My PCOS & insulin-related issues cause a similar reaction in me, but it was even WORSE when I was on BCP (ortho tri cyclen lo). I gained 80 pounds over 3 years on BCP when it was started for irregular cycle, with no changes in diet & I constantly felt hungry.

Really, the only way for me to combat this is to lower the amount of carbs I eat. The "constant need to feed" goes away for me at no more than 20% of my diet being carbs (& then mainly veggie or sweet potato based, not grain, sweets or fruits), although I lose weight more predictably if I drop my carbs lower.

If you haven't experimented with lowering the amount of carbs you eat (maybe not going "low carb" unless it looks like it is the best path for you), you might want to check into it?

That constant hunger is more a sign of insulin resistance than of your birth control. And PCOS is often caused by IR, even if the IR is not diagnosed. So, honestly, I'd get the IR tested. That is a FASTING INSULIN test, not glucose. Your glucose readings can have no bearing on your insulin numbers, or they can show a problem, so they are not a good diagnostic tool. Fasting insulin is as simple a test as fasting glucose, it's just not an automatic test. I would request it as soon as possible.

As with @aSearch4Me, I only gained control over my constant hunger with dropping carbs (a dietary change recommended by my PCP for years before my endo seconded the recommendation), and it's been a life-altering choice for the better. I won't go into everything here, but my quality of life is better now than I ever remember before. I'm 39.

But it is really easy for one slip-up or carb creep to put me back in "hungry-hungry-HUNGRY" mode. My body treats an apple or banana like a Snicker's bar, so I can't have much of any of it. Even strawberries (one of the lower sugar fruits) triggers carb cravings, so I'm mostly fruit-free these days, and happier for it...

I have never really noticed major weight gain with being on Birth Control Pills, though I've been on them off and on for years. I've been on a steady incline with weight my whole life, and so honestly, I hadn't noticed whether BCP made it worse. Though, looking back, I did gain 25+ pounds after getting back on BCP three years ago, and increased hunger, but I also went from being single, recovering from a bitter divorce, to dating a former high school love and learning to cook all over again. So I can't isolate the change...

I know that PCOS, and IR, are hormonally sourced and driven, so it stands to reason that increasing hormones (BCP) would increase the conditions/therefore the hunger. I wonder if anyone has actually had IR TRIGGERED by the BCP?

I was on Ortho-Tri-Cylcen-Lo, and that was the worst thing ever for me. I was PMSing 24/7/365. I had to get a stronger form to survive and to stop bleeding, because it was like the slightest stress had me bleeding and ugh... I'm on Microgestin now, continuously, and love it. I have a friend who takes Seasonique, and loves it, too...

Fasting Insulin is a test most docs associate with diabetes, but you can be insulin resistant without having diabetes. In many cases, insulin resistance can CAUSE PCOS, which is what happened for me. Looking back now, I can see the signs of IR even before I was 10 years old, now that I know how it presents...

A fasting insulin test is as simple to do as a fasting glucose test, but it must be done in a lab. If you have PCOS and a decent endocrinologist (other docs might as well), they shouldn't hesitate at giving you this test. My results indicated that I was insulin resistant but not yet pre-diabetic, but on the path. Don't hesitate to request this test.

It could make all the difference in how you treat yourself.

And my insulin levels were out of control while my A1c and fasting glucose were level...