The oral contraceptive pill, commonly referred to as "the pill," is a form of hormonal contraception taken by approximately 12 million women in the US each year to prevent pregnancy.1
The pill is a highly effective method of birth control when taken correctly (at the same time daily), with only 0.1% of women experiencing an unintended pregnancy, according to the Association of Reproductive Health Professionals (ARHP); around 1 in 100 women taking the pill experience an unintended pregnancy in the first year of pill use.1,2
However, pregnancy rates increase dramatically in women who miss a pill (rates rise 30-80 times, according to the ARHP).2
There are two types of contraceptive pills, both of which contain synthetic forms of the hormones estrogen and progesterone (progestin).3 Combination pills contain both of these hormones, whereas the "mini pill" - known as the progestin-only pill - contains only the hormone progestin.1
The pill may also be taken for non-contraceptive medical purposes to address issues such as:3,4
"The pill" is a type of hormonal contraception that is taken by around 12 million women per year in the US to prevent pregnancy and for other medical reasons.
- Regulation of menstrual periods
- Irregular periods
- Menorrhagia (heavy periods)
- Dysmenorrhea (painful periods)
- Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD)
- Acne, hirsutism (excess hair growth) and alopecia (hair loss)
- Decreasing the risk of breast cysts, ovarian cysts, pelvic inflammatory disease (PID) and pregnancies in the fallopian tubes.
Oral contraceptives are also used as a method to prevent ovarian and endometrial cancers. Birth control pills do not prevent sexually transmitted diseases.1,3,4
Common birth control pill side effects
Common side effects of oral contraceptives include: intermenstrual spotting, nausea, breast tenderness, headaches, weight gain, mood changes, missed periods, decreased libido, vaginal discharge and visual changes with contact lenses.
We'll look at each of these side effects in detail below.
1. Intermenstrual spotting
Approximately 50% of people using the pill experience vaginal bleeding between expected periods - also known as breakthrough bleeding - most commonly within the first 3 months of starting to take the pill. Generally, this resolves in over 90% of cases by the third pill pack.
During spotting, the pill is still effective as long as it has been taken correctly and no doses were missed. People who experience 5 or more days of bleeding while on active pills or heavy bleeding for 3 or more days should contact a health care professional for advice.4
Intermenstrual spotting may occur due to the uterus adjusting to having a thinner endometrial lining, or maybe due to the body adjusting to having different levels of hormones.5
Some people experience mild nausea when first taking the pill, but symptoms usually subside after a short period of time. Taking the pill with food or at bedtime can help lower the likelihood of nausea. Anyone experiencing persistent or severe nausea should seek medical guidance.4
3. Breast tenderness
Birth control pills may cause breast enlargement or tenderness. This side effect tends to improve a few weeks after starting the pill, but anyone who finds a lump in the breast or who has persistent pain or tenderness or severe breast pain should seek medical help.
Reducing caffeine and salt intake can decrease breast tenderness, as can wearing a supportive bra.4
Some people experience side effects with "the pill," such as irregular periods, nausea, headaches or weight change.
The sex hormones have an effect on the development of headaches and migraine. Pills with different types and doses of hormone may result in different headache symptoms. Some studies have previously suggested that headaches are least likely to occur with pills that contain low doses of hormones.6
Headache symptoms are likely to improve over time. Anyone who experiences new onset of headaches when taking the pill should seek medical attention.4
5. Weight gain
Clinical studies have found no consistent association between the use of birth control pills and weight fluctuations. However, many people taking the pill report experiencing some fluid retention, especially in the breast and hip areas.4
Fat cells can also be affected by the estrogen in birth control pills, although the hormone causes the cells to become larger rather than more numerous.7
6. Mood changes
People with a history of depression are recommended to discuss this with their medical provider, as some people do experience depression or other emotional changes while taking the pill. Anyone experiencing mood changes during pill use should contact their medical provider.4
A study of 90 women published in Human Mapping in 2015 found that use of the birth control pill was associated with smaller cortical thickness measurements in the lateral orbitofrontal cortex and the posterior cingulate cortex. These areas of the brain are linked with reward response and evaluating incoming stimuli.8
The authors of the study write that further research needs to be conducted to confirm whether or not there is a connection between cortical thinning in these areas of the brain, mood changes and birth control pill use.
7. Missed periods
There are times when, despite proper pill use, a period may be skipped or missed. Several factors can influence this, such as stress, illness, travel, and hormonal or thyroid abnormalities.
If a period is missed or is very light while on the pill, a pregnancy test is recommended prior to taking the next pack of pills; if further periods are missed or are very light, seek medical advice.4
8. Decreased libido
The hormone(s) in the contraceptive pill can affect sex drive (libido) in some people. However, many other factors can contribute to a decrease in libido. If decreased libido persists and is bothersome, this should be discussed with a medical provider.4
In some instances, however, the birth control pill can increase libido. Such an increase may be due to the relief of painful symptoms such as menstrual cramping, premenstrual syndrome, endometriosis and uterine fibroids.9
9. Vaginal discharge
Some people experience changes in vaginal discharge when taking the pill. This can range from an increase to a decrease in vaginal lubrication, an alteration in the nature of the discharge, and changes which can affect sexual intercourse. In the event of vaginal lubrication decreasing, added lubrication can be utilized to make sex a more comfortable prospect.4
Typically, changes in vaginal discharge are not harmful. Anyone who is concerned about such changes, however, including those who suspect an infection, should speak with their medical provider.
10. Visual changes with contact lenses
Hormonal changes caused by the birth control pill can lead to fluid retention which, in turn, can cause the corneas to swell or change shape. When this swelling occurs, contact lenses may no longer fit comfortably.10
Contact lens wearers should consult their ophthalmologist if they experience any changes in vision or lens tolerance during pill use.4
It is important that anyone who experiences any of the following side effects while taking the pill contacts their medical provider or visits an emergency room immediately, as they may signify a serious condition.4,11
Birth control pill side effects that should be investigated are:
- A: Abdominal/stomach pain
- C: Chest pain (as well as shortness of breath)
- H: Headaches that are severe
- E: Eye problems such as blurred vision or loss of vision
- S: Swelling or aching in the legs and thighs (also redness, swelling or pain in the calf or thighs).
These symptoms can be remembered using the acronym ACHES.
Precautions and risks while taking the pill
People with a history of blood clots, heart attacks or stroke are advised not to take the combination birth control pill.
Blood clots are rare, but anyone with a history of blood clots, heart attacks or stroke is advised not to take the combination birth control pill and to speak with their medical provider about using an alternative method.
It is also important to note that an unintended pregnancy has its own side effects.1
The US Food and Drug Administration (FDA) advise against the use of combination pills in women aged 35 years or older who smoke. Additional factors that increase the risk of blood clots include obesity or a family history of heart disease.1
It is not recommended to take hormonal contraceptives if there is a personal history of liver or heart disease, uterine or breast cancer, uncontrolled blood pressure or migraines with an aura.11
A qualified health care provider should be consulted for individual guidance on the most appropriate method of birth control.
Alternative forms of contraception
There are many other methods of contraception that a health care provider can prescribe, particularly if the side effects of the birth control pill are severe.
The following are just a selection of alternatives to the birth control pill that are available.
A form of barrier contraceptive that prevents sperm from coming into contact with egg cells. Male condoms are sheathes that are placed over the penis, while female condoms are pouches with rings at each end.12,13
Condoms are often made from latex, which can trigger an allergy in some individuals. Alternative condoms are available that are made from polyurethane or lambskin.
A shallow, dome-shaped rimmed cup that is placed in the vagina to block the cervix. A diaphragm must be used alongside spermicide, chemicals that cause sperm to stop moving, rendering them unable to come into contact with egg cells.
People using diaphragms may experience urinary tract infections and vaginal irritation. The latter side effect can be attributed to either the material the diaphragm is made from or the spermicide that is used alongside it.
NuvaRing (vaginal ring)
A plastic ring inserted into the vagina that releases hormones to suppress ovulation.14
The vaginal ring can have similar side effects to the birth control pill, including intermenstrual spotting, headache and reduced libido.
Injections such as Depo-Provera can suppress ovulation and thicken cervical mucus to reduce the chances of sperm from reaching egg cells.
These injections can have similar side effects to the birth control pill. In addition, Depo-Provera could cause a loss of bone mineral density, increasing the risk for osteoporosis and bone fracture in later life.15
A small plastic rod that is implanted into the upper arm and releases a hormone to thicken cervical mucus, thin the endometrial lining and suppress ovulation.
These implants can have similar side effects to the birth control pill. In addition, contraceptive implants may cause abdominal or back pain or increase the risk of noncancerous ovarian cysts.16
Intrauterine devices are an alternative form of contraception to the birth control pill.
Intrauterine devices (IUDs)
A small device made from plastic and copper that is inserted into the uterus. IUDs can be hormonal or non-hormonal. Hormonal IUDs thicken cervical mucus and suppress ovulation, while non-hormonal IUDs produce an inflammatory response in the uterus that is toxic for sperm.
IUDs can cause intermenstrual spotting and irregular menses. Some IUDs can lead to heavier periods with worsened cramps.
A surgical process of male sterilization whereby the tubes that transport sperm from the testicles to the penis are blocked or cut.
Potential complications of the vasectomy procedure include infection, hematoma, bruising and the formation of sperm granulomas - lumps developing in the tissue surrounding the vas deferens where sperm have leaked out.
To learn more about alternative forms of contraception, visit our Knowledge Center article: Birth control methods: types, effectiveness and side effects.
A study published in the journal Cell has claimed that men may soon be able to take their own birth control pill, instead of just women.
A number of studies have suggested that birth control pills increase the risk of breast cancer. A new study published in August 2014 suggests that this increased risk may only apply to recent users and is dependent on the formulation of the pill.
A study published in The Lancet Oncology in August 2015 claims the birth control pill offers long-term protection against endometrial cancer. Researchers say that over the past decade alone, the pill has prevented 200,000 cases of the disease in developed countries.