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Stopping the Pill and Starting a Family
By Sam Thatcher, MD, Ph.D.
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 Q. I was diagnosed with PCOS when I was 19 and was put on the pill to help regulate my cycles. I am 26 now, and my husband and I would like to try for a baby. I will be going off the pill in November. My question is, should I expect my periods to go back to being very irregular? Also, do women with PCOS ovulate at all? I don't know what to expect -- and I don't want to waste time trying to conceive when I should be put on some sort of medication right away.
A. I am a big supporter of oral contraceptives for those with PCOS who have no contraindications and do not want to be pregnant. Contrary to what many advise, I suggest trying in the first month off the pill. The chances of miscarriage may be slightly higher, but this may be the best chance for a pregnancy. It is surprising how many women say, "I had no problems getting pregnant the first time. I happened the first month off the pill." There may be a rebound effect and ovulation. I would not worry about temperature tracking or ovulation detection kits until you have demonstrated that you will have regular periods.
If a period does not begin after 45 days, it may be reasonable to perform a home pregnancy test. One of the best ways to regulate periods is with "natural" progesterone usually as the brand PrometriumT. Evaluation should be started including tests for insulin resistance if periods are not regular (26-35 days) after about 3 months.
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