Is Birth Control as Bad as They Say? What Patients Need to Know Before They Stop
For many women, birth control goes beyond family planning. It's an active treatment for conditions like PMOS (formerly known as PCOS), endometriosis, or PMDD.1,2 Stopping it doesn't "detox" your hormones (whatever that means), it removes the treatment that was managing your symptoms. This means that those symptoms are likely to return. That's not meant to be a scare tactic, it's how these conditions and their medications work.
If you've been following our series on birth control misinformation, we've already covered how birth control doesn't definitively cause depression, what realistic side effects look like and why thinking of it as "just a symptom mask" oversimplifies a complex picture.
This time, we're going deeper on three conditions where that oversimplification does the most damage: PMOS, endometriosis, and PMDD.
What Is PMOS (Formerly Known as PCOS)?
PMOS stands for Polyendocrine Metabolic Ovarian Syndrome, the new name for what was previously called Polycystic Ovary Syndrome (PCOS). The old name placed too much emphasis on cysts whereas PMOS is a complex and multifaceted condition that women can have, even without the presence of cysts.3,4 If you were diagnosed with PCOS, you have PMOS. Nothing about your diagnosis or your treatment plan has changed.
PMOS involves elevated androgens (male hormones) driven by excess LH (luteinizing hormone), irregular or absent ovulation, and metabolic effects that go beyond the ovaries.
How Does Birth Control Help Manage PMOS Symptoms?
While it’s true that combined hormonal birth control doesn't cure PMOS, it can be an effective component of a PMOS treatment plan. Birth control can help by interrupting the specific hormonal cycle that causes many of the symptoms:5,6
- It suppresses the LH surge that drives excess androgen production, which is why it helps with acne, excess hair growth, and hair thinning.
- It raises SHBG (sex hormone-binding globulin), a protein that binds up free testosterone, reducing androgen effects further.
- It regulates a menstrual cycle that PMOS often makes irregular or absent.
- It protects the uterine lining from the effects of chronic anovulation, which without treatment can lead to endometrial thickening over time.
As we previously covered, not all birth control formulations will have the same effect on everybody, and women can even have vastly different experiences with the exact same product.
By no means are we denying that negative side effects exist. Women’s stories and voices absolutely need to be heard. But one woman’s story does not necessarily mean that yours will look the same, especially if you’ve already been using your birth control for years with no ill effects.
To have informed consent, patients deserve to have a thorough explanation about the risk of side effects and the purpose of the treatment. A story we hear all too often is, “I was diagnosed with PMOS and my doctor told me to just go on birth control.” This is unfortunate and what’s often missing is a thorough explanation of the “why” behind the “what.”
How Does Birth Control Treat Endometriosis?
Endometriosis is a condition where tissue, similar to the uterine lining, grows outside the uterus. Here, it can respond to hormonal cycling the same way the uterine lining does by thickening, breaking down, and causing inflammation and pain.7,8
Hormonal birth control helps by reducing retrograde menstruation and suppressing the estrogenic stimulation that feeds those lesions.7,8 Put simply, it limits how much fuel the condition gets to work with, which is why it's so often used to manage endometriosis-related pain and slow disease activity.7,8
When someone with endometriosis stops hormonal birth control, symptom recurrence is a documented and predictable outcome of removing the treatment that was limiting disease activity.7,8,9
The anti-pill narrative that seems hellbent on encouraging women to stop their birth control and go “natural” does not seem to account for conditions like endometriosis. Going “natural” is also going to lead to a return of the disease.
How Does Birth Control Treat PMDD?
PMDD (premenstrual dysphoric disorder) is driven by an unusually strong sensitivity to the normal hormonal shifts of the luteal phase, particularly fluctuations in estrogen and allopregnanolone.10 For people with PMDD, those fluctuations can trigger a severe symptom cascade which can involve intense mood changes, anxiety, irritability, and more.10
Birth control treats PMDD by flattening those fluctuations. A few facts worth knowing:10-12
- Continuous regimens tend to outperform cyclic ones, because they eliminate the hormonal variability of the luteal phase instead of just shortening it.
- Formulation matters. Drospirenone-containing pills have a specific evidence base for PMDD, related to their anti-androgenic and antimineralocorticoid activity. They are not interchangeable with other progestin formulations for this purpose.
"The pill" is not one thing. For PMDD specifically, which pill and which regimen you're on can be the difference between real symptom relief and no relief at all.
Telling someone to get off birth control without understanding foundational differences between formulations, the evidence to support their use as treatment and the complexity of the conditions they treat is a massive red flag.
What Happens If You Stop Birth Control Suddenly?
If you're using hormonal birth control primarily as contraception, stopping is a straightforward conversation about alternative methods, fertility planning or what your goals are. But if you're using it to manage PMOS, endometriosis, or PMDD, stopping abruptly means:
- Androgen-driven symptoms (acne, hair changes, cycle irregularity) can return, often quickly.
- Endometriosis-related pain and disease activity can resume.
- PMDD symptom cycles can come back at full intensity, sometimes worse than remembered, since the contrast after a period of suppression can feel more severe.
None of this means birth control is the right long-term choice for everyone with these conditions, or that you shouldn't ever stop. It means stopping should be a decision made with a plan rather than a late-night, panic fuelled doom scroll session.
How Do I Know If I'm Ready to Stop My Birth Control?
If you're thinking about stopping your birth control, take a moment to consider the following:
- Identify why you started. Was it purely contraception, or was it also managing a diagnosed condition?
- Name what it's been controlling. List the specific symptoms it's been suppressing, even ones you've forgotten you used to have.
- Ask yourself what happens if those symptoms return. For PMOS, endometriosis, and PMDD, recurrence is the expected outcome of stopping, not a possibility.
- Build a transition plan before you stop, not after. That might mean a different medication, a monitoring plan, or lifestyle supports lined up in advance.
Where Can I Get Answers About Birth Control?
According to many of our patients, contraceptive counseling in a typical visit with their doctor is often brief and rushed. Many patients leave feeling like they didn’t get the full time and attention they felt they deserved.
Is it any wonder that women are filling that gap with whatever is trending on their feeds? While we understand why this happens, it’s important to emphasize that a TikTok video is not a substitute for a thorough assessment and medical care that considers your health history.
At July Health, we treat the conversation about why you're on birth control as seriously as the conversation about what to do if you want to stop.
If you have PMOS, endometriosis, or PMDD and you're navigating conflicting information about your treatment it’s time to talk to clinicians who are here to offer you evidence-based advice while considering your complex needs. Book a session today to get started.
This is Part 3 in our series on birth control misinformation. Catch up on Part 1 and Part 2 if you missed them.
References:
1. Sánchez‐Millán N, Martínez‐Vázquez S, Ballesta‐Castillejos A, Martínez‐Galiano JM, Martínez‐Rodríguez S, Hernández‐Martínez A. Characteristics of Menstrual Cycles, Prevalence of Menstrual Disorders in Young Women and Their Relationship to Hormonal Contraceptive Use. Health science reports. 2026;9(3):e71981-n/a. doi:10.1002/hsr2.71981
2. Oddsson K, Leifels-Fischer B, Wiel-Masson D, et al. Superior cycle control with a contraceptive vaginal ring compared with an oral contraceptive containing 30 μg ethinylestradiol and 150 μg levonorgestrel: a randomized trial. Human reproduction (Oxford). 2005;20(2):557-562. doi:10.1093/humrep/deh604
3. Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics. 2023;13(6):1113. doi:10.3390/diagnostics13061113
4. Polycystic ovary syndrome. Accessed March 25, 2026. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
5. Oguz SH, Yildiz BO. An Update on Contraception in Polycystic Ovary Syndrome. Endocrinol Metab (Seoul). 2021;36(2):296-311. doi:10.3803/EnM.2021.958
6. Kasperska-Zaj c A, Zamlynski J. Chronic urticaria and irregular menstrual cycle: A case report of effective therapy with oral contraception. The Journal of dermatological treatment. 2012;23(2):159-160. doi:10.3109/09546634.2010.499933
7. Teal S, Edelman A. Contraception Selection, Effectiveness, and Adverse Effects: A Review. JAMA. 2021;326(24):2507-2518. doi:10.1001/jama.2021.21392
8. Brown J, Crawford TJ, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018;2018(5):CD001019. doi:10.1002/14651858.CD001019.pub3
9. Brunner Huber LR, Hogue CJ, Stein AD, et al. Contraceptive use and discontinuation: Findings from the contraceptive history, initiation, and choice study. American Journal of Obstetrics and Gynecology. 2006;194(5):1290-1295. doi:10.1016/j.ajog.2005.11.039
10. Carlini SV, Deligiannidis KM. Evidence-based treatment of Premenstrual Dysphoric Disorder: a concise review. J Clin Psychiatry. 2020;81(2):19ac13071. doi:10.4088/JCP.19ac13071
11. Efficacy of a New Low-Dose Oral Contraceptive... : Obstetrics & Gynecology. doi:10.1097/01.AOG.0000175834.77215.2e
12. Freeman EW, Halbreich U, Grubb GS, et al. An overview of four studies of a continuous oral contraceptive (levonorgestrel 90 mcg/ethinyl estradiol 20 mcg) on premenstrual dysphoric disorder and premenstrual syndrome. Contraception. 2012;85(5):437-445. doi:10.1016/j.contraception.2011.09.010
