Birth Control Can Be Helpful, But Are There Any Long-Term Effects?
Birth control can be a lifesaver for people who want to hit the sheets without worrying as much about pregnancy, who have painful or irregular periods, who experience hormonal imbalances and more. Given those reasons, it's likely you may be on the pill (or another form of birth control) for a while, too. As with any medicine, you may wonder if you'll experience any long-term side effects as a result and how much of an issue they'll be. Here's what doctors want you to know.
The long-term effects you may experience
Let's start with the good news.
"In terms of hormonal contraception, most people have no long-term side effects," said Allison K. Rodgers, M.D., a board-certified OB-GYN and an infertility specialist at the Fertility Centers of Illinois.
She doesn't want people to feel scared to use birth control.
"The benefits are so great: better skin, lower risk of ovarian cysts, pregnancy prevention, reduction in endometriosis, control of PCOS [and] painful or heavy periods…the list goes on," Rodgers said. PCOS, or polycystic ovary syndrome, is a condition in which the ovaries produce an abnormal number of androgens, creating a hormonal imbalance.
Any long-term impacts from birth control are usually positive ones, according to Florence Comite, M.D., a clinician-scientist and the founder and CEO of Groq Health, a digital healthcare company based in New York City.
"For example, use of combination birth control for seven years or longer significantly reduces risk of uterine and several other cancers of the reproductive system; [the] exception is cervical cancer," she said. "This impact lasts for decades beyond taking birth control."
However, let's be clear: There are some potential risks, depending largely on your personal health history. Rodgers listed blood clots, especially if you have a genetic predisposition (otherwise, they're rare); increased risk of stroke or heart attack if you use the pill and smoke or have migraines with auras; worsened blood pressure if yours is already high or uncontrolled; and higher pregnancy-related risks.
Many of the risks—such as blood clots, blood pressure changes, etc.—can pop up anywhere from days to years after starting birth control, according to Comite. Decreased bone density is another potential risk, one that increases the longer you're on birth control, she added.
"Low-dose birth control can undermine bone density, leading to osteopenia and osteoporosis since bone turnover is dependent on hormones," Comite said.
The progestin-only Depo shots are an example of a form of birth control that can lower bone density and possibly lead to those diseases.
Additionally, getting certain types of cancer may be more likely.
"There is a lot of conflicting data on this, but the current consensus is that there seems to be an increased risk of some cancers, like cervical and possibly breast, with a decrease in other cancers, [such as] ovarian, colon and endometrial [uterine]," Rodgers said.
But additional factors must be taken into account, she explained. For example, the breast cancer risk is so low, many people find the benefits of birth control worth it. And cervical cancer could be a result of getting HPV from unprotected sex rather than from birth control.
Lastly, according to a 2018 study in Contraception and Reproductive Medicine, you shouldn't have any long-term fertility issues after taking birth control. Comite said birth control can even help with pregnancy, in its own way.
"The pill puts you in charge of your fertility," she said. "By working in partnership with your gynecologist or specialized practitioner, such as an NP, PA or clinician, you can reap the health, convenience and timing benefits of birth control and minimize even the risks of this time-tested therapy."
Does the risk depend on the type of birth control?
Are some forms of birth control safer than others? To an extent, yes.
"The estrogen-containing birth control [has the] highest risk," Rodgers said.
Comite added estrogen can impact your liver and heart, raising cholesterol and blood pressure.
"Usually, milder elevation of blood pressure occurs, however, in some women, it may be more significant, or if you already have high blood pressure, physicians may prescribe progesterone alone," she said.
Having a history of blood clots is another circumstance in which your best option is a progestin-only form of birth control. While the risk is still raised, it's lower than it would be with estrogen. But if you have a personal or family history of breast cancer, you should avoid the progestin-only type, Comite said.
Other than that, the "best" type of birth control isn't clear-cut.
"Each birth control comes with its own risk/benefit profile," Comite said. "Risk increases with age, smoking and those with genetic susceptibility to blood clots."
How to take care of yourself
Before starting birth control (or as soon as possible after starting), ensure you're educated on the signs of the aforementioned risks and any proactive steps to take. Talk to your doctor, weigh any potential concerns and benefits, and choose the birth control option that's right for you.
It's important to note that you may not recognize any signs, by the way. However, with blood clots, Rodgers said you might notice pain in your calf. Other symptoms of a blood clot include swelling, tenderness and redness of the skin.
Additional details to know: Blood pressure issues can usually be reversed. While blood clots and cancer aren't necessarily reversible, on the other hand, they can be treated. Routine cancer screenings and general healthcare practices are crucial for the best results. For example, Rodgers mentioned getting regular breast exams and Pap smears to detect any possible cancer before it spreads.
And, of course, keep in contact with your doctor.
"Stay in touch with your clinician every six months at a minimum to review responsiveness and ensure safety," Comite urged.
Birth control has many benefits and is typically safe in the long term, but you still have to use it responsibly.