What you should and shouldn't be concerned about when it comes to birth control pills

The first birth control pill was approved by the US FDA almost six decades ago—and it was far from ideal. Extremely high hormone doses caused unneeded and hazardous side effects, scaring patients away from contraception entirely.

Although pills on the market now have far lower hormone levels and are much safer, doubts about how they function and their negative effects remain, especially since the FDA just permitted one version of the drug to be sold without a prescription.

Some side effects and hazards are to be expected with any medicine, but experts believe birth control pill advantages much exceed the risks when used properly, especially when it comes to avoiding pregnancy.

"We're still trying to figure out everything that the pill does, and while we know it affects women, it's not dangerous," says Sarah Hill, a research psychologist who studies women's health and author of This Is Your Brain On Birth Control. "It's about making decisions that are right for you, given your specific goals."

Here's a primer on the birth control pill.

What is the distinction between birth control pills?

Birth control pills are classified into three categories. They all function by secreting synthetic hormones that prevent the ovaries from producing an egg and thickening cervical mucus, preventing sperm from entering the uterus.

The most often prescribed combination pill, also known as "the pill," comprises synthetic forms of the hormones estrogen (ethinyl estradiol), which controls menstrual bleeding, and progesterone (progestin), which prevents conception.

The progestin-only tablet, sometimes known as a "mini-pill," contains only progestin. On July 13, the FDA approved an over-the-counter version of this tablet.

A continuous-use pill is a form of combination tablet that contains more active pills per pack and can shorten, reduce the frequency of, or entirely stop your period. (Inactive pills, commonly known as placebo pills, are hormone-free. These cause your period to begin.)

The estrogen in most birth control pills is the same. But, according to Stephanie Teal, chief of the OB-GYN department at University Hospitals Cleveland Medical Center in Ohio, there are many types of progestin utilized in pills that differ in how they connect to active receptors on your cells.

According to Teal, this could explain why one sort of medication causes acne while another clears it.

Because generic medicines contain the same active components as brand-name tablets, they carry the same dangers and benefits.

How may the pill benefit me other than avoiding pregnancy?

All birth control pills can help make your periods lighter and less painful, as well as reduce your risk of ectopic pregnancy, which occurs when a fertilized egg develops outside the uterus.

The combo pill, in particular, can help you get your period on time while also preventing acne, bone thinning, cysts in your breasts, endometriosis symptoms, anemia, strong mood swings, and certain types of cancer (more on this later).

The pills include synthetic hormones that assist balance natural hormonal swings in your body, which are responsible for numerous symptoms such as acne and severe cramps.

Will the pill make me moody?

It depends, according to Hill.

According to surveys, mood changes are one of the most prevalent side effects reported by pill users. Depressive symptoms and an increased risk of suicide are frequently related with hormonal contraception, particularly among teenagers aged 15 to 19.

According to Hill, progestin increases receptors in the brain for the stress hormone cortisol, which is why some people feel nervous or depressed.

At the same time, some women may use the pill to treat premenstrual dysphoric disorder, which causes significant irritability, depression, or anxiety in the weeks before their period. This works by adjusting the amounts of your hormones.

Will I gain weight if I take the pill?

According to research, the tablet does not cause considerable weight gain. (The ring, patch, and intrauterine devices are likewise not linked to weight gain.)

People who used the progestin-only pill gained an average of four pounds after six or twelve months, which was comparable to those who used other birth control methods; researchers concluded that people may gain weight naturally over time regardless of contraceptive use.

It's difficult to blame the medication for weight gain because many other factors, such as nutrition and stress, might play a role.

"On the whole, we don't see a change in weight other than what we would expect somebody to gain just by aging," Jennifer Kaiser, an OB-GYN and assistant professor of complex family planning at the University of Utah ASCENT Center for Reproductive Health, says. She goes on to say that if you do gain weight, you can work with your doctor to reduce your dose or change your birth control method.

Does the pill raise my chances of developing blood clots?

According to the National Blood Clot Alliance, approximately one in every 3,000 women using the pill will develop a blood clot. Although this is one of the most serious hazards connected with the tablet, physicians say it is extremely unusual.

According to Kaiser, this risk applies to any birth control method that contains estrogen since the hormone stimulates the liver to make more chemicals that can form clots. This means that progestin-only pills pose no danger of blood clots.

Meanwhile, pregnancy, which increases estrogen levels in the body, has a considerably higher thrombosis risk, according to Teal: People on the pill have around twice the chance of developing a blood clot as those who are not on the pill. According to Teal, pregnancy increases this risk 5- to 20-fold, depending on their age, weight, and smoking status. It increases 40- to 65-fold in the first six weeks after birth.

That is what researchers refer to as the relative risk, or the risk of getting a clot while taking the pill vs the risk of not taking the pill. When it comes to absolute risk, or the likelihood of developing a clot while taking the tablet, the odds are "incredibly low," according to Teal.

Can the pill enhance my chances of getting breast cancer?

Some studies reveal that people who are now using or have previously used any hormonal birth control pill have a 25% higher chance of developing breast cancer than non-users. According to some research, the risk increases the longer you use the tablet.

When you stop taking medication, the danger decreases and then disappears after about ten years.

Some malignancies are aided in their genesis and proliferation by estrogen and progesterone. Because the pill contains synthetic versions of these hormones, it is assumed that it will fuel cancer growth in people who already have mutations in their breast tissue cells, according to Heather Eliassen, professor of epidemiology at Harvard T.H. Chan School of Public Health and the director of the Nurses' Health Study II, who studies breast cancer.

However, the absolute risk, according to Eliassen, is much smaller. This is because the majority of people who take the pill are young and in good condition. Breast cancer risk naturally rises with age.

People with the BRCA1 and BRCA2 genes, which raise their risk of breast cancer, may be more likely to acquire the disease while taking the pill than those who do not have the genes. However, Kaiser believes that this amplified effect is "pretty minimal" when you consider that these genes also raise the risk of ovarian cancer, which the pill has been shown to protect against.

Can the pill keep me safe from other cancers?

Yes. People who have ever used the pill had a 30 to 50% lower risk of ovarian cancer than those who have never used it, according to research.

According to the National Cancer Institute, studies have found that the pill can reduce your risk of endometrial cancer by at least 30% and colorectal cancer by 15 to 20%.

Does the pill reduce libido?

There is no conclusive proof that it works, however studies have found that anywhere from 5% to 48% of people on the pill report a decrease in sexual desire.

According to Hill, this makes sense because the tablet lowers testosterone levels, a hormone that boosts libido in women.

Is it okay to smoke while taking the pill?

If you're 35 or older, smoking while on the pill can increase your chance of blood clots and high blood pressure, both of which are risk factors for heart attack and stroke.

According to research, elevated estrogen levels from the pill are linked to faster nicotine metabolism, resulting in greater dependence, cravings, and withdrawal symptoms.

According to Planned Parenthood, if you smoke 15 or more cigarettes a day, you should avoid using the pill or other estrogen-based birth control methods such as the patch and ring. If you smoke or vape nicotine in any way, consult your doctor about the best method of birth control for you.

It is safe to take progestin-only pills or other non-estrogen options such as a shot, implant, or IUD.

Can the pill make it more difficult for me to conceive?

No. No matter how long you've been on the pill, you can become pregnant soon after stopping it.

In fact, the month after you stop using the pill, your hormones have a "rebound effect," making you more fertile than usual, according to Teal. The pill may also protect you from pelvic inflammatory disease, a reproductive organ infection that can lead to infertility.

However, Kaiser warns that fertility naturally falls with age. So, if you started taking the pill when you were 18 and now want to get pregnant at 36, your baseline fertility will be different, according to Kaiser, "not because of the pill, but because you're older."

Should I be concerned about the pill's long-term risks?

Absolutely not, says Hill. There is no proof that the tablet creates long-term effects in the body.

Side effects are usual, common, and only last a short time. Your body should have acclimated to the hormonal changes two to three months after starting the pill, and any unpleasant effects should have subsided.

Is it better if I don't take the pill?

At any given time, only you know what is best for you and your health. If you have uncontrolled hypertension, a blood-clotting issue, severe diabetes, a stroke, or lupus, you may want to avoid some types of medicines.

When it comes to health concerns, however, there is no doubt that pregnancy is the most serious of them all, according to specialists. Depression, heart issues, diabetes, anemia, infection, and mortality are all pregnancy consequences. Meanwhile, maternal mortality rates in the United States are increasing, reaching 32.9 deaths per 100,000 live births in 2021, up from 23.8 in 2020 and 20.1 in 2019.

"We talk a lot about risks with birth control because people feel like they're opting to take something that they don't necessarily have to," says Kristyn Brandi, an OB-GYN and complicated family planning specialist and Darney-Landy Fellow at the American College of Obstetricians and Gynecologists.

"But, at the same time," Brandi points out, "being pregnant is always more dangerous than not being pregnant."

However, we all react differently to hormonal changes, according to Hill.