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What are the benefits and risks of taking birth control pills?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 27, 2020.

Overview: Benefits and Risks of the Pill

There are many advantages to using the birth control pill as a means of female contraception. It's convenient, usually covered by your insurance, and has few side effects for most women. But what do you really need to know before you make this long-term birth control decision?

The birth control pill has been used safely and successfully since 1960 when it was first approved by the FDA. Many of today's birth control pills contain lower amounts of hormones and come in many different dosing options to allow women effective and flexible methods of family planning.1,2 Many women are able to take the birth control pill with few or no side effects.

However, the risks associated with taking oral contraceptives increase significantly if you are a smoker,
have high blood pressure, diabetes, high cholesterol, a tendency to form blood clots, or are obese.

Risks are also higher if you have or have had clotting disorders, heart attack, stroke, angina pectoris, cancer of the breast or sex organs, jaundice, or malignant or benign liver tumors.

You should not take the pill if you suspect you are pregnant or have unexplained vaginal bleeding.

Benefits of the pill

The birth control pill can result in lighter bleeding and decreased pain during your monthly period.

Studies have shown the birth control pill leads to lower rates of pelvic inflammatory disease and cancer in the uterus and ovaries.

Effective birth control leads to less worry and is a very effective form of family planning, allowing women and their partners the ability to select the best time to start a family. The pill has a <1% failure rate (meaning less than 1 out of 100 women unintentionally become pregnant) when used correctly.

There are a variety of birth control pills available to fit your need. For example, progestin-only versions of the pill ("mini-pill") exist if you are breastfeeding or unable to use estrogen due to medical reasons.

Using extended-cycle (i.e., Seasonique, Seasonale) or continuous-cycle (i.e., Amethyst) pills allows a woman to have fewer periods or no periods at all, respectively.

Some birth control pills can help prevent sudden mood changes during a woman’s cycle due to changing hormone levels.

Acne or premenstrual dysphoric disorder (PMDD) may improve with some birth control pills.

The birth control pill can lessen heavy bleeding, pain and severity of endometriosis and fibroid tumors.

Weight gain is not a common side effect with low dose birth control pills in use today. Many years ago the pill contained higher levels of estrogen which may have caused weight gain. Birth control pills may cause slight fluid retention, but that effect is usually temporary.

Progestin-only pills may be associated with less nausea, breast pain, weight gain, and mood changes than combination birth control pills. Research has not revealed that the progestin-only pill leads to weight gain, depression or headaches.4

Many generic versions of the birth control pill are available at a lower cost than brand names and are equally effective. Ask your doctor or pharmacist if you prefer a generic birth control pill.

It is also possible to completely eliminate periods by taking only the active pills continuously (each day) from certain combination birth control pills and skipping the inactive pills. Ask your healthcare provider if this would be a good option for you and which options you can use. You may require additional pill packs and your insurance may not pay for more than 12 packs per year, so be sure to check with your insurance, as well.1,2

Risks of the pill

  • Blood clots
  • Heart attacks
  • Stroke
  • Gallbladder disease
  • Liver tumors
  • Cancer of the reproductive organs
  • Elevated triglycerides and pancreatitis

The choice of birth control is individual for each woman. Some women may have medical conditions that prevent them from using birth control pills, while other women may be at higher risk for side effects due to age or smoking status. There are some disadvantages to using the birth control pill, and women should consider these risks and discuss them with their health care provider.

Birth control pills can lead to a higher risk for blood clots, heart attack, and stroke in women who smoke, especially if older than 35 years of age. Birth control pills should NOT be used by women who are over 35 years of age and smoke.

Taking a pill every day may be difficult for some people. If you miss a pill, you may need to use another form of birth control (i.e., condom) during your cycle. If you think you'll have trouble taking a pill every day, an IUD may be a better option for you.

The birth control pill does not protect against sexually transmitted diseases. Only a condom can protect you from sexually transmitted diseases.

The pill has a <1% failure rate (meaning less than 1 out of 100 women unintentionally become pregnant) if used perfectly, without missing any pills. However, for women who miss taking their pills, the failure rate goes up to roughly 5%, or 5 out of 100 women become pregnant unintentionally.

There can be drug interactions that may lower the effectiveness of birth control pills (for example, rifampin, some seizure medications, some HIV drugs, modafinil, and other drugs). Be sure to ask your pharmacist about potential drug interactions each time you have a prescription filled. Tell them the names of all of the drugs you take, including prescription, over-the-counter, vitamins or herbal dietary supplements like St. Johns Wort or other herbs.

Spotting (breakthrough bleeding) may occur (mid-cycle) for the first few months of birth control use as your body adjusts to the changes in hormone levels. Breakthrough bleeding may be worse with extended- or continuous-cycle birth control pills or with progestin-only pills. 

Birth control pills can cause breast pain or vaginal dryness; these side effects may continue with use or subside.

A progestin called drospirenone is found in some birth control pills (examples include: Slynd, Yaz, Yasmin, Gianvi, Syeda, Safyral, Beyaz, Loryna, Jasmiel, Nikki, OcellaZarah) and is linked to a higher risk for blood clots than other birth control pills. Drospirenone may also raise potassium levels in the blood which may cause heart or health problems. It is important to discuss your health history with your doctor prior to using these birth control pills.

After stopping the pill, it may take several months or longer to begin ovulating again if pregnancy is desired.

Some women may find that the progestin-only birth control can affect their milk supply, especially when they first start breastfeeding. If you start using a progestin-only pill and your milk supply decreases, talk with your doctor about ways to increase your milk supply or other options for preventing pregnancy.6

The birth control pill requires a prescription from a healthcare provider. While this may seem inconvenient, it is important to have a regular checkup with your doctor when using the birth control pill.1,2

The birth control pill may require a monthly cost or copay, and therefore may not be affordable for all women. Generic birth control pills are less expensive, but just as effective. Most insurance plans will cover birth control at no cost in the US; check with your plan to see which pills are covered on their formulary. If you don't have insurance, ask your doctor or pharmacist about low-cost or free options for birth control. 

Warnings for birth control pill use

Women who use oral contraceptives should not smoke. Smoking increases the risk of serious side effects when using the pill. Heavy smoking (> 15 cigarettes per day) may be linked with an especially high risk. Birth control should NOT be used in women over 35 years of age who smoke due to an increased risk of serious side effects, such as heart attack, blood clots, and stroke, which may lead to death.

Cardiovascular (heart and blood vessel) risks increase with age, weight, family history of heart disease, and number of cigarettes smoked per day.

You should not use the pill if you have had any of the following conditions:

  • Heart attack or stroke.
  • Blood clots in the legs (thrombophlebitis), lungs (pulmonary embolism), or eyes.
  • Blood clots in the deep veins of your legs.
  • Known or suspected breast cancer or cancer of the lining of the uterus, cervix, or vagina or certain hormonally-sensitive cancers.
  • Liver tumor (benign or cancerous).
  • Pregnant or think you are pregnant.

Or, if you have any of the following:

  • Chest pain (angina pectoris).
  • Unexplained vaginal bleeding (until a diagnosis is reached by your doctor).
  • Yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during previous use of the pill.
  • Known or suspected pregnancy.
  • Heart valve or heart rhythm disorders that may be associated with formation of blood clots.
  • Diabetes affecting your circulation.
  • Uncontrolled high blood pressure.
  • Active liver disease with abnormal liver function tests.
  • Take any Hepatitis C drug combination containing ombitasvir / paritaprevir / ritonavir, with or without dasabuvir. This may increase levels of the liver enzyme "alanine aminotransferase" (ALT) in the blood.
  • Allergy or hypersensitivity to any of the components (active or inactive ingredients) of your birth control regimen

Tell your health-care provider if you have ever had any of these conditions. Your health-care provider can recommend another method of birth control.

The birth control pill does not protect against any form of sexually transmitted disease (STD), including HIV and AIDS. A condom should be used in combination with any other form of birth control for protection against STDs.

Tell your health-care provider if you or any family member has ever had:

  • Breast nodules, fibrocystic disease of the breast, an abnormal breast X-ray or mammogram.
  • Diabetes.
  • Elevated cholesterol or triglycerides.
  • High blood pressure.
  • A tendency to form blood clots.
  • Migraine or other headaches or epilepsy.
  • Mental depression.
  • Gallbladder, heart, or kidney disease.
  • History of scanty or irregular menstrual periods.

Women with any of these conditions should be checked often by their health-care provider if they choose to use oral contraceptives. Also, be sure to inform your doctor or health-care provider if you smoke or are on any medications.

The pill and breastfeeding

Breastfeeding mothers should avoid estrogen in combination hormonal birth control (which contain both estrogen and progestin) as it may reduce milk supply.

Birth control options for breastfeeding women include IUDs, progestin only pills (“mini-pills”), the implant or the birth control shot.3 Condoms and abstinence are other options, but may be less reliable in preventing pregnancy.

Side effects with the pill

  • Spotting or vaginal bleeding between periods (breakthrough bleeding)
  • Possible weight gain or fluid retention
  • Breast swelling or tenderness
  • Nausea or upset stomach
  • Mood changes
  • Melasma (darkening of skin, often on the face)
  • Contact lens changes

Other side effects

Other side effects may include nausea, breast tenderness, change in appetite, headache, nervousness, depression, dizziness, loss of scalp hair, rash, vaginal infections, inflammation of the pancreas, and allergic reactions.

If any of these side effects bother you, call your doctor or health-care provider.

Serious side effects with the pill

  • Blurred vision
  • Severe stomach pain
  • Severe headache
  • Swelling or pain in the legs
  • Chest pain, heart attack, blood clots, stroke which may be fatal.

Call your doctor immediately or get emergency help if any of these effects occur while you are taking oral contraceptives:

  • Sharp chest pain, coughing of blood, or sudden shortness of breath (indicating a possible clot in the lung).
  • Pain in the calf (indicating a possible clot in the leg).
  • Crushing chest pain or heaviness in the chest (indicating a possible heart attack).
  • Sudden severe headache or vomiting, dizziness or fainting, disturbances of vision or speech, weakness, or numbness in an arm or leg (indicating a possible stroke).
  • Sudden partial or complete loss of vision (indicating a possible clot in the eye).
  • Breast lumps (indicating possible breast cancer or fibrocystic disease of the breast; ask your doctor or health-care provider to show you how to examine your breasts).
  • Severe pain or tenderness in the stomach area (indicating a possibly ruptured liver tumor).
  • Difficulty in sleeping, weakness, lack of energy, fatigue, or change in mood (possibly indicating severe depression).
  • Jaundice or a yellowing of the skin or eyeballs, accompanied frequently by fever, fatigue, loss of appetite, dark-colored urine, or light-colored bowel movements (indicating possible liver problems).

This is not all the information you need to know about safe and effective use of birth control pills. Review the full product information leaflet for your specific birth control product and speak to your doctor or pharmacist if you have questions or concerns.

See Also

Sources

  1. Planned Parenthood. Website. Birth Control Pills. Accessed May 27, 2020 at https://www.plannedparenthood.org/health-info/birth-control/birth-control-pill
  2. American College of Obstetrics and Gynecology (ACOG): Combined Hormonal Birth Control: Pill, Patch, and Ring. FAQs. Contraception. Accessed May 27, 2020 at https://www.acog.org/patient-resources/faqs/contraception/combined-hormonal-birth-control-pill-patch-and-ring
  3. U.S. Food and Drug Administration (FDA). Birth Control Guide. Accessed May 27, 2020 at https://www.fda.gov/consumers/free-publications/birth-control
  4. New Zealand Family Planning. Progestin-Only Contraceptive Pill. Advice. 2018. Accessed May 27, 2020 at https://www.familyplanning.org.nz/advice/contraception/progestogen-only-contraceptive-pill
  5. Patient Counseling Information. Trivora. Drugs.com Accessed May 27, 2020 at https://www.drugs.com/pro/trivora.html#LINK_f74517f0-142c-45cf-a657-9ed4d122a593
  6. American College of Obstetrics and Gynecology (ACOG): Breastfeeding. Accessed May 27, 2020 at https://www.acog.org/patient-resources/faqs/labor-delivery-and-postpartum-care/breastfeeding-your-baby

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.