* [PCOS](https://nabtahealth.com/glossary/pcos/) is sometimes treated with metformin, a drug for [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/). * 60-70% of women with [PCOS](https://nabtahealth.com/glossary/pcos/) are insulin resistant which is why metformin may be prescribed. * Clinical studies exploring metformin and [PCOS](https://nabtahealth.com/glossary/pcos/) symptoms have been small and inconsistent, but there is some evidence metformin increases [ovulation](https://nabtahealth.com/glossary/ovulation/) rate in women with [PCOS](https://nabtahealth.com/glossary/pcos/) when compared to treatment with a placebo. * Other studies have found that there is no consistent evidence that metformin improves the signs of hyperandrogegism (such as hairiness from excess male hormones). * However, metformin should not be completely discounted as an option for the management of [PCOS](https://nabtahealth.com/glossary/pcos/) [Metformin](https://nabtahealth.com/what-is-metformin/) is the first line treatment approach for type 2 diabetes mellitus (T2DM). It works by improving the way in which the body responds to insulin, preventing blood sugar levels from getting too high. Metformin is not licensed for the treatment of [](https://nabtahealth.com/what-is-pcos/)[PCOS](https://nabtahealth.com/glossary/pcos/), but as many women with the condition are [insulin resistant](https://nabtahealth.com/treating-the-associated-symptoms-of-pcos/), it is often prescribed ‘off label’ to help manage the symptoms. This article aims to address some questions regarding the use of metformin in the management of [PCOS](https://nabtahealth.com/glossary/pcos/). Is there justification in its use? Can it help to improve the symptoms of the condition, or are there alternative options that will be more effective? Will there ever be a time when metformin is prescribed as standard for all women with [PCOS](https://nabtahealth.com/glossary/pcos/) and to treat [PCOS](https://nabtahealth.com/glossary/pcos/) side effects? #### **Why metformin and [PCOS](https://nabtahealth.com/glossary/pcos/)?** Metformin is safe and cost effective, hence it’s widespread use in the management of T2DM. [Insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) is not one of the three diagnostic criteria used in defining [PCOS](https://nabtahealth.com/glossary/pcos/), however it is recognised as a common feature. In fact, 60-70% of women with [PCOS](https://nabtahealth.com/glossary/pcos/) will be insulin resistant and it is thought that the higher than normal levels of insulin contribute to many of the phenotypic traits of the condition. Thus, it makes sense that treating the [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) might help to alleviate other [PCOS](https://nabtahealth.com/glossary/pcos/) side effects, for example regulating the menstrual cycle and improving signs of unwanted hair growth and acne. #### **What does the science say about [PCOS](https://nabtahealth.com/glossary/pcos/) and metformin?** Unfortunately metformin has not turned out to be the wonder drug that some anticipated. The clinical studies to date have largely been small in sample size and results have been inconsistent. In 2017, the American Society for Reproductive Medicine published guidelines on the use of metformin for the treatment of [infertility](https://nabtahealth.com/glossary/infertility/) in women with [PCOS](https://nabtahealth.com/glossary/pcos/). They based these guidelines on the results of a comprehensive literature review. The main conclusions reached were: * There is some evidence that metformin increases [ovulation](https://nabtahealth.com/glossary/ovulation/) rate in women with [PCOS](https://nabtahealth.com/glossary/pcos/) when compared to treatment with a placebo. **However:** * Clomiphene citrate is more effective at inducing [ovulation](https://nabtahealth.com/glossary/ovulation/) than metformin. * Metformin plus clomiphene citrate is more effective than metformin alone. * There is insufficient data on pregnancy and live birth rates following metformin treatment. Thus, the longer term overall reproductive benefit cannot currently be established. **Furthermore:** * There is insufficient evidence to recommend metformin as an option to [reduce the risk of](https://nabtahealth.com/pcos-and-pregnancy/) [miscarriage](https://nabtahealth.com/glossary/miscarriage/) in women with [PCOS](https://nabtahealth.com/glossary/pcos/). * Preliminary work suggesting that preventative treatment with metformin reduces the risk of [](https://nabtahealth.com/gestational-diabetes-8-things-you-should-know/)[gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) has not been replicated in newer studies. The final conclusion reached by the Society was that they would not recommend metformin as the first line treatment approach for [ovulation](https://nabtahealth.com/glossary/ovulation/) induction. Medications such as clomiphene citrate, known to be an [ovulation](https://nabtahealth.com/glossary/ovulation/) inducer, are generally more effective than metformin for women who are experiencing [PCOS](https://nabtahealth.com/glossary/pcos/)\-related fertility issues. In addition to these findings, other studies have found that there is no consistent evidence that metformin improves the signs of [](https://nabtahealth.com/masculine-hormones-in-women/)[hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/). #### **The outlook for metformin as a [PCOS](https://nabtahealth.com/glossary/pcos/) treatment** Metformin should not be completely discounted as an option for the management of [PCOS](https://nabtahealth.com/glossary/pcos/). Whilst less effective than other options, metformin has been shown to restore [ovulation](https://nabtahealth.com/glossary/ovulation/) in some women with [PCOS](https://nabtahealth.com/glossary/pcos/). For women with [PCOS](https://nabtahealth.com/glossary/pcos/) clomiphene citrate is commonly used to induce [ovulation](https://nabtahealth.com/glossary/ovulation/), however, not all women respond to treatment with this drug. For the women that do not respond, it is possible that combination therapy with metformin may be more successful at inducing [ovulation](https://nabtahealth.com/glossary/ovulation/). However, the work on this to date is limited. There is a need for longer term studies on metformin, as most studies have only explored short course treatment approaches. [PCOS](https://nabtahealth.com/glossary/pcos/) varies considerably from woman to woman. The presenting symptoms differ in both type and severity, which is why [diagnosing it can be so challenging](https://nabtahealth.com/problems-with-traditional-diagnosis-of-pcos/). Women with [PCOS](https://nabtahealth.com/glossary/pcos/) are prone to other conditions such as obesity and [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/); they are also at greater risk of developing T2DM and [endometrial cancer](https://nabtahealth.com/a-guide-to-endometrial-cancer/). Whether metformin can be given prophylactically to reduce these risks remains unclear and once again highlights the need for longer-term studies with extensive follow-up periods. #### Will metformin be prescribed as standard to all women that receive a diagnosis of [PCOS](https://nabtahealth.com/glossary/pcos/)? Unlikely. A more valuable course of action would be for doctors to better understand the various [PCOS](https://nabtahealth.com/glossary/pcos/) phenotypes and thus, take a more individualised approach to treatment, deciding which of their patients could genuinely benefit from treatment with the drug. As a final note, the value of [lifestyle modifications](https://nabtahealth.com/is-it-possible-to-reverse-pcos/) should not be understated. Adopting lifestyle changes and losing weight has proven to be, by far, the best approach for managing the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/). It is also the most effective way for women with [PCOS](https://nabtahealth.com/glossary/pcos/) to reduce their risk of developing T2DM. Medication should remain a contingency strategy for use in those who do respond adequately to lifestyle alterations. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#a0d9c1ccccc1e0cec1c2d4c1c8c5c1ccd4c88ec3cfcd) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Lashen, Hany. “Review: Role of Metformin in the Management of Polycystic Ovary Syndrome.” Therapeutic Advances in Endocrinology and [Metabolism](https://nabtahealth.com/glossary/metabolism/), vol. 1, no. 3, June 2010, pp. 117–128., doi:10.1177/2042018810380215. * Practice Committee of the American Society for Reproductive Medicine (Penzias, Alan, et al.) “Role of Metformin for [Ovulation](https://nabtahealth.com/glossary/ovulation/) Induction in Infertile Patients with Polycystic Ovary Syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)): a Guideline.” Fertility and Sterility, vol. 108, no. 3, Sept. 2017, pp. 426–441., doi:10.1016/j.fertnstert.2017.06.026. * “Summary of Possible Benefits and Harms: Information for the Public: Polycystic Ovary Syndrome: Metformin in Women Not Planning Pregnancy: Advice.” NICE, Feb. 2013, [www.nice.org.uk/advice/esuom6/ifp/chapter/Summary-of-possible-benefits-and-harms](http://www.nice.org.uk/advice/esuom6/ifp/chapter/Summary-of-possible-benefits-and-harms). * “Treatment. Polycystic Ovary Syndrome .” NHS Choices, NHS, [www.nhs.uk/conditions/polycystic-ovary-syndrome-](http://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/)[pcos](https://nabtahealth.com/glossary/pcos/)/treatment/. * Yarandi, Razieh Bidhendi, et al. “Metformin Therapy before Conception versus throughout the Pregnancy and Risk of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus in Women with Polycystic Ovary Syndrome: a Systemic Review, Meta-Analysis and Meta-Regression.” Diabetology & Metabolic Syndrome, vol. 11, no. 1, 23 July 2019, doi:10.1186/s13098-019-0453-7. * Zhou, Joseph, et al. “Metformin: An Old Drug with New Applications.” International Journal of Molecular Sciences, vol. 19, no. 10, 21 Sept. 2018, p. 2863., doi:10.3390/ijms19102863.
Medication for [endometriosis](https://nabtahealth.com/glossary/endometriosis/), the most common [symptom](https://nabtahealth.com/the-symptoms-of-endometriosis/) of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is pain, with up to 80% of patients complaining of period pain and up to 50% experiencing chronic pelvic pain. Aside from the physical discomfort and day-to-day limitations that long-term, chronic pain causes, it can also massively impact a patient’s quality of life, potentially leading to psychological conditions including anxiety and depression. The anxiety can be exacerbated in those patients who experience heavy periods every month, which causes additional discomfort and worry. #### Painkillers The first line approach for managing the symptoms of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) are over-the-counter painkillers. Non-steroidal anti-inflammatories ([NSAIDs](https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids)), such as ibuprofen, partly function by inhibiting the production of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/). [Prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) cause the [uterus](https://nabtahealth.com/glossary/uterus/) to contract during [menstruation](https://nabtahealth.com/articles/menopause-the-symptoms-nobody-talks-about/) and this contributes to the [period pain](https://nabtahealth.com/articles/what-is-period-pain/) experienced by patients with _[endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. Reducing the levels of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) will reduce the painful [contractions](https://nabtahealth.com/glossary/contraction/). Codeine-based medications and paracetamol-containing products are other options for pain relief. #### Hormone treatment If painkillers do not provide sufficient relief from the symptoms of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) there is the option of hormonal treatment. This is not a suitable option for those who are seeking help for [infertility](https://nabtahealth.com/glossary/infertility/). The endometrial deposits that develop outside the [uterus](https://nabtahealth.com/glossary/uterus/), and are characteristic of the condition, form in response to the hormone [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Hormonal therapy aims to block or reduce the production of [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Frequently prescribed hormonal therapies include the [combined contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/), [progesterone](https://nabtahealth.com/glossary/progesterone/) pills and gonadotrophin releasing hormone (GnRH) analogues: * The combined pill contains [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/); it prevents [](https://nabtahealth.com/articles/is-oligo-ovulation-anovulation-a-symptom-of-pcos/)[ovulation](https://nabtahealth.com/glossary/ovulation/) and makes periods lighter and less painful. * [Progesterone](https://nabtahealth.com/glossary/progesterone/) suppresses the growth of endometrial tissue, reducing [inflammation](https://nabtahealth.com/glossary/inflammation/) and pain. * GnRH analogues block [oestrogen](https://nabtahealth.com/glossary/oestrogen/) production, causing the endometrial tissue to shrink and become inactive. These drugs place the body into a temporary [menopausal](https://nabtahealth.com/i-am-post-menopause/) state, and long term use may require further medication to combat [](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/)[menopause](https://nabtahealth.com/glossary/menopause/)\-associated symptoms, such as [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and bone density loss. #### Alternative options Medication is just one option for the treatment of [endometriosis](https://nabtahealth.com/glossary/endometriosis/). If symptoms persist, another option to consider is [surgery](https://nabtahealth.com/should-i-have-surgery-for-endometriosis/). A fully personalised treatment approach is recommended for each patient, taking into account their age, symptoms, [fertility](https://nabtahealth.com/product/fertility-selfcare/) status and family situation. Nabta is reshaping [women’s healthcare](https://nabtahealth.com/). We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, [pregnancy](https://nabtahealth.com/articles/pregnancy-symptoms/), and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#225b434e4e43624c434056434a47434e564a0c414d4f) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bulletti, C, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [Infertility](https://nabtahealth.com/glossary/infertility/).” Journal of Assisted Reproduction and Genetics, vol. 27, no. 8, 25 June 2010, pp. 441–447., doi: 10.1007/s10815-010-9436-1. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Treatment. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) UK, [www.](http://www.endometriosis-uk.org/endometriosis-treatment)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-uk.org/[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-treatment. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). Mayo Clinic, 24 July 2018, [https://www.mayoclinic.org/diseases-conditions/](https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/diagnosis-treatment/drc-20354661. * Treatment: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/treatment/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/treatment/. Page last reviewed: 18/01/2019.
If you have [PCOS](https://nabtahealth.com/glossary/pcos/) there is a fairly good chance that you have heard of a success story about taking inositol. Making regular appearances on the various forums set up to aid women with the condition, inositol supplements are growing in popularity. Those women who take it are quick to highlight its benefits and virtues; claiming improvements in menstrual cycle regularity and relief from the symptoms of [androgen excess](https://nabtahealth.com/male-hormones-in-women/). Despite all of this positive press, questions remain over the effectiveness of inositol as a treatment option and it is highly improbable that your doctor will advocate its usage. So, why the disconnect? Why has inositol not advanced beyond being a supplement? On paper, it certainly sounds like the ideal drug candidate, so what has hindered further work on its development? Why are women so keen to use it that they are prepared to invest in over-the-counter complementary therapies, rather than those prescribed by their doctor? Let’s not forget that these supplements are also likely to have undergone a substantial mark-up in price. This review aims to explore some of these issues; deciphering the facts from the myths, and presenting a balanced argument so that you can make the decision that is right for you #### **What is Inositol?** Inositols (plural) are sugars; their chemical structure would suggest they belong to the vitamin B complex, however, as they can be synthesised by the body, they cannot be classed as essential nutrients. Endogenous biosynthesis of inositols from glucose primarily occurs in the kidneys. However, the body obtains most of its inositol supply from the diet; foods such as plants, beans and fruits are particularly rich in this beneficial carbohydrate. Inositols are involved in many normal physiological functions, including cell growth and survival, the development and function of nerve cells, bone remodeling (osteogenesis) and reproduction. As such, the different tissues throughout the body have varying requirements and inositol absorption differs accordingly. There are nine stereoisomers of inositol and two of these appear to have a role in insulin regulation, myo-inositol (MI) and D-chiro-inositol (DCI). In fact, MI is converted into DCI in a non-reversible reaction and the two isomers usually work in synergy to regulate glucose [metabolism](https://nabtahealth.com/glossary/metabolism/). #### Why is Inositol used to treat [PCOS](https://nabtahealth.com/glossary/pcos/)? [Polycystic Ovary Syndrome](../what-is-pcos) is a condition of hormonal dysregulation, thought to affect between 5 and 10% of women of reproductive age. Many women with the condition [struggle to conceive](../pcos-and-pregnancy) and they are at increased risk of developing other metabolic conditions, including type 2 diabetes. With no definitive cure, the current emphasis is on providing symptomatic relief, but with such a range of clinical manifestations, the burden of [PCOS](https://nabtahealth.com/glossary/pcos/), from both an economic and a social perspective, is high. ##### More research… According to the 2003 Rotterdam criteria, a diagnosis of [](https://nabtahealth.com/articles/can-pcos-cause-urinary-and-bowel-issues/)[PCOS](https://nabtahealth.com/glossary/pcos/) will be made if a female presents with two out of three of the following symptoms; [anovulation](https://nabtahealth.com/glossary/anovulation/), [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/) and/or polycystic [ovaries](https://nabtahealth.com/glossary/ovaries/). Despite not featuring as one of the defining characteristics of the condition, [](https://nabtahealth.com/what-is-the-connection-between-insulin-resistance-and-pcos/)[insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) is strongly associated with [PCOS](https://nabtahealth.com/glossary/pcos/). 80% of obese women with [PCOS](https://nabtahealth.com/glossary/pcos/) are insulin resistant, hardly surprising, as the two are intrinsically linked. However, even those women with a normal [BMI](https://nabtahealth.com/glossary/bmi/) are at increased risk of developing hyperinsulinaemia and peripheral [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/). [Insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) occurs when the cells and tissues of the body do not respond normally to insulin and require a greater amount to exert a biological effect. This results in a state of ‘compensatory hyperinsulinaemia’, whereby insulin secretions are increased to counteract the deficiency. Excess circulating insulin can further exacerbate th[e risk of type 2 diabetes](https://nabtahealth.com/articles/risk-factors-for-gestational-diabetes/). It is thought that the [ovaries](https://nabtahealth.com/glossary/ovaries/) never become fully insulin resistant, however, they are sensitive to fluctuating levels of the hormone. Insulin stimulates the ovarian theca cells to produce [androgens](https://nabtahealth.com/glossary/androgen/) and this can be one of the triggers for the [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/) seen in women with [PCOS](https://nabtahealth.com/glossary/pcos/). #### Inositol as an insulin sensitiser Insulin sensitisers clearly have a role in the management of [PCOS](https://nabtahealth.com/glossary/pcos/) and its associated symptoms, particularly for those women looking to restore (or maintain) their normal ovulatory cycle with a view to falling pregnant. The two most widely utilised options to date have been [metformin](../what-is-metformin) and thiazolidinediones, which have been shown to improve [ovulation](https://nabtahealth.com/glossary/ovulation/) and reduce metabolic symptoms. However, both exhibit significant side effects, including gastrointestinal complaints in the case of metformin and weight gain in the case of the thiazolidinediones and therefore, patient compliance can be low. An association between the thiazolidinediones and liver toxicity, led to this class of drugs being removed from the market. Interestingly, it has been proposed that the beneficial effects of metformin are secondary to an increase in inositol availability. Furthermore, alternative research has suggested that the [metabolism](https://nabtahealth.com/glossary/metabolism/) of inositol (MI to DCI conversion) is severely disrupted in obese [PCOS](https://nabtahealth.com/glossary/pcos/) patients who are insulin resistant. Currently, this data has not been replicated in lean women; however, the information to date is sufficient to suggest a possible therapeutic role for the inositols in alleviating [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/). #### **What does the science suggest?** With the ongoing drive to find a treatment approach that will simultaneously rectify multiple [PCOS](https://nabtahealth.com/glossary/pcos/) symptoms and the growing interest in the inositols, clinically relevant research was essential. So, what was investigated and what did it show? As mentioned previously, the predominant forms of inositols are MI and DCI. Within the [ovaries](https://nabtahealth.com/glossary/ovaries/), MI is the more highly expressed of the two, and acts to regulate glucose uptake and [FSH](https://nabtahealth.com/glossary/fsh/) (follicle stimulating hormone) signaling. DCI, expressed at lower levels, modulates insulin-induced androgen synthesis. Despite the lower expression of DCI, preliminary work was performed using this form of inositol. Partly because of the specific link between androgen synthesis and DCI, but also because women with [PCOS](https://nabtahealth.com/glossary/pcos/) were found to have reduced serum levels and increased urinary loss of that isoform. Initial results were encouraging; women who had [PCOS](https://nabtahealth.com/glossary/pcos/), diagnosed using the Rotterdam criteria, who were treated with DCI, had improved insulin sensitivity and 86% saw a restoration in [ovulation](https://nabtahealth.com/glossary/ovulation/). However, the sample size was only 22 so conclusions were speculative at best and larger, more well-designed studies are imperative for further validation. ##### Subsequent Studies Subsequent studies, using higher doses of DCI, found that [oocyte](https://nabtahealth.com/glossary/oocyte/) quality was deteriorating with high concentrations of the compound. In contrast, women with [PCOS](https://nabtahealth.com/glossary/pcos/) who took a MI supplement had improved ovarian function and enhanced [oocyte](https://nabtahealth.com/glossary/oocyte/) and embryo quality. This, in turn, led to studies looking at the effectiveness of just giving MI as a supplement and, encouragingly, some women did see an improvement in their symptoms. However, it soon became apparent that an excess of MI could have a paradoxical effect, exacerbating the imbalance between MI and DCI. More recent studies have used a combination of MI and DCI for maximal benefit, although the optimal proportion of each remains controversial. The rationale behind using a combination of the two comes from the suggestion that [PCOS](https://nabtahealth.com/glossary/pcos/)\-induced [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) is caused by an imbalance between MI and DCI and that the ratio of the two might be insulin dependent. The normal ratio of MI:DCI in the ovary is estimated to be 100:1, based on measurements taken from the follicular fluid. However, the normal physiological ratio of MI:DCI in the plasma is 40:1 and this is the combination used in most commercially available inositol supplements. ##### MI and DCI Certainly, some studies show that this combination of MI and DCI can be effective at improving [ovulation](https://nabtahealth.com/glossary/ovulation/) and increasing menstrual cycle regularity, but there is scant reliable evidence that it is the optimal dose. The ovary is not metabolically active, thus what is happening in the plasma is unlikely to be indicative of what is happening in the ovary and there is no data on the ovarian uptake of free MI/DCI following exogenous delivery. Meaning that dietary supplements, given in the proportions currently accepted as standard, may not even be reaching the target organ (the ovary) in the case of [PCOS](https://nabtahealth.com/glossary/pcos/). MI and DCI given in combination prior to in vitro fertilisation ([IVF](https://nabtahealth.com/glossary/ivf/)) has been shown to improve pregnancy rates, when compared to DCI given in isolation; but only in younger women. As this data came from a single study, further validation is necessary. #### Using Inositols for weight loss There have been a number of meta-analyses, attempting to compare the efficacy of MI, DCI and/or MI+DCI across studies. The majority of studies do show an improvement in [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) with treatment, however most are considered to be poorly designed and of low quality. Significant increases in [ovulation](https://nabtahealth.com/glossary/ovulation/) rates and improved menstrual cycle frequencies are often reported, but improved experimental design would show whether these positive effects were scientifically robust. Using inositols for weight loss is something heavily advocated by those who manufacture the commercially available supplements. However, the truth is, most of the data in terms of [BMI](https://nabtahealth.com/glossary/bmi/) reduction is inconclusive. At best, minimal weight loss with treatment is seen, but as the majority of studies to date have utilised obese patients, a small reduction in [BMI](https://nabtahealth.com/glossary/bmi/) is unsatisfactory. ##### To understand more Theoretically, correcting any hyperinsulinaemia should reduce the production of ovarian [androgens](https://nabtahealth.com/glossary/androgen/), which will have been contributing to the symptoms of [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/), including [](../how-to-manage-facial-hair)[hirsutism](https://nabtahealth.com/glossary/hirsutism/), acne and [hair loss](../coping-with-pcos-hair-loss). Studies have indicated a trend towards reduced androgen levels with inositol treatment and there is limited data that suggests improvements in [hirsutism](https://nabtahealth.com/glossary/hirsutism/) and acne. However, longer-term studies may be necessary to confirm the effectiveness of MI and DCI in improving [PCOS](https://nabtahealth.com/glossary/pcos/)\-induced [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/). It should also be considered that metformin, which is an alternative insulin sensitiser, has never been as effective as other treatment options at improving [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/). #### **Why don’t doctors routinely recommend Inositols?** Up to this point, everything has looked encouraging; the data published to date suggests that inositols are a viable treatment option, providing symptomatic relief for women with [PCOS](https://nabtahealth.com/glossary/pcos/), with minimal to no adverse side effects. However, doctors do not routinely prescribe them and women who wish to use them are reliant on sourcing and purchasing these supplements themselves. ##### Why? As positive as the data initially appears, it is preliminary in nature and most of the studies have employed very small sample sizes. This may not be such a problem if the methodology was consistent across the different studies, enabling cross-study comparisons and detailed meta-analyses. However, the study designs are inherently variable, with different dosages, treatment regimes and controls. There is a distinct lack of quantifiable data on reproductive end points, such as live birth and [miscarriage](https://nabtahealth.com/glossary/miscarriage/) rates. As discussed above, there is a fundamental lack of understanding with regards to the normal physiological levels of MI and DCI in the ovary. If, as has been suggested, [PCOS](https://nabtahealth.com/glossary/pcos/) is causing an imbalance in the ratio of the two, the exact magnitude of this disruption remains unclear. Thus, the current 40:1 ratio that is most often cited seems slightly arbitrary. Multicenter phase II clinical trials on DCI as a treatment for [PCOS](https://nabtahealth.com/glossary/pcos/) were initiated. However, they were suspended as the beneficial effects seen in smaller studies could not be replicated. Unfortunately, the results were never published. ##### Cochrane Review Cochrane reviews are widely regarded as providing amongst the highest standards of evidence-based healthcare. They undertake systematic reviews of primary research to provide unbiased answers to pertinent questions. In the case of using inositols for [PCOS](https://nabtahealth.com/glossary/pcos/), a cochrane review was established, looking at 13 inositol trials, involving 1472 women. The published conclusion was that the evidence across the trials was low, to very low. There was poor reporting of methods, inconsistencies and a lack of clinically relevant information, such as live birth rates and adverse events. Likewise, the guidelines from the American Society for Reproductive Medicine state that inositols are “currently considered an ‘experimental’ therapy with very low quality evidence for their use”. #### **What’s next for Inositols?** So where do we go from here? It is a challenging question. ##### **More clinical trials** Inositol therapy, in its current guise as a dietary supplement, does provide symptomatic relief to some women with [PCOS](https://nabtahealth.com/glossary/pcos/). Look hard enough and there is scientific evidence to support this, as well as biological justification for their use. However, the data available is weak and there is an urgent need for well designed, multicenter trials before inositol can be routinely recommended by healthcare professionals. ##### **Testing effects on ovarian function** There remain extensive gaps in our knowledge; for example, it is still not known how inositols improve insulin sensitivity at the molecular level. The role of inositols in the [ovaries](https://nabtahealth.com/glossary/ovaries/) in unclear and the data on whether there is dysregulation in MI and DCI [metabolism](https://nabtahealth.com/glossary/metabolism/) within the reproductive system is conflicting. Whether inositols have an effect on other ovarian functions, such as steroidogenesis also remains to be elucidated. ##### **Targeting [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/)** What we do know is that improving [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) is a key therapeutic target for those investigating [PCOS](https://nabtahealth.com/glossary/pcos/). Although [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) is not one of the main [diagnostic criterium](https://nabtahealth.com/problems-with-traditional-diagnosis-of-pcos/) for [PCOS](https://nabtahealth.com/glossary/pcos/); it is a feature in many women who are diagnosed with [PCOS](https://nabtahealth.com/glossary/pcos/) and triggers many of the phenotypic features of the disease, including [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/) and menstrual cycle irregularities. It also increases the risk of type 2 diabetes. Inositol supplementation is still a potentially valuable tool to explore for combating some of these symptoms and risks. ##### **Personalising treatment options** As our understanding of the specifics of the inositol stereoisomers grows, there is scope for a more personalised treatment approach. Those with a familial history of hyperinsulinaemia seem to respond well to DCI treatment, particularly if they are also obese. Women whose ovarian function is compromised may respond better to MI treatment. Although interest in a combination approach has grown, perhaps this is not the best option for all patients. It should be remembered that [PCOS](https://nabtahealth.com/glossary/pcos/) is a multi-faceted condition, presenting with a range of symptoms, differing in severity between patients. Thus, a simple therapeutic approach that works for all patients is highly unlikely. Supplements are less regulated than medicines, therefore, the safety data for inositols is limited and the specific formulations available are restricted. A highly individualised treatment plan for each patient may be what is required. ##### **Understanding inositol resistance** A further area that requires additional investigation is with regards to inositol resistance. Across the different studies, MI has been shown to be relatively successful at inducing [ovulation](https://nabtahealth.com/glossary/ovulation/); however, up to 40% of women still do not ovulate. Resistance to MI has been proposed to occur as a result of insufficient absorption of inositols. Indeed, it has already been shown that the gut microbiota is altered in women with [PCOS](https://nabtahealth.com/glossary/pcos/) and hypothesised that this could affect nutrient absorption. Preliminary work suggests that alpha-lactalbumin milk protein improves the uptake of MI and induces [ovulation](https://nabtahealth.com/glossary/ovulation/). As with all work on the inositols, sample sizes in this study were small and further work is essential before conclusions can be drawn; however, this study does highlight the value in considering combination therapy for the treatment of [PCOS](https://nabtahealth.com/glossary/pcos/). #### In conclusion As far as the inositols go, currently it appears we have more questions than answers. Until inositols become a regulated supplement recommended by clinicians, is likely that women will continue to take dietary supplements. Women struggling with the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/) should also be encouraged to adopt [lifestyle changes](../is-it-possible-to-reverse-pcos), as even small changes in weight have been shown to alleviate some of the negative effects of the condition. Try Nabta’s [](https://nabtahealth.com/product/pcos-selfcare-pack/)[PCOS](https://nabtahealth.com/glossary/pcos/) Pack and get to learn more and understand your health better. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#d6afb7babab796b8b7b4a2b7beb3b7baa2bef8b5b9bb) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Baillargeon, J.-P., et al. “Altered D-Chiro-Inositol Urinary Clearance in Women With Polycystic Ovary Syndrome.” _Diabetes Care_, vol. 29, no. 2, Feb. 2006, pp. 300–305., doi:10.2337/diacare.29.02.06.dc05-1070. * Carlomagno, Gianfranco, et al. “The D-Chiro-Inositol Paradox in the Ovary.” _Fertility and Sterility_, vol. 95, no. 8, 30 June 2011, pp. 2515–2516., doi:10.1016/j.fertnstert.2011.05.027. * Genazzani, Alessandro D. “Inositol as Putative Integrative Treatment for [PCOS](https://nabtahealth.com/glossary/pcos/).” _Reproductive BioMedicine Online_, vol. 33, no. 6, Dec. 2016, pp. 770–780., doi:10.1016/j.rbmo.2016.08.024. * Genazzani, Alessandro D., et al. “Modulatory Role of D-Chiro-Inositol (DCI) on [LH](https://nabtahealth.com/glossary/lh/) and Insulin Secretion in Obese [PCOS](https://nabtahealth.com/glossary/pcos/) Patients.” _Gynecological Endocrinology_, vol. 30, no. 6, June 2014, pp. 438–443., doi:10.3109/09513590.2014.897321. * Lauretta, Rosa, et al. “Insulin-Sensitizers, Polycystic Ovary Syndrome and Gynaecological Cancer Risk.” _International Journal of Endocrinology_, vol. 2016, 2016, pp. 1–17., doi:10.1155/2016/8671762. * Legro, Richard S. “[Ovulation](https://nabtahealth.com/glossary/ovulation/) Induction in Polycystic Ovary Syndrome: Current Options.” _Best Practice & Research Clinical Obstetrics & Gynaecology_, vol. 37, 2016, pp. 152–159., doi:10.1016/j.bpobgyn.2016.08.001. * Monastra, Giovanni, et al. “Combining Treatment with Myo-Inositol AndD-Chiro-Inositol (40:1) Is Effective in Restoring Ovary Function and Metabolic Balance in [PCOS](https://nabtahealth.com/glossary/pcos/) Patients.” _Gynecological Endocrinology_, vol. 33, no. 1, Jan. 2017, pp. 1–9., doi:10.1080/09513590.2016.1247797. * Montanino Oliva, Mario, et al. “Effects of Myo-Inositol plus Alpha-Lactalbumin in Myo-Inositol-Resistant [PCOS](https://nabtahealth.com/glossary/pcos/) Women.” _Journal of Ovarian Research_, vol. 11, no. 1, 10 May 2018, p. 38., doi:10.1186/s13048-018-0411-2. * Nestler, John E., et al. “Ovulatory and Metabolic Effects of d-Chiro-Inositol in the Polycystic Ovary Syndrome.” _New England Journal of Medicine_, vol. 340, no. 17, 29 Apr. 1999, pp. 1314–1320., doi:10.1056/nejm199904293401703. * Norman, Robert J., et al. “The Role of Lifestyle Modification in Polycystic Ovary Syndrome.” _[Trends in Endocrinology &](https://www.cell.com/trends/endocrinology-metabolism/home) [Metabolism](https://nabtahealth.com/glossary/metabolism/)_, vol. 13, no. 6, Aug. 2002, pp. 251–257., doi:10.1016/s1043-2760(02)00612-4. * Pundir, J, et al. “Inositol Treatment of [Anovulation](https://nabtahealth.com/glossary/anovulation/) in Women with Polycystic Ovary Syndrome: a Meta-Analysis of Randomised Trials.” _BJOG: An International Journal of Obstetrics & Gynaecology_, vol. 125, no. 3, Feb. 2018, pp. 299–308., doi:10.1111/1471-0528.14754. * Rotterdam ESHRE/ASRM-Sponsored [PCOS](https://nabtahealth.com/glossary/pcos/) consensus workshop group. “Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)).” _Human Reproduction_, vol. 19, no. 1, Jan. 2004, pp. 41–47., doi:10.1093/humrep/deh098. * Showell, Marian G, et al. “Inositol for Subfertile Women with Polycystic Ovary Syndrome.” _Cochrane Database of Systematic Reviews_, 20 Dec. 2018, doi:10.1002/14651858.cd012378.pub2. * Sortino, Maria A., et al. “Polycystic Ovary Syndrome: Insights into the Therapeutic Approach with Inositols.” _Frontiers in Pharmacology_, vol. 8, 8 June 2017, p. 341., doi:10.3389/fphar.2017.00341. * Teede, Helena J., et al. “Recommendations from the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.” _Clinical Endocrinology_, vol. 89, no. 3, Sept. 2018, pp. 251–268., doi:10.1111/cen.13795. * Unfer, Vittorio, et al. “[Hyperinsulinemia](https://nabtahealth.com/glossary/hyperinsulinemia/) Alters Myoinositol to d-Chiroinositol Ratio in the Follicular Fluid of Patients With [PCOS](https://nabtahealth.com/glossary/pcos/).” _Reproductive Sciences_, vol. 21, no. 7, July 2014, pp. 854–858., doi:10.1177/1933719113518985. * Unfer, Vittorio, et al. “Myo-Inositol Effects in Women with [PCOS](https://nabtahealth.com/glossary/pcos/): a Meta-Analysis of Randomized Controlled Trials.” _Endocrine Connections_, vol. 6, no. 8, Nov. 2017, pp. 647–658., doi:10.1530/ec-17-0243. * Zacchè, Martino M., et al. “Efficacy of Myo-Inositol in the Treatment of Cutaneous Disorders in Young Women with Polycystic Ovary Syndrome.” _Gynecological Endocrinology_, vol. 25, no. 8, Aug. 2009, pp. 508–513., doi:10.1080/09513590903015544.
 **[Perimenopause](https://nabtahealth.com/glossary/perimenopause/)** is a natural process in a woman’s life caused by a normal biological decline in reproductive hormones. [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) onset varies from woman to woman and can take place at any stage from a woman’s mid-30s (premature [menopause](https://nabtahealth.com/glossary/menopause/)) into her late 50s. Also known as the ‘[menopause](https://nabtahealth.com/glossary/menopause/) transition’, [perimenopause](https://nabtahealth.com/glossary/perimenopause/) lasts between three and 10 years. The average length of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) is 4-5 years, and the average age of [menopause](https://nabtahealth.com/glossary/menopause/) is 51 years. **[Menopause](https://nabtahealth.com/glossary/menopause/)** marks the end of [perimenopause](https://nabtahealth.com/glossary/perimenopause/), when a woman has gone a full 12 months without menstruating. After a year of no menstrual periods a woman is considered to have gone through [menopause](https://nabtahealth.com/glossary/menopause/) to her post-menopausal phase. **Induced [menopause](https://nabtahealth.com/glossary/menopause/)** is when a woman’s menstrual periods stop due to medical treatments or intervention. [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) or radiation damage to the [ovaries](https://nabtahealth.com/glossary/ovaries/), and surgical removal of the [ovaries](https://nabtahealth.com/glossary/ovaries/) result in medically induced [menopause](https://nabtahealth.com/glossary/menopause/). **[Postmenopause](https://nabtahealth.com/glossary/postmenopause/)** is the ongoing phase of a woman’s life after [menopause](https://nabtahealth.com/glossary/menopause/). It’s important to note that many women continue to experience the classic [menopause](https://nabtahealth.com/glossary/menopause/) symptoms for years after their ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). #### What happens to a woman’s body when she is perimenopausal? The hormones that flooded a woman’s body during [puberty](https://nabtahealth.com/glossary/puberty/) and her fertile years start to fluctuate due to the decline in the female reproductive hormones (estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/)) produced by her [ovaries](https://nabtahealth.com/glossary/ovaries/). These hormonal deficiencies [lead](https://nabtahealth.com/glossary/lead/) to many physical changes taking place in a woman’s body long before her ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). #### What are the symptoms of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/)? * Hot flashes / flushes * Night sweats * Vaginal dryness * Irregular periods * Hair loss * Weight gain and slowed [metabolism](https://nabtahealth.com/glossary/metabolism/) * Itchy or dry skin * Disturbed sleep * Urinary incontinence * Mood swings and anxiety * Brain fog or memory loss * Low libido The physical changes and symptoms women experience due to the reduction in hormones can be debilitating. #### What are the long-term health risks of [menopause](https://nabtahealth.com/glossary/menopause/)? Long-term hormone deficiency increases women’s risk of chronic health conditions including cardiovascular disease, [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), type 2 diabetes, dementia, and bowel cancer. #### How is [perimenopause](https://nabtahealth.com/glossary/perimenopause/) diagnosed? A doctor will assess symptoms and may recommend a blood test to check follicle-stimulating hormone ([FSH](https://nabtahealth.com/glossary/fsh/)) and estrogen levels. As hormones fluctuate during [perimenopause](https://nabtahealth.com/glossary/perimenopause/) the test may be repeated after a few months if the results are inconclusive. Women who want to confirm their symptoms can also take a [perimenopause](https://nabtahealth.com/glossary/perimenopause/) test measuring the levels of three hormones [from the comfort of their home](https://nabtahealth.com/product/perimenopause-test/). However, a hormone test isn’t always necessary, and some doctors will diagnose [perimenopause](https://nabtahealth.com/glossary/perimenopause/) based on physical symptoms. #### Can [perimenopause](https://nabtahealth.com/glossary/perimenopause/) be treated? [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) are natural biological processes in a woman’s body and cannot be delayed or halted with treatment. That said, a healthcare professional may discuss Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)) and lifestyle adjustments to help manage the physical impacts of hormone deficiency. #### What is [HRT](https://nabtahealth.com/glossary/hrt/)? [HRT](https://nabtahealth.com/glossary/hrt/) replaces the hormones the body is no longer producing. The hormone treatment includes estrogen, and sometimes [progesterone](https://nabtahealth.com/glossary/progesterone/) and [testosterone](https://nabtahealth.com/glossary/testosterone/) if needed, and is given as a skin patch, gel, spray, or pill. Most women report their [perimenopause](https://nabtahealth.com/glossary/perimenopause/) symptoms improving within 3-6 months of starting [HRT](https://nabtahealth.com/glossary/hrt/). Taking [HRT](https://nabtahealth.com/glossary/hrt/) reduces the risk of developing [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), cardiovascular disease, type 2 diabetes, bowel cancer, osteoarthritis, and other health conditions due to hormone deficiency. There are risks associated with [HRT](https://nabtahealth.com/glossary/hrt/), including a small increased risk of breast cancer and blood clots in women with a family history. However, research has shown that for most women who take [HRT](https://nabtahealth.com/glossary/hrt/) the benefits outweigh the risks. A woman should always have a conversation with her healthcare team to decide the best approach for her individual circumstances. #### Are there natural ways to reduce the symptoms of [menopause](https://nabtahealth.com/glossary/menopause/)? Lifestyle adjustments can also be beneficial in managing perimenopausal symptoms. Women should try to eat a balanced diet with plenty of fresh fruit and vegetables, protein, whole foods, and foods rich in omega-3 fatty acids and calcium. Phytoestrogens can mimic the effects of estrogen in the body and occur naturally in foods including flaxseeds, sesame seeds, beans, soy, garlic, and cruciferous vegetables. Stop smoking and cut back on foods that might disturb sleep or trigger hot flashes, such as caffeine and alcohol. And exercise is essential. The decline in hormones affects bone and joint health, so it is more important than ever to maintain strength and flexibility with regular cardio and weight bearing exercise. As a woman’s [metabolism](https://nabtahealth.com/glossary/metabolism/) naturally changes with age, exercise will also help with weight control. #### Can I still become pregnant during [perimenopause](https://nabtahealth.com/glossary/perimenopause/)? While you are still having your period you can become pregnant. If you don’t want to be pregnant you should continue to use contraceptives until you are postmenopausal. #### Understanding [menopause](https://nabtahealth.com/glossary/menopause/) Health organisations and governments are increasingly recognising the gaps in knowledge and understanding of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) and its enormous impact on women’s health and wellbeing. Efforts are now being made to address gender inequalities in broader healthcare provision and rebalance the lack of [menopause](https://nabtahealth.com/glossary/menopause/) research. The last few years have seen investment in improving education around [perimenopause](https://nabtahealth.com/glossary/perimenopause/) with the goal of empowering the more than 50% of the world’s population who will go through [menopause](https://nabtahealth.com/glossary/menopause/) with evidence-based therapeutic support. Sources: Internal > [What is](https://nabtahealth.com/articles/what-you-need-to-know-about-perimenopause/) [Perimenopause](https://nabtahealth.com/glossary/perimenopause/)? External: > [](https://www.balance-menopause.com/menopause-library/)[Menopause](https://nabtahealth.com/glossary/menopause/) Library https://www.mayoclinic.org/diseases-conditions/[menopause](https://nabtahealth.com/glossary/menopause/)/symptoms-causes/syc-20353397 https://flo.health/menstrual-cycle/[menopause](https://nabtahealth.com/glossary/menopause/)/changes/[menopause](https://nabtahealth.com/glossary/menopause/)\-symptoms-and-stages
 Men have a well-deserved reputation for avoiding the doctor and ignoring unusual symptoms. Sometimes until it’s too late. Unfortunately, it can often take a health scare to get a man in front of a doctor. This is despite men being just as likely to be affected by chronic diseases, cardiovascular disease, type 2 diabetes, cancer, kidney disease, stroke, dementia as women. And there are more unique health conditions such as prostate cancer, erectile dysfunction, and the andropause. #### Habits for a healthy lifestyle Men can protect health, wellbeing, and lifespan by avoiding damaging behaviours and focusing on positive lifestyle actions: * **Exercise** regularly: A combination of cardiovascular exercise and strength training for 30 to 45 minutes at least 3 to 4 times a week. * **Eat well**: Eat a nutritionally balanced diet. Follow a diet low in fat, with a balanced mix of fruit, vegetables, fibre, protein, lean meats and fish, and complex carbohydrates. Limit processed foods and refined sugars. * **Drink water**: Stay hydrated. * **Avoid** excessive **weight gain or loss.** * **Don’t smoke**. **Limit alcohol** intake. **Avoid drugs.** * Reduce stress: Get outside. Change your environment. Take a break. * Get some **sleep**: Aim for a minimum seven hours’ beauty sleep each night. * Go for **routine health checks** and screenings. #### Essential screening tests for men Routine health check-ups and health screening tests (even without pre-existing medical conditions or symptoms) are designed to spot early signs of health problems before they become an issue. Heart disease, stroke, type 2 diabetes, kidney disease and dementia all have early warning markers and can significantly compromise quality of life if not picked up early. Health checks recommended for all adult men include: * Dental: Get your teeth checked yearly at the minimum. * Skin cancer: Check moles and skin lesions every few months. See a doctor every two years for a full body check. * Heart health, blood pressure and [cholesterol](https://nabtahealth.com/glossary/cholesterol/): High [cholesterol](https://nabtahealth.com/glossary/cholesterol/) and elevated blood pressure ([hypertension](https://nabtahealth.com/glossary/hypertension/)) can increase the risk of developing coronary heart disease and type 2 diabetes. * Testicular cancer: Monthly self-examinations are recommended after [puberty](https://nabtahealth.com/glossary/puberty/). See a doctor for a full examination as soon as you notice a lump or any changes. Further screening tests are recommended for men over 50 years: * Prostate cancer: Accounts for high numbers of cancer deaths in older men. Screening includes a PSA (prostate specific antigen) test and DRE (digital rectal examination). * Bowel cancer: Another leading cause of death in older men. Go for a faecal occult blood test every two years. * Hearing and eyesight: Hearing loss and eyesight problems become more common after 50 and can affect quality of life. * Diabetes type 2: Depending on the level of risk a fasting blood sugar test will be recommended every 1 to 3 years. * Dementia: Screening for cognitive impairment is typically included in an annual health check for all adults from 65 years. * Abdominal Aortic Aneurysm (AAA): Affects more men than women. Males over 65 are offered regular screenings. Doctors decide whether to screen earlier based on medical and family history. #### What affects male fertility? Male fertility problems can be caused by low [sperm](https://nabtahealth.com/glossary/sperm/) count, poor quality [sperm](https://nabtahealth.com/glossary/sperm/), or blockages preventing [sperm](https://nabtahealth.com/glossary/sperm/) moving through the reproductive tract. [Sperm](https://nabtahealth.com/glossary/sperm/) can be vulnerable to lifestyle and environmental factors including raised body temperature, weight gain, exposure to toxins, smoking, heavy alcohol intake and drug use. Fertility specialists may recommend blood work to check hormone levels and scan for certain infections or a possible genetic cause for [infertility](https://nabtahealth.com/glossary/infertility/). A doctor may request a [sperm](https://nabtahealth.com/glossary/sperm/) sample to assess [sperm](https://nabtahealth.com/glossary/sperm/) count, shape and movement, and a scrotal ultrasound to check if there are any problems or blockages in the testicles preventing [sperm](https://nabtahealth.com/glossary/sperm/) getting into a man’s ejaculate. #### What is the male [menopause](https://nabtahealth.com/glossary/menopause/)? Men also experience age-related hormonal decline. The ‘male [menopause](https://nabtahealth.com/glossary/menopause/)’ is more a gradual flattening out in [testosterone](https://nabtahealth.com/glossary/testosterone/) and other hormone levels over a number of years, than the dramatic cliff-plunge of female reproductive hormones during [menopause](https://nabtahealth.com/glossary/menopause/). Also called the andropause, age-related low [testosterone](https://nabtahealth.com/glossary/testosterone/), or late-onset hypogonadism, this period of a man’s life is sometimes described as the ‘midlife crisis’. Still, it brings associated physical and emotional health problems for men in their late 40s and into their 50s: * Low moods and depression * Low libido * Erectile dysfunction * Fatigue and low energy levels * Hot flashes or flushes and increased sweating * Loss of muscle mass * Increase in body fat * Dry skin The symptoms of low [testosterone](https://nabtahealth.com/glossary/testosterone/) can have a very real impact on everyday life. If you are concerned, speak to a healthcare professional who will assess your symptoms and may recommend hormone levels testing and possible treatment options. [Testosterone](https://nabtahealth.com/glossary/testosterone/) therapy has its pros and cons, and your doctor will want to weigh up options with you. For any men still reluctant to go to the doctor, at-home [men’s health](https://nabtahealth.com/product/mens-health-test/) and [](https://nabtahealth.com/product/testosterone-test/)[testosterone](https://nabtahealth.com/glossary/testosterone/) tests offer convenient and private testing options. #### Getting started with Men’s Health and Nabta Health [Nabta’s marketplace](https://nabtahealth.com/shop/collections/type/mens-health/) features products to support men wherever they are in their health journeys. At-home [testosterone](https://nabtahealth.com/glossary/testosterone/) level and men’s health tests allow men to screen essential hormone levels in the comfort and privacy of home. While wellness and pampering packages are designed to provide men with that well-deserved lifestyle boost.
Ribavirin therapy is contraindicated in women who are pregnant and in the male partners of women who are pregnant. Ribavirin should be avoided during pregnancy and during the 6 months before pregnancy in both the female and the male sexual partner. Significant [teratogenic](https://nabtahealth.com/glossary/teratogenic/) effects have been demonstrated in all animal species exposed to ribavirin. * Ribavirin is a Category X drug, meaning it can cause birth defects. * Ribavirin is an antiviral drug used to treat chronic cases of [Hepatitis C](https://nabtahealth.com/glossary/hepatitis-c/). * Both men and women should not take Ribavirin if they are trying to get pregnancy. * If you are taking Ribavirin, consider using birth control to prevent pregnancy. Ribavirin is in a class of medications called nucleoside analogues. It works by stopping the virus that causes [hepatitis C](https://nabtahealth.com/glossary/hepatitis-c/) from spreading inside the body. Because of the high potential for complications, women are advised to wait six months after discontinuing Ribavirin to start trying to get pregnant. Men should do the same if they are on Ribavirin, as it can cause abnormalities in the [sperm](https://nabtahealth.com/glossary/sperm/). Despite patient education and counseling, Ribavirin-exposed pregnancies occur. What effect does Ribavirin have on the baby? -------------------------------------------- A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects. Whilst the full impact of Ribavirin has not been properly studied, medical professionals state “Ribavirin can cause birth defects, [miscarriage](https://nabtahealth.com/glossary/miscarriage/), or death to an unborn baby if the mother or father is using this medicine.” What does the research say about Ribavirin and pregnancy? --------------------------------------------------------- In studies involving pregnant animals, Ribavirin caused many fetal birth defects or death. The animal fetuses in almost all cases were subject to embryo lethality and [teratogenicity](https://nabtahealth.com/glossary/teratogenicity/). Understanding more about the risk of ribavirin exposure in human pregnancy is critical. If you have any concerns over taking medication if you are trying to get pregnant or you are pregnant, please speak to a healthcare professional or an [OBGYN](https://nabtahealth.com/top-10-gynaecologists/)\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) [Get in touch](/cdn-cgi/l/email-protection#4f6a7d7f362e23232e0f212e2d3b2e272a2e233b27612c2022) if you have any questions about this article or any aspect of women’s health. We’re here for you. Source: [http://www.healthinsurancequotes.org/7-medications-you-shouldnt-take-while-pregnant/](http://www.healthinsurancequotes.org/7-medications-you-shouldnt-take-while-pregnant/) [https://www.uofmhealth.org/health-library/d00085a1](https://www.uofmhealth.org/health-library/d00085a1) Sinclair Roberts, S, _Assessing ribavirin exposure during pregnancy: the Ribavirin Pregnancy Registry_, Gastroent Nur. Nov 2008 [https://pubmed.ncbi.nlm.nih.gov/19077835](https://pubmed.ncbi.nlm.nih.gov/19077835)/
Birth control is a way for a couple to prevent pregnancy. There are different types of birth control, including the Intrauterine Device ([IUD](https://nabtahealth.com/glossary/iud/)), implant, shot, patch, ring, and the [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/) (the pill). The type of birth control you decide to use is a personal decision and will often be based on a doctor’s recommendation. Hormonal contraceptives include the pill, the patch, and the vaginal ring. They all contain synthetic (man-made) versions of the hormones [progesterone](https://nabtahealth.com/glossary/progesterone/) (called progestin) and [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Hormonal contraceptives usually work by changing the cervical mucus, making it harder for the [](https://nabtahealth.com/everything-you-need-to-know-about-sperm/)[sperm](https://nabtahealth.com/glossary/sperm/) to swim or find the egg. They also prevent the body from ovulating. They are several types of hormonal contraceptives or hormonal birth control, and they include: #### **Oral Contraceptives** Oral contraceptives, also known as birth control pills are medications taken by mouth to prevent pregnancy. They are widely used, but before use, you should explore what side effects they cause, as well as how well they work. That way you will discover if they are also the best option for you. They are two types of oral contraceptives: 1. Combined pills 2. Mini pills ##### **Combined pills** Combined pills contain the hormones [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and progestin. Taken throughout the cycle, most of the month you will take an active pill, meaning it contains hormones. Inactive pills (hormone free, or placebo) pills will be taken at certain times, depending on the exact pill you are on. There are different types of combined pills: * **Multiphasic pills**: These are taken for a one-month cycle, they provide varying levels of hormones throughout the cycle. During the last week of your cycle, an inactive (placebo) pill is taken, which causes a withdrawal bleed. * **Monophasic pills**: Mostly used in one-month cycles. However, each of these active pills offers you an equivalent dose of the hormone. Just like multiphasic pills, in the last week of your cycle an inactive placebo pill is taken, causing a withdrawal bleed. * **Extended-cycle pills**: These work differently from the multiphasic and monophasic pills. They are used for a 13-week cycle. The active pills are taken for 12 weeks, while the inactive pills are taken during the last week of your cycle. This results in you having withdrawal bleeding only three to four times per annum. ##### **Mini pills** Mini pills are birth control pills that only contain the hormone progestin. Therefore, they are known as progestin-only pills. There are no inactive pills and they are taken continually throughout the cycle, meaning you may or may not menstruate whilst using them. These pills are a good choice for women who cannot take [oestrogen](https://nabtahealth.com/glossary/oestrogen/) or have a history of blood clots in the lungs or in the legs. Mini pills usually solidify the cervical mucus and weaken the lining of the [uterus](https://nabtahealth.com/glossary/uterus/) (the endometrium), thus preventing [sperm](https://nabtahealth.com/glossary/sperm/) from reaching the egg. The pills also suppress [ovulation](https://nabtahealth.com/glossary/ovulation/); however, this is not constant, and can sometimes vary month to month. For optimal efficiency, you should take the mini pill every day at about the same time. Your doctor might recommend the mini pill if: * You have health problems, such as blood clots. * You are breast-feeding, as [oestrogen](https://nabtahealth.com/glossary/oestrogen/) can inhibit the production of breast milk. These pills are not appropriate for everyone. You should avoid, or seek medical advice, if: * You have ever had or have breast cancer. * In case of liver disease. * You have [unexplained uterine bleeding](https://nabtahealth.com/what-is-abnormal-uterine-bleeding/). * You are on medications for [HIV](https://nabtahealth.com/glossary/hiv/)/AIDS, seizures, or tuberculosis. As with all forms of birth control, there are several benefits and disadvantages that come with the use of birth control pills (oral contraceptives): ##### **Benefits** * Birth control pills can be used to treat painful periods. * They manage [unwanted symptoms](https://nabtahealth.com/menopause-the-symptoms-nobody-talks-about/) of [perimenopause](https://nabtahealth.com/glossary/perimenopause/); such as irregular periods, and even [hot flushes](https://nabtahealth.com/glossary/hot-flushes/). * They can help to reduce negative side effects of [](https://nabtahealth.com/coping-with-pms/)[premenstrual syndrome](https://nabtahealth.com/glossary/premenstrual-syndrome/) like cramps and mood swings. * Can be used to [avoid the need for](https://nabtahealth.com/will-i-need-to-have-my-uterus-removed-if-i-have-endometriosis/) [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/) in those with debilitating [endometriosis](https://nabtahealth.com/glossary/endometriosis/). * When used for at least 5 years the pill [protects against the risk](https://nabtahealth.com/can-the-oral-contraceptive-pill-protect-against-cancer/) of endometrial cancer by 50% and also ovarian cancer by 20%. ##### **Disadvantages** * For some women, these birth control pills can [lead](https://nabtahealth.com/glossary/lead/) to an increase in blood pressure, increasing the risk of type 2 diabetes and heart disease. * The extra hormones can [lead](https://nabtahealth.com/glossary/lead/) to an increased risk of blood clots, especially for smokers. * Can [lead](https://nabtahealth.com/glossary/lead/) to weight gain. * Increased risk of certain types of cancer, including [cervical](https://nabtahealth.com/the-pill-and-cervical-cancer/), liver, and [breast cancer](https://nabtahealth.com/the-pill-and-breast-cancer/) has been connected to pill use. * When one stops taking the pills, the menstrual cycle can take months, and even years, to return to normal. #### **Mirena coil** The Mirena coil is classified as a hormonal [IUD](https://nabtahealth.com/glossary/iud/) that can offer long-term birth control, for up to 5 years after being inserted. It can be used by all premenopausal women, including teenagers. It is a T-shaped plastic frame, which is inserted into the [uterus](https://nabtahealth.com/glossary/uterus/). It releases the hormone progestin, preventing pregnancy as it stops [ovulation](https://nabtahealth.com/glossary/ovulation/). It has been approved for use by the Food and Drug Administration ([FDA](https://nabtahealth.com/glossary/fda-2/)). As well as being used as a contraceptive, the Mirena is prescribed to women with: * [](https://nabtahealth.com/what-is-endometriosis/)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/). * [Heavy menstrual bleeding](https://nabtahealth.com/what-is-abnormal-uterine-bleeding/). * Abnormal growth of the [uterus](https://nabtahealth.com/glossary/uterus/) lining ([endometrial hyperplasia](https://nabtahealth.com/what-is-atypical-endometrial-hyperplasia/)). * Abnormal growth of the uterine tissue on the muscular wall of the [uterus](https://nabtahealth.com/glossary/uterus/) ([](https://nabtahealth.com/what-is-adenomyosis/)[adenomyosis](https://nabtahealth.com/glossary/adenomyosis/)). * [](https://nabtahealth.com/a-simple-guide-to-fibroids/)[Fibroids](https://nabtahealth.com/glossary/fibroids/). There are several benefits and disadvantages to using the Mirena: ##### **Benefits** * You do not require your partner’s participation. * It can remain in place when inserted for up to five years. * You can remove it at any time and theoretically experience a quick return to your normal fertility. * You can breast-feed while using it. * No risk of complications, such as [endometriosis](https://nabtahealth.com/glossary/endometriosis/), pelvic infection and severe period pain. These can all be triggered by birth control methods that contain [oestrogen](https://nabtahealth.com/glossary/oestrogen/). As such, the coil is often recommended for women with [endometriosis](https://nabtahealth.com/glossary/endometriosis/), and [fibroids](https://nabtahealth.com/glossary/fibroids/). ##### **Disadvantages** * Possible association with [cervical](https://nabtahealth.com/cervical-cancer-symptoms/) and [endometrial cancer](https://nabtahealth.com/a-guide-to-endometrial-cancer/). * Irregular [menses](https://nabtahealth.com/glossary/menses/), which can improve after 3-6 months of use. * It does not protect you from STIs. * You might have irregular bleeding. * Acne. * Headaches. * Breast tenderness. * Mood changes. If you conceive whilst the Mirena is in place, then the fertilised egg might be implanted outside the [uterus](https://nabtahealth.com/glossary/uterus/), generally in a fallopian tube. This is known as an [](https://nabtahealth.com/what-is-an-ectopic-pregnancy/)[ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) and can be very dangerous. #### **Vaginal Ring** Just like other hormonal birth controls, the vaginal ring prevents pregnancy through the release of hormones into the body. One can use the vaginal ring for 3 weeks, remove it and allow menstruation to occur, then after a week insert a new ring. There are two vaginal rings with [FDA](https://nabtahealth.com/glossary/fda-2/) approval in the United States: NuvaRing and Annovera. ##### **Benefits** * Easy to use and comfortable. * Can be removed at any time and fertility should be restored quickly. * Good for women experiencing latex (condom) allergies. * No weight gain. * Not likely to trigger irregular bleeding, unlike oral contraceptives. ##### **Disadvantages** * Can cause Vaginal irritation or infection. * Increased vaginal discharge. * Not recommended for women who have a history of blood clots, heart attacks, stoke and those over 35 years of age. * [Diarrhoea](https://nabtahealth.com/glossary/diarrhoea/). * Headache. * Breast tenderness. * Nausea. * Abdominal pain. * Depression Understanding your options as an individual and taking an open evaluation of the relationship you are in is certainly part of your choice process. It will help you in deciding which, if any, type of hormonal birth control is most suitable for you. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#b4cdd5d8d8d5f4dad5d6c0d5dcd1d5d8c0dc9ad7dbd9) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources** * Cooper DB, Mahdy H. Oral Contraceptive Pills. \[Updated 2020 Aug 23\]. In: StatPearls \[Internet\]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK430882/](https://www.ncbi.nlm.nih.gov/books/NBK430882/) * “Hormonal [IUD](https://nabtahealth.com/glossary/iud/) (Mirena).” _Mayo Clinic_, Mayo Foundation for Medical Education and Research, 26 Feb. 2020, [www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354](http://www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354). * “Minipill (Progestin-Only Birth Control Pill).” _Mayo Clinic_, Mayo Foundation for Medical Education and Research, 29 Dec. 2020, [www.mayoclinic.org/tests-procedures/minipill/about/pac-20388306](http://www.mayoclinic.org/tests-procedures/minipill/about/pac-20388306). * “Vaginal Ring.” _Mayo Clinic_, Mayo Foundation for Medical Education and Research, 12 Feb. 2020, [www.mayoclinic.org/tests-procedures/nuvaring/about/pac-20394784](http://www.mayoclinic.org/tests-procedures/nuvaring/about/pac-20394784). * “What Should I Do If I Miss a Pill (Combined Pill)?” _NHS Choices_, NHS, [www.nhs.uk/conditions/contraception/miss-combined-pill/](http://www.nhs.uk/conditions/contraception/miss-combined-pill/).
It is very difficult to conclusively state whether the [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/) directly impacts cancer rates; not least because the time between taking the pill and receiving a positive cancer diagnosis can span many years, during which time a female may be exposed to multiple (additional) risk factors. What is becoming apparent is that different cancer types have differing risk/benefit profiles when it comes to an association with the pill. Whilst pill use seems to lower the risk of developing certain cancers, there is a more negative link with other types, including cervical cancer. Taking the pill for five or more years is associated with a significantly increased risk of developing cervical cancer. The duration of use increases the risk, so that women who take the pill for 5 years have a 10% increased risk, but those who take it for longer, are more than 60% more likely to be diagnosed. Ten years after stopping the pill there is no increased risk of developing cervical cancer. Having a [women health test](https://nabtahealth.com/product/womens-health-test/) will determine cancer availability and any other women’s issue that come along with cervical cancer. After use some of Nabta products like [Cancer selfcare pack](https://nabtahealth.com/product/cancer-care/) and the [cancer pack for women](https://nabtahealth.com/product/cancer-pamper-me-%e2%99%80/) will help you look and stay healthy. #### **Cervical cancer and [HPV](https://nabtahealth.com/glossary/hpv/)** One important thing to note is that as a risk, oral contraceptives will always be cofactors that interact with high risk human papillomavirus ([HPV](https://nabtahealth.com/glossary/hpv/)) strains to induce cervical carcinogenesis. This means that oral contraceptives in isolation are not a risk factor in women who are [HPV](https://nabtahealth.com/glossary/hpv/) negative; however, for those who are [HPV](https://nabtahealth.com/glossary/hpv/) positive, the pill can exacerbate the risk. Steroid hormone receptors (mainly [progesterone](https://nabtahealth.com/glossary/progesterone/)) are found in cervical tissue and are thought to enhance the expression of high risk [HPV](https://nabtahealth.com/glossary/hpv/), contributing to cancerous changes in the [cervix](https://nabtahealth.com/glossary/cervix/). #### **Take home message** The link between pill use and cervical cancer is really only realised in those women who test positive for [HPV](https://nabtahealth.com/glossary/hpv/). Reducing your risk of contracting [HPV](https://nabtahealth.com/glossary/hpv/), via [vaccination](https://nabtahealth.com/can-cervical-cancer-be-prevented/), or identifying pre-cancerous changes early on, via [PAP screening](https://nabtahealth.com/when-should-i-get-a-pap-smear/), are more effective methods of minimising cervical cancer risk. To read more about a possible link between pill use and cancer risk click [here](https://nabtahealth.com/will-taking-the-pill-increase-my-risk-of-developing-cancer/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#e198808d8d80a18f808395808984808d9589cf828e8c) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Brynhildsen, Jan. “Combined Hormonal Contraceptives: Prescribing Patterns, Compliance, and Benefits versus Risks.” _Therapeutic Advances in Drug Safety_, vol. 5, no. 5, Oct. 2014, pp. 201–213., doi:10.1177/2042098614548857. * “Does the Contraceptive Pill Increase Cancer Risk?” _Cancer Research UK_, 4 Mar. 2019, [https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk](https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk). * Gierisch, J. M., et al. “Oral Contraceptive Use and Risk of Breast, Cervical, Colorectal, and Endometrial Cancers: A Systematic Review.” _Cancer Epidemiology Biomarkers & Prevention_, vol. 22, no. 11, Nov. 2013, pp. 1931–1943., doi:10.1158/1055-9965.epi-13-0298. * Knowlden, Hilary A. “The Pill and Cancer: a Review of the Literature. A Case of Swings and Roundabouts?” _Journal of Advanced Nursing_, vol. 15, no. 9, Sept. 1990, pp. 1016–1020., doi:10.1111/j.1365-2648.1990.tb01981.x. * “Oral Contraceptives (Birth Control Pills) and Cancer Risk.” _National Cancer Institute_, [https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet](https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet). * Roura, Esther, et al. “The Influence of Hormonal Factors on the Risk of Developing Cervical Cancer and Pre-Cancer: Results from the EPIC Cohort.” _Plos One_, vol. 11, no. 1, 25 Jan. 2016, doi:10.1371/journal.pone.0147029. * Smith, Jennifer S, et al. “Cervical Cancer and Use of Hormonal Contraceptives: a Systematic Review.” _The Lancet_, vol. 361, no. 9364, 5 Apr. 2003, pp. 1159–1167., doi:10.1016/s0140-6736(03)12949-2.
The [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/) has been widely used since the late 1950s and early 1960s when it became a revolutionary tool allowing women to take control of their family planning for the first time. However, in the decades since, questions and concerns have been raised over its long-term safety. One concern is that taking the pill could increase your risk of developing breast cancer. The association between breast cancer and the oral contraceptive pill is small, but significant. Studies suggest that those women who are currently on the pill are 20% to 24% more likely to receive a breast cancer diagnosis. The increased risk is lost once the pill is discontinued and after ten years, prior pill users are at no greater risk than never users of getting breast cancer. The risk also falls significantly once a woman goes through the [menopause](https://nabtahealth.com/glossary/menopause/). #### **Why would current pill use increase your breast cancer risk?** Pill use is associated with clinically challenging types of breast cancer, including the [triple negative](https://nabtahealth.com/breast-cancer-staging/) form, which usually has a worse prognosis and higher mortality rate. The exact mechanisms linking the two are unclear, although many breast cancers have a hormonal component. It is thought that increased lifetime exposure to oestrogens increases the risk of breast cancer, primarily because the hormone promotes or initiates tumour growth. Studies have failed to find an elevated risk of breast cancer in pill users with a family history of the disease. However, the data may be skewed by the fact that these women are less likely to use the pill due to their already increased susceptibility. #### **The mini pill and breast cancer** The established link between [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and breast cancer may [lead](https://nabtahealth.com/glossary/lead/) you to wonder whether using the progestin-only ‘mini pill’ would be a safer option. There have been very few studies on this form of contraception, probably because it is not as widely used as the combined pill (which contains [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and progestin). The work that has been performed has suggested that women who take the mini pill still have a higher risk of breast cancer than those who have never used oral contraceptives, perhaps by as much as 21%. The link between progestins and breast cancer is poorly understood and likely to be complex. However, it is validated by studies on postmenopausal women who take hormone replacement therapy. Those on combined [oestrogen](https://nabtahealth.com/glossary/oestrogen/) plus progestin therapy have a higher breast cancer risk than those who take just [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Thus, the mini pill is no longer considered a safer contraceptive option for those considered to be high risk for developing breast cancer. #### **Take home message** Women who are considered to be at higher risk of developing breast cancer, for example, those with a family history of the disease, will probably be encouraged to consider alternative forms of contraception. For many other women, the risks are low, becoming negligible once pill use is discontinued, and the benefits of the pill may well outweigh its negatives. To read more about a possible link between pill use and cancer risk click [here](https://nabtahealth.com/will-taking-the-pill-increase-my-risk-of-developing-cancer/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#fd849c91919cbd939c9f899c95989c918995d39e9290) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Brynhildsen, Jan. “Combined Hormonal Contraceptives: Prescribing Patterns, Compliance, and Benefits versus Risks.” _Therapeutic Advances in Drug Safety_, vol. 5, no. 5, Oct. 2014, pp. 201–213., doi:10.1177/2042098614548857. * “Does the Contraceptive Pill Increase Cancer Risk?” _Cancer Research UK_, 4 Mar. 2019, [https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk](https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk). * Gierisch, J. M., et al. “Oral Contraceptive Use and Risk of Breast, Cervical, Colorectal, and Endometrial Cancers: A Systematic Review.” _Cancer Epidemiology Biomarkers & Prevention_, vol. 22, no. 11, Nov. 2013, pp. 1931–1943., doi:10.1158/1055-9965.epi-13-0298. * Knowlden, Hilary A. “The Pill and Cancer: a Review of the Literature. A Case of Swings and Roundabouts?” _Journal of Advanced Nursing_, vol. 15, no. 9, Sept. 1990, pp. 1016–1020., doi:10.1111/j.1365-2648.1990.tb01981.x. * Li, Li, et al. “Association between Oral Contraceptive Use as a Risk Factor and Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis.” _Molecular and Clinical Oncology_, vol. 7, no. 1, 12 May 2017, pp. 76–80., doi:10.3892/mco.2017.1259. * Mørch, L S, et al. “Contemporary Hormonal Contraception and the Risk of Breast Cancer.” _New England Journal of Medicine_, vol. 377, no. 23, 7 Dec. 2017, pp. 2228–2239., doi:10.1056/NEJMoa1700732. * “Oral Contraceptives (Birth Control Pills) and Cancer Risk.” _National Cancer Institute_, [https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet](https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet). * Schairer, Catherine. “Menopausal Estrogen and Estrogen-Progestin Replacement Therapy and Breast Cancer Risk.” _Jama_, vol. 283, no. 4, 26 Jan. 2000, pp. 485–491., doi:10.1001/jama.283.4.485. * Soroush, Ali, et al. “The Role of Oral Contraceptive Pills on Increased Risk of Breast Cancer in Iranian Populations: A Meta-Analysis.” _Journal of Cancer Prevention_, vol. 21, no. 4, 30 Dec. 2016, pp. 294–301., doi:10.15430/jcp.2016.21.4.294.
There has been a substantial amount of negative press linking use of the [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/) to increased cancer rates, specifically breast and cervical cancer. However, the reality is a lot less clear and there is evidence suggesting that the pill might even protect against certain types of cancer. #### **Ovarian cancer** Research suggests that women who have taken the pill are significantly less likely to develop [ovarian cancer](https://nabtahealth.com/the-diversity-of-ovarian-cancer/) than those who have never taken it. In fact, studies have suggested that for every 5 years of pill use there is a 20% reduction in ovarian cancer risk. Furthermore, these protective effects are maintained for at least 30 years after discontinuation of pill use. #### **Endometrial cancer** The pill exerts a substantial protective effect against the development of [endometrial cancer](https://nabtahealth.com/a-guide-to-endometrial-cancer/). The risk is thought to be reduced by between 30 and 50%, depending on the duration of use. Protection lasts for at least 20 years after cessation of treatment. #### **Colorectal cancer** Ever-users of the pill are approximately 15% less likely to develop colorectal cancer than those that have never taken it. Whether increased duration of use has a beneficial effect is difficult to know as the quality of data from these studies is poor. These findings are interesting because it is estimated that as many as 140 million women worldwide take the oral contraceptive pill. Whilst a direct causative or protective effect of pill use is likely to be very difficult to ever conclusively prove, one long-term, UK-based study found that taking the pill resulted in a 12% reduction in overall cancer risk. To read more about a possible link between pill use and cancer risk click [here](https://nabtahealth.com/will-taking-the-pill-increase-my-risk-of-developing-cancer/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#2b524a47474a6b454a495f4a434e4a475f4305484446) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Brynhildsen, Jan. “Combined Hormonal Contraceptives: Prescribing Patterns, Compliance, and Benefits versus Risks.” _Therapeutic Advances in Drug Safety_, vol. 5, no. 5, Oct. 2014, pp. 201–213., doi:10.1177/2042098614548857. * “Does the Contraceptive Pill Increase Cancer Risk?” _Cancer Research UK_, 4 Mar. 2019, [https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk](https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk). * Gierisch, J. M., et al. “Oral Contraceptive Use and Risk of Breast, Cervical, Colorectal, and Endometrial Cancers: A Systematic Review.” _Cancer Epidemiology Biomarkers & Prevention_, vol. 22, no. 11, Nov. 2013, pp. 1931–1943., doi:10.1158/1055-9965.epi-13-0298. * Knowlden, Hilary A. “The Pill and Cancer: a Review of the Literature. A Case of Swings and Roundabouts?” _Journal of Advanced Nursing_, vol. 15, no. 9, Sept. 1990, pp. 1016–1020., doi:10.1111/j.1365-2648.1990.tb01981.x. * Murphy, Neil, et al. “Reproductive and Menstrual Factors and Colorectal Cancer Incidence in the Women’s Health Initiative Observational Study.” _British Journal of Cancer_, vol. 116, no. 1, 29 Nov. 2016, pp. 117–125., doi:10.1038/bjc.2016.345. * “Oral Contraceptives (Birth Control Pills) and Cancer Risk.” _National Cancer Institute_, [https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet](https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet).
The oral contraceptive pill (‘the pill’) was introduced in May 1950. Initially marketed as a way of regulating the menstrual cycle, it contained artificial versions of the two female sex hormones, [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/). These synthetic hormones were designed to mimic the activities of their endogenous counterparts. However, unlike the naturally-occurring hormones, there was no cyclical change in their levels throughout the menstrual cycle, meaning there was no trigger for the [ovaries](https://nabtahealth.com/glossary/ovaries/) to release an egg and thus [ovulation](https://nabtahealth.com/glossary/ovulation/) was impeded. Without [ovulation](https://nabtahealth.com/glossary/ovulation/), fertilisation could not occur. The composition of the pill has changed since its early incarnation. The first pill contained 9.85mg progestin (synthetic version of [progesterone](https://nabtahealth.com/glossary/progesterone/)) and 150µg [oestrogen](https://nabtahealth.com/glossary/oestrogen/), today’s choice of pills are more likely to contain in the region of 0.1-3mg progestin and 20-50µg [oestrogen](https://nabtahealth.com/glossary/oestrogen/). The refining of the component parts has made the pills in use today far more pharmacologically specific and safer. Using less than 50µg [oestrogen](https://nabtahealth.com/glossary/oestrogen/) means that there is no increased risk of stroke. The development of the pill meant that, for the first time, women were able to take control of their own fertility and plan their families. However, its usage over the past 70 years has been marred by controversy, falsified claims and rumour-mongering, meaning that even today people are unsure whether the pill is to be celebrated or vilified. #### **Positives** In addition to preventing unplanned pregnancies, the pill has several non-contraceptive hormonal benefits. It is used to treat painful heavy periods and is often prescribed for those with [PCOS](https://nabtahealth.com/glossary/pcos/), as well as managing the unwanted symptoms of the [](../what-you-need-to-know-about-perimenopause)[perimenopause](https://nabtahealth.com/glossary/perimenopause/), including [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and irregular periods. It also reduces the negative side effects of [](../)[premenstrual syndrome](https://nabtahealth.com/glossary/premenstrual-syndrome/), such as mood swings and cramps. For women experiencing debilitating heavy bleeding, the pill can reduce this, significantly improving the quality of life and reducing [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/) rates. This makes it a valuable tool for managing the symptoms of [](../what-medications-are-recommended-for-endometriosis)[endometriosis](https://nabtahealth.com/glossary/endometriosis/) in those women who do not wish to conceive. It has also been shown to protect against both ovarian cancer (relative risk reduced by 20% for each five years of use) and endometrial cancer (risk reduction of 50%, regardless of duration of use). It protects against unplanned pregnancy, which is generally considered to carry more risks, physically and emotionally, than contraceptive use. #### **Negatives** A lot of the negative press related to the pill has come from the identification of adverse side effects. The pill is said to increase the risk of venous thromboembolism (blood clots). In fact, for non-smokers the risk of developing a blood clot if they take the pill is 9.1 in 10,000. In contrast, the risk of developing a blood clot during a normal, otherwise healthy pregnancy is 30 in 10,000. That said, an element of caution is recommended, and those with a family history of thrombosis or blood clots should choose an alternative to the pill when considering contraception. Doctors will also exert caution when prescribing the pill to women who smoke and are over 35 years old, due to an increased risk of heart attack. The combined pill is also not recommended for those who suffer from [migraines](../) with an aura. This highlights the need for a doctor to take a detailed medical history of each patient prior to selecting a form of contraception. The pill has been linked to an increased risk of breast, cervical and liver cancer. However, the data is limited and any associated risk disappears five to ten years after treatment ceases. To put it into context, the pill is thought to be implicated in less than 1% of breast cancer cases, with many studies finding that pill use does not increase breast cancer risk at all. As previously mentioned, the pill can be used to treat conditions with hormonal elements, including [endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [](../what-is-pcos)[PCOS](https://nabtahealth.com/glossary/pcos/). However, in the case of [PCOS](https://nabtahealth.com/glossary/pcos/), its likely benefits are dubious. [PCOS](https://nabtahealth.com/glossary/pcos/) is often strongly associated with increased [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) and as many forms of the pill impair insulin sensitivity, for these patients it is not an ideal treatment option. This does not mean it is not regularly prescribed, but does mean you should consider whether it is the best treatment option for you. Discuss the [pros and cons with your doctor](../five-things-your-doctor-probably-wont-tell-you-about-pcos) before starting any medication. Another factor to consider is that the pill is not regulating the menstrual cycle; the monthly bleeds are not genuine periods, they are withdrawal bleeds. If your [periods were irregular](../what-is-abnormal-uterine-bleeding) before you started taking the pill, once you stop taking it you are likely to revert to a similar state. The final thing to note is that once you stop taking the pill, it can take months, or in rare cases years, for your menstrual cycle to become regular again. The pill has a complicated history, but with an effectiveness of 92% (99% if taken correctly and consistently), it is still the contraceptive of choice for many women. The pill has given rise to alternative hormonal contraceptive devices, including the [progesterone](https://nabtahealth.com/glossary/progesterone/)\-only ‘mini pill’, implants, intrauterine devices and injectables, giving women more options than they have ever had before for managing their fertility. However, all of these options involve hormonal regulation, usually with synthetic products, which means that even now, in the 21st century, women’s bodies are still being manipulated to control fertility. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#4b322a27272a0b252a293f2a232e2a273f2365282426) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Cibula, D, et al. “Hormonal Contraception and Risk of Cancer.” _Human Reproduction Update_, vol. 16, no. 6, 2010, pp. 631–650., doi:10.1093/humupd/dmq022. * Liao, P V, and J Dollin. “Half a Century of the Oral Contraceptive Pill: Historical Review and View to the Future.” _Canadian Family Physician_, vol. 58, no. 12, Dec. 2012, pp. e757–760. * Trussell, J, and B Jordan. “Reproductive Health Risks in Perspective.” _Contraception_, vol. 73, no. 5, May 2006, pp. 437–439., doi:10.1016/j.contraception.2006.01.008. * “Combined Pill.” _NHS_, [www.nhs.uk/conditions/contraception/combined-contraceptive-pill/](http://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/). Page last reviewed: 06/07/2017. * _World Health Organisation_ \[website\] Family planning. Fact sheet no. 351. July 2012. Available from: [www.who.int/mediacentre/factsheets/fs351/en/](http://www.who.int/mediacentre/factsheets/fs351/en/). Accessed 15th April 2019.
There is no cure for [](https://nabtahealth.com/what-is-endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/). The treatment provided aims to reduce the severity of the symptoms and improve quality of life. The exact treatment offered will depend on the symptoms, patient age, fertility and priority of starting a family. Broadly speaking, there are two types of treatment; medication and surgery. #### Medication If their [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is causing pain, patients will be offered medication to ease this. Drugs such as non-steroidal anti-inflammatories (NSAIDs) and paracetamol may help to ease painful menstrual cramps. Some patients will be prescribed hormonal therapy to help alleviate their symptoms. The combined [oral contraceptive pill](../the-oral-contraceptive-pill) and progestin therapies, such as the mirena coil, are used to reduce the buildup of endometrial tissue every month. They do this either by preventing monthly menstruation completely, or by making the menstrual flow a lot lighter and shorter. With fewer endometrial deposits, [inflammation](https://nabtahealth.com/glossary/inflammation/) will be reduced and patients will experience less pain. Gonadotrophin-releasing hormone (GnRH) analogues and [testosterone](https://nabtahealth.com/glossary/testosterone/) derivatives both block [oestrogen](https://nabtahealth.com/glossary/oestrogen/) production, essentially putting the body into a state of artificial [menopause](https://nabtahealth.com/glossary/menopause/). The problem with hormonal treatment is that it will not help to improve fertility, quite the reverse in fact. Most hormonal options cause the body to enter into a state of artificial pregnancy or [menopause](https://nabtahealth.com/glossary/menopause/), thus preventing fertilisation and [implantation](https://nabtahealth.com/glossary/implantation/). Therefore, this treatment is not suitable for those patients who are seeking help to conceive. #### Surgery The first line of treatment for women experiencing [endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-associated [infertility](https://nabtahealth.com/glossary/infertility/) is to undergo a [](../what-is-a-laparoscopy)[laparoscopy](https://nabtahealth.com/glossary/laparoscopy/), a surgical process where a camera is inserted through the abdomen in order to examine the underlying organs. This is classed as conservative surgery. Used in the first instance for diagnosis, surgeons will attempt to remove accessible endometrial deposits at the same time. This treatment is reasonably effective for patients with mild-moderate [endometriosis](https://nabtahealth.com/glossary/endometriosis/). The drawback is that there is a high recurrence rate, so symptomatic relief may only be temporary. It is believed that between 5 and 20% of women with [endometriosis](https://nabtahealth.com/glossary/endometriosis/) will get recurrence of symptoms each year, probably due to further endometrial deposits forming. A year after surgery, 45% of women are likely to report that they are experiencing pain again. More [radical surgery](https://nabtahealth.com/will-i-need-to-have-my-uterus-removed-if-i-have-endometriosis/) involves removal of the [uterus](https://nabtahealth.com/glossary/uterus/) ([hysterectomy](https://nabtahealth.com/glossary/hysterectomy/)) and/or [ovaries](https://nabtahealth.com/glossary/ovaries/) ([oophorectomy](https://nabtahealth.com/glossary/oophorectomy/)). Removing the [ovaries](https://nabtahealth.com/glossary/ovaries/) causes an instant and irreversible [menopause](https://nabtahealth.com/glossary/menopause/) and is thus only suitable for women who are not planning on having children. Optimal treatment strategies for [endometriosis](https://nabtahealth.com/glossary/endometriosis/) will generally incorporate a multidisciplinary approach, with a view to treating both the physical and psychological effects of the condition. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#bdc4dcd1d1dcfdd3dcdfc9dcd5d8dcd1c9d593ded2d0) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bulletti, C, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [Infertility](https://nabtahealth.com/glossary/infertility/).” _Journal of Assisted Reproduction and Genetics_, vol. 27, no. 8, 25 June 2010, pp. 441–447., doi: 10.1007/s10815-010-9436-1. * D’Hooghe, T, and L Hummelshoj . “Multi-Disciplinary Centres/Networks of Excellence for [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Management and Research: a Proposal.” _Human Reproduction_, vol. 21, no. 11, Nov. 2006, pp. 2743–2748., doi:10.1093/humrep/del123. * _[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Treatment_. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) UK, [www.](http://www.endometriosis-uk.org/endometriosis-treatment)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-uk.org/[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-treatment. * _[Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. Mayo Clinic, 24 July 2018, [https://www.mayoclinic.org/diseases-conditions/](https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/diagnosis-treatment/drc-20354661.
