Birth Control: Dangers & Side Effects

Maybe you've recently gotten into or out of a relationship, maybe you're curious to learn more about your body, or maybe you're just overwhelmed by the variety of options when it comes to birth control these days. Hopefully, you've seen our post explaining how hormonal birth control works in your body, (if not, check it out here!) but that might still leave you wondering - is this a good idea for me or not? While a quick google search on the dangers of hormonal contraception will bring up site after site quoting the usual suspects in terms of side effects, there are more and more consequences emerging that every woman should know about. We'll dig into the research and give you the run-down of effects ranging from general considerations to downright serious concerns of hormonal birth control methods such as the pill, the patch, injections, or an IUD. First, we'll start with the basics.

Birth Control Side Effects

When discussing hormonal birth control, any clinic or pamphlet will give you the laundry list of birth control side effects to know. Some of the more common and documented ones include headaches, weight gain, breast tenderness, nausea, breakthrough bleeding, and a somewhat elevated risk of blood clots (1). This blood clot risk can be higher if you smoke, are over 35, or have a history of high blood pressure so it's important to be really transparent with your healthcare provider. With the multitude of options, sometimes it can take a bit of trial and error before you find a method that works for you and results in the least amount of side effects, whether it's a combination pill, progestin-only, patch, injection, or IUD.

Recently, more evidence and personal stories have emerged of women connecting more chronic symptoms to their (years or even decades spent on) hormonal birth control. A survey-based study of college women across the United States found that the use of hormonal birth control significantly increased the odds of ever being diagnosed with depression (2). This link is further supported by a study of over 1 million women tracked over 10 years, that found women taking combination birth control pills increased their rate of taking antidepressants by 23% (3). For adolescent women (between 15 and 19 years old), those using hormonal birth control were diagnosed with depression at a rate that was 70% higher than those who hadn't used it. Seventy percent! That is no joke. A large 2018 study in Denmark examining similar issues found increased suicide risk with hormonal contraceptives, especially for younger women, with the relative risk of suicide for birth control users more than 3 times that of non-users (4).

Long-Term Birth Control Side Effects

So, maybe you don't fit the risk profile that the brochure describes, and you don't have issues with depression, does that mean you're in the clear? Unfortunately, we're finding out-it doesn't. More studies are also documenting changes and deficiencies in your body linked to hormonal contraception. These are changes that may be affecting you at a level just minor enough that you've never thought to make the connection. For example, like many drugs, oral contraceptives can deplete nutrients in your body, so physicians will often recommend supplements to make up for it. For those taking hormonal contraceptives, these deficiencies can include folate, Vitamin C, Vitamin E, and Vitamin B2, B6, and B12, as well as the minerals magnesium, selenium, and zinc (5). Many women's diets aren't high quality, to begin with, so this additional removal of vitamins and minerals is concerning.

There is also evidence for connections between hormonal contraception and chronic, yet seemingly mysterious hormonal issues such as estrogen dominance, hypothyroidism, and polycystic ovary syndrome (PCOS). Many articles have now linked issues of estrogen dominance to hypothyroidism, and have even found estrogen dominance to be a trigger for thyroid conditions such as Hashimoto's Thyroiditis (6). For women facing a diagnosis of PCOS, they are often told they should try to lose weight and given a birth control pill to help "even things out". However, now that we know how birth control pills work, it's easier to understand that this is not addressing the actual root cause of the problem. Instead, it's just slapping a bandaid on the irregularity, and ignoring the growing evidence that insulin resistance likely has a large role to play and will go on unchecked! (7) Similarly, more and more stories of Post-Birth Control Syndrome, or PBCS, have been surfacing as many women feel more empowered to discuss this topic and find that others experience the same symptoms they do, including heavy periods, infertility, hypothyroidism, headaches, hair loss, anxiety, bloating, and acne, to name just a few (8). Though scientific research on this is lacking, the possibility of your hormones being out of whack after years or decades on synthetic versions of them seems worth exploring.

It's important that you discuss your options with your health care provider because although hormonal birth control is prescribed to and used by many, many women, certain populations are at higher risk for some of the more dangerous side effects. Another recent study in Denmark found that women who took hormonal birth control had a 20% higher risk of breast cancer than those who never did, and that risk was even higher for those women who took it for 10 years (9). Other U.S. based studies have also resulted in similar findings, with one study team reporting that certain types of oral contraceptives gave the user a 50% increased risk in breast cancer (though, the effects were more pronounced with high-dose estrogen compared to moderate-dose estrogen pills) (10). A large meta-analysis in 2006 also found an increased risk of breast cancer for premenopausal women, especially when used prior to first pregnancy for 4 years or more (11).

The Bottom Line

Based on your own life, desires, and financial or romantic situation - you are now armed with the information to make the best choice for you. The best choice now might be different than 5 years from now - but this should be a choice where you use your voice. Unfortunately, given the way the healthcare system is set up today, it can be difficult for doctors to spend more than 10-15 minutes with a patient, and discussing all of these options and side effects will often require more than that. If you feel like you still have questions or aren't getting all of the information you need from your doctor - don't be afraid to take ownership of your health and your body and seek out other informed resources.

While the emergence of "The Pill" and greater access to non-invasive birth control has been a true gamechanger for women over the last few decades, many doctor's offices are so eager to provide it and so rushed in appointments that women will leave a clinic with a prescription and a head full of questions. They may not have even asked for birth control so are confused about whether it's the right choice for them, but proceed anyway because their provider encouraged it. The bottom line is, you know what's best for your body, so listen to yourself and don't be afraid to ask more questions!

References

1. Mayo Clinic. Combination Birth Control Pills. 2019. Available from: https://www.mayoclinic.org/tests-procedures/combination-birth-control-pills/about/pac-20385282
2. Gregory, S.T., et al. Hormonal Contraception, depression, and Academic Performance among females attending college in the United States. Psychiatry Res. 2018 Dec;270:111-116.
3. Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154-1162.
4. Skovlund, CV, Morch LS, Kessing LV, Lange T, Lidegaard O. Association of Hormonal Contraception With Suicide Attempts and Suicides. Am J Psychiatry. 2018 Apr 1;175(4):336-342.
5. Palmery, M, Saraceno, A, Vaiarelli, A, Carlomagno, G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci 2013; 17 (13): 1804-1813.
6. The National Academy of Hypothyroidism. Estrogen Dominance and Hypothyroidism: Is it Hypothyroidism or Hormone Imbalance? 2017. Available from: https://www.nahypothyroidism.org/estrogen-dominance-and-hypothyroidism-is-it-hypothyroidism-or-hormone-imbalance/
7. Traub, ML. Assessing and treating insulin resistance in women with polycystic ovarian syndrome. World J Diabetes. 2011 Mar 15; 2(3): 33-40.
8. Jolene Brighten. Post Birth Control Syndrome and How to Heal Now. N.D. Available from: https://drbrighten.com/post-birth-control-syndrome/
9. Mørch, Lina S., et al. Contemporary Hormonal Contraception and the Risk of Breast Cancer. New England Journal of Medicine. 2017. vol. 377, no. 23, pp. 2228-2239.
10. Whiteman, H. Recent use of some oral contraceptives increases breast cancer risk. Medical News Today. 2014. Available from: https://www.medicalnewstoday.com/articles/280407.php?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Medical_News_Today_TrendMD_1
11. Kahlenborn, Chris et al. Oral Contraceptive Use as a Risk Factor for Premenopausal Breast Cancer: A Meta-analysis. Mayo Clinic Proceedings, 2006. Volume 81, Issue 10, 1290 - 1302.