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Dear Selfy,
Initially, oral contraceptives, may very well, mitigate the symptoms of PCOS, by virtue of the regulatory effect; they have on the sexual cycle. However, ultimately, they may prove to be counterproductive.
PCOS, is more accurately known as "Functional Hyperandrogenism". You don't have to have ovarian cysts, to have PCOS. However, elevated testosterone, an androgen, is a hallmark of PCOS. The progesterone component, of oral contraceptives, is metabolized into testosterone, potentially, raising total testosterone levels, i.e., free and bound.
The exogenous estradiol, found in the oral contraceptives usually prescribed for PCOS, reduces serum SHBG, i.e., sex hormone binding globulin, making more free testosterone available to be metabolized into DHT, i.e., 5-alpha-dihydrotestosterone. It is DHT, that causes the acne, hirsutism, and alopecia, associated with PCOS.
Lastly, a well known side affect, of oral contraceptives, is hyperinsulinemia, i.e., elevated insulin levels. Not only, do the elevated insulin levels cause weight gain, they have an adverse effect on the ovaries. Follicles, get stuck in the thecal stage, producing testosterone, rather than maturing to the point, where they produce estradiol.
Alternatives, to treating PCOS are antiandrogens, e.g., saw palmeto, flutamide, finasteride and dutasteride, as well as the antidiabetic metformin. Antiandrogens, either interfere with the enzymes, that reduce testosterone to DHT, or compete with the androgens for their binding sites, i.e., the androgen receptor on the nuclei of the target cells. The metformin, will reduce the elevated insulin levels, often found in PCOS, causing weight normalization, rather than weigh gain.
Lastly, and probably the most important, in the treatment of PCOS, is a healthy, low carbohydrate diet, coupled with abundant exercise.
I wish you the best,
Larry
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