out too early. People with telogen effluvium usually shed between 100 and 150 hairs a day.

Anagen effluvium is hair loss that occurs during the anagen phase of the hair cycle when the hairs are actively growing. It prevents the matrix cells, which produce new hairs, from dividing normally. This type of hair loss usually occurs within a few days to weeks after taking the medication. It’s most common in people who are taking chemotherapy medications and is often severe, causing people to lose most or all of the hair on their head, as well as their eyebrows, eyelashes and other body hairs.

The severity of medication-induced hair loss depends on the type of medication and dosage, as well as your sensitivity to that medicine.

What types of medications cause hair loss?

Many different types of medicines are thought to cause hair loss, including some of the following types of medications:

  • Acne medications
  • Antibiotics and antifungal medications
  • Antidepressants
  • Oral contraceptives
  • Blood thinners (anticoagulants)
  • Cholesterol-lowering medications
  • Immunosuppressant medications
  • Chemotherapy medications
  • Epilepsy medications (anticonvulsants)
  • High blood pressure medications (anti-hypertensives)
  • Hormone replacement therapy – estrogen or progesterone for women, androgens and testosterone for men
  • Interferons
  • Mood stabilizers
  • Non-steroidal anti-inflammatory medications ( NSAIDs)
  • Parkinson’s disease medications
  • Steroids
  • Thyroid medications

Chemotherapy medications often lead to the anagen effluvium type of hair loss. As these kill cancer cells throughout the body, they can also damage healthy cells, including hair matrix cells. The hair typically starts to fall out after the second cycle of chemotherapy. Hair loss is more common and severe in patients taking combinations of chemotherapy medications than in those who take just one medication.

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