Stopping the pill does not cause PCOS, but it can lead to an increase in testosterone to natural/pre-pill levels, which may result in increased body hair growth. This can happen in individuals with or without PCOS.
How the Pill Lowers Testosterone
1️⃣ Hormone Suppression:
- The pill contains synthetic oestrogen and progesterone, which suppress the ovaries’ production of hormones, including testosterone. Oestrogen is actually made from a testosterone precursor called androstenedione.
2️⃣ Increased SHBG Production:
- The pill increases the liver’s production of a protein called sex hormone-binding globulin (SHBG). SHBG acts like a sponge, binding to testosterone and making it less biologically active. This means that while blood tests might show normal testosterone levels, the biologically active amount is very low. In PCOS, insulin resistance causes low SHBG, so total testosterone might be normal, but the biologically active amount is increased.
Post-Pill Changes
Unless underlying PCOS resolves while on the pill (which is possible with lifestyle changes that improve insulin sensitivity), increased body hair or other symptoms of hyperandrogenism can come back after stopping the pill. Even without PCOS, everyone has some level of testosterone, which can increase facial and body hair. Some ethnicities naturally have more body hair. In a world of airbrushed photos and unrealistic beauty standards, it’s easy to pathologize normal things like body hair.
Misconceptions About PCOS
If you stop the pill and notice increased body hair, this can be normal and does not automatically mean you have PCOS or “post-pill PCOS” (a made-up condition).
PCOS is diagnosed by excluding other conditions and having two of the following:
1️⃣ Absent or irregular periods
2️⃣ Clinical or biochemical signs of hyperandrogenism
3️⃣ Polycystic ovarian morphology on ultrasound.
If you think your amount of body hair is abnormal, a GP or endocrinologist can help exclude PCOS or other causes of elevated androgens