PCOS- How to regulate period without birth control

Dear Ask The Doctor: I have PCOS, and was taking birth control to regulate my period, and help with the pain. Last February I was diagnosed with a pulmonary embolism and was told that I could never take birth control again. Are there any other options for regulating my period or controling the heaviness?

Dear Daisy:

I understand your concern about PCOS, oral contraceptive pills and pulmonary embolism. Certainly I agree with the way you have been guided about avoiding contraceptive pills due to the increased risk in developing thrombus.

Estrogen is the hormone that is related to the predisposition of forming new thrombus.  You might have been taking low-dose birth control pills that contain a combination of synthetic estrogen and progesterone. They decrease androgen production and give your body a break from the effects of continuous estrogen. This decreases your risk of endometrial cancer and corrects abnormal bleeding.

Now, to avoid the presence of estrogen an alternative approach is taking progesterone for 10 to 14 days each month. This regulates your periods and offers protection against endometrial cancer, but it doesn't improve androgen levels. Another medication that your physician might also prescribe is metformin (Glucophage, Glucophage XR), an oral medication for type 2 diabetes that lowers insulin levels. This drug improves ovulation and leads to regular menstrual cycles. Metformin also slows the progression to type 2 diabetes if you already have prediabetes and aids in weight loss if you follow a diet and exercise program. I suggest you to consult your physician about these medications and the best treatment for your particular case.