What Are the Side Effects of Hormonal Contraception 

In this article, I invite you to explore side effects & risks of hormonal contraception with me. I encourage you to look at the articles and studies, too, in order to see these findings for yourself and the nuance involved with issues related to hormonal contraceptive use.

Labeling Hormonal Contraception with Side Effects

In the 1970s, a law was passed to include the listing of side effects of drugs on pharmaceuticals. This particular law was spurred by conversations and debates about hormonal contraception. Many women complained of side effects and didn’t have an understanding that these side effects could be connected to hormonal contraceptive use. This change allowed users to see what possible side effects could occur with pharmaceutical drug use (a very important move to increase informed consent for individuals to know how to advocate for themselves at medical appointments).

Lack of Training in Medical Schools

Studies are being conducted on the effectiveness and side effects of hormonal contraception to better understand its impact on women’s health. Unfortunately, due to a lack of education in medical schools & communities about women’s health, specifically gynecological health, and the various treatment options for diagnoses like poly-cystic ovary syndrome (PCOS), endometriosis, amenorrhea, etc., medical professionals find themselves in a unique position: not understanding the full extent of a woman’s cycle and the impact of her hormonal and egg quality health, uncertain of what’s available for treatment, and a lack of education about the impact of hormonal contraception for short-term or long-term treatment of various cycle concerns and disorders. 

Fortunately, organizations like FACTS are building out extensive programming for medical professionals to learn more and to be able to offer fertility awareness education for patients, along with increased awareness for treatment plans. For many women, the lack of education from the medical community is creating a huge gap in women’s healthcare and in the opportunity for healing root cause issues. This is promoting women to learn their cycles and be stronger advocates for their health, while seeking medical care from medical professionals who are educated much more extensively in women’s health than the average provider.

All that said, I’d like to highlight research that provides insight into the challenges hormonal contraception has introduced to the advancements of care in women’s health. And, what may be causing further health issues for some women. It’s important to note, not every woman experiences side effects, but the information needs to be made readily available so women understand the spectrum of side effects that are possible and that these side effects can be connected to hormonal contraception use. 

How Many Women Are on Hormonal Contraception? 

One particular study, which was updated in 2022, found that 25% of women in the United States aged 15-44 are on a form of hormonal contraception. According to a recent census, there are approximately 64,543,832 women aged 15-44 residing in the United States. So, approximately 16,135,958 women are on a form of hormonal contraception. 

How Does Hormonal Contraception Work? 

There are two different kinds of hormonal contraceptive pills: Oral contraceptive pills are either combined estrogen-progesterone(also called combined oral contraceptive pill- COC) or progesterone-only pill (POP). It’s also important to note that this same study highlighted that most women take hormonal contraception to prevent pregnancy, but about 14% of women take it for other reasons. That means approximately 2,259,034 women take hormonal contraception for other health reasons (acne, endometriosis, unexplained infertility, cycle issues, heavy bleeding, etc.). 

This same study explains how hormonal contraception works in the body and what it is particularly impacting in the cycle: 

Progesterone is primarily responsible for preventing pregnancy. The main mechanism of action is the prevention of ovulation; they inhibit follicular development and prevent ovulation. Progestogen negative feedback works at the hypothalamus to decrease the pulse frequency of the gonadotropin-releasing hormone. This, in turn, will reduce the secretion of follicle-stimulating hormone (FSH) and decreases the secretion of luteinizing hormone (LH). If the follicle isn’t developing, there is no increase in the estradiol levels (the follicle makes estradiol). The progestogen negative feedback and lack of estrogen positive feedback on LH secretion stop the mid-cycle LH surge. With no follicle developed and no LH surge to release the follicle, ovulation is prevented.

Estrogen has some effect with inhibiting follicular development because of its negative feedback on the anterior pituitary with slowed FSH secretion; it’s just not as prominent as the progesterone’s effect. Another primary mechanism of action is progesterone’s ability to inhibit sperm from penetrating through the cervix and upper genital tract by making the cervical mucous unfriendly. Progesterone-induced endometrial atrophy should deter implantation, but there is no proof that this occurs.

What does this mean? Your body stops ovulating and stops reaping the benefits of a healthy cycle. It’s important to remember that a sign of a healthy cycle is ovulation – not your period. Optimal ovulation is ideal for overall health and has positive benefits for sleep, nutrition, and mood. Hormonal contraception has been compared to tricking your body like it’s pregnant, but ultimately the common denominator between a pregnant woman, a menopausal woman, and a woman on hormonal contraception is that your body stops ovulating. However, in both cases of a pregnant woman and a menopausal woman, ovulation stops naturally. Natural Womanhood created a great piece on this topic and explains how different contraceptives work on the cycle and the body.

Is Birth Control a Class 1 Carcinogen? 

In 2007, the International Agency for Research on Cancer (the specialized cancer agency of the World Health Organization) came out with a 543 page publication researching and reviewing studies regarding the risk of combined estrogen-progestogen contraceptives and combined estrogen-progestogen menopausal therapy and if it had the potential to be linked to increasing various forms cancer in women. 

5.5 Evaluation There is sufficient evidence in humans for the carcinogenicity of combined estrogenprogestogen menopausal therapy in the breast. There is evidence suggesting lack of carcinogenicity in humans for combined estrogenprogestogen menopausal therapy in the colorectum. There is sufficient evidence in humans for the carcinogenicity of combined estrogenprogestogen menopausal therapy in the endometrium when progestogens are taken for fewer than 10 days per month, and there is evidence suggesting lack of carcinogenicity in the endometrium when progestogens are taken daily. The risk for endometrial cancer is inversely associated with the number of days per month that progestogens are added to the regimen. There is limited evidence in experimental animals for the carcinogenicity of conjugated equine estrogens plus medroxyprogesterone acetate. Overall evaluation Combined estrogen–progestogen menopausal therapy is carcinogenic to humans (Group 1).

6. Overall evaluation Combined oral estrogen-progestogen contraceptives are carcinogenic to humans (Group 1). There is also convincing evidence in humans that these agents confer a protective effect against cancer of the endometrium and ovary.

The answer? Yes, the extensive research conducted found both forms of hormonal contraception and hormonal therapy to be positively linked to increasing risk of certain forms of cancer, but that does not mean you are guaranteed to develop cancer. Therefore, it is listed as a class 1 carcinogen.

Does birth control cause cancer? 

While women are at an increased risk, not all hormonal contraceptives are created equally and it can impact each woman differently (based on the hormones introduced into a woman’s body that may or may not already have hormonal imbalances at play). Hormonal contraception is designed to be a “one size fits all”, which may sound wonderful, but can actually cause negative health effects because women aren’t receiving personalized care for their reproductive health. 

In 2012, a study was published reviewing the risk and side effects of hormonal contraceptives. This particular study reviewed the risk to patients and if it, in fact, supported women’s health or created more challenges.

We have concentrated our efforts on three major areas: increased rates of cardiovascular disease, breast cancer, and human papillomavirus (HPV) or cervical cancer. If fertility and pregnancy are not disease states, and are, in fact, normal conditions associated with healthy individuals, OCPs fail the most important test of preventive medicine: they increase risk of disease instead of decreasing it. Patients should not be misled or confused into believing that what they are taking is “good for them” and is of the same beneficial effect as other preventive measures.

What are the Side Effects? 

Brown University lists the possible side effects women can experience with use of hormonal contraception. Additionally, American Family Physician Journal (from the American Academy of Family Physicians) lists side effects that almost exactly match the list from Brown University, which is important to note as many hormonal contraceptive options cause similar side effects. While often these lists are titled as minor side effects, I would argue these side effects can range in severity. Additionally, if multiple side effects are experienced, these can drastically impact quality of life and how you function on a daily basis.

As an example, I’ve had women reach out who said they experienced low libido while on hormonal contraception during the early years of marriage. Due to a lack of education about the side effects, they didn’t realize this could be causing challenges in their sexual intimacy with their spouses. Finally, these women sought out alternatives and found that, once off of hormonal contraception, their libido increased and sex became more enjoyable. 

Increased Risk of Suicide Attempts & Suicide in Adolescent Girls

In 2017, a study was published by the American Journal of Psychiatry that found girls and women using hormonal contraception were 97% more likely to attempt suicide than those not taking hormonal contraception and these same women were 200% more likely to succeed in their suicide attempt. This study particularly looked at women in Denmark and the study found suicide attempts were more common in adolescent girls in the first two months of taking hormonal contraception. After about one year of use, the risk of suicide decreased, although risk of suicide was still higher in those who used hormonal contraception. While other factors can be attributed to suicide risk, this particular study found use of hormonal contraception was positively associated with subsequent suicide attempt and risk.

How Your Brain is Impacted by Hormonal Contraception

In 2019, Dr. Sarah Hill released a book, “How the Pill Changes Everything: Your Brain on Birth Control”. Hill highlighted that hormonal contraception impacts a woman’s mood, perceptions, and stress response because of hormonal changes due to synthetic hormones introduced into the body to stop ovulation from occurring. She also confirmed previous research conducted that has found hormonal contraception can influence the choice of a romantic partner. Dr. Hill also found the pill can alter the brain’s response to stress and links have been found to have effects on the immune system, learning, and memory. While she talks critically about hormonal contraception and its side effects on women’s health, she’s not ready to throw away its use because she identified that “not being pregnant when you don’t want to be pregnant – for me, the benefits of that far outweigh almost any brain changes the pill can cause”. She does recommend looking at other family planning options that have less side effects and less negative impacts on overall health.

Citizen’s Petition Sent to the FDA for Review 

In the same year Dr. Hill’s book was published, the organization Natural Womanhood highlighted a Citizen’s Petition taking place asking women to share their stories of negative side effects from hormonal contraception. The organization and its CEO, Gerard Migeon, were incredibly vocal about asking women to sign and share their stories. At that time, the document was over 100 pages long, filled with stories and concerns about usage of hormonal contraception. This document was sent to the FDA to add a black box warning to all hormonal contraception packaging in which the particular drug has proven serious side effects.

Doesn’t this sound like a familiar cause that took place during the inception of the development of hormonal contraception? It seems that women’s voices about the seriousness of side effects and the desire for their health to be taken seriously is a constant battle. If alternatives could be offered and if adverse effects could be taken seriously by the FDA and medical community, what would women’s healthcare look like? What advancements might we see in care? I would argue that it would create positive changes and better, varied options for women’s healthcare. And, finally listening to women’s voices and their stories.