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Without continuous education, our understanding of birth control remains stagnant. In The State of Your Birth Control, Mytour traces the evolution of contraception in the U.S. and offers essential insights into available options, medical progress, and legal availability. Explore the entire series here.
Choosing a birth control method can feel overwhelming, especially if you're apprehensive about severe side effects. You might have heard alarming stories about risks like organ perforation from using intrauterine devices, or claims linking birth control to migraines. However, severe side effects are rare, typically occurring only if you have a pre-existing condition that could trigger them.
When it comes to more common side effects, the positive aspect is that with so many options available, you're likely to find a birth control method that minimizes the side effects you're most concerned about. The downside is that there's no surefire way to predict how any specific form of birth control will affect you personally.
How likely are you to experience side effects from birth control?
The list of side effects on packaging can seem overwhelming, like the 21 potential side effects listed on the label of Yaz, a widely used birth control pill. These include irregular periods, headaches, changes to your menstrual cycle, fatigue, nausea, bloating, mood swings, breast tenderness, cramps, weight fluctuations, and more serious risks like depression, blood clots, strokes, and heart attacks. Additionally, many hormonal birth control methods may cause changes to your physical appearance, such as worsening or improving acne, hair growth changes, or swelling in the hands and feet.
More serious risks like blood clots and an increased likelihood of deep vein thrombosis or stroke are usually connected to pre-existing risk factors such as smoking, obesity, or a family history of these conditions, according to Dr. Brett Worly, an associate professor of obstetrics and gynecology at The Ohio State University.
Fortunately, current research has debunked two widely believed claims about birth control: that it causes depression in individuals who were not previously depressed, and that it leads to weight gain.
Dr. Worly, who conducted a 2018 meta-analysis on this subject, explains, 'I looked as thoroughly as I could to find evidence linking hormonal contraception to depression. I couldn’t find any convincing proof that one directly causes the other.'
Recent research similarly refutes the connection between hormonal birth control and weight gain, with the only exception being the Depo-Provera injection.
Dr. Amy Bryant, an assistant professor of obstetrics and gynecology at the University of North Carolina-Chapel Hill, explains, "Most research shows no significant weight change in women using hormonal contraception methods. People tend to gain weight over time in this country."
However, that doesn't mean you should disregard other possible side effects of your birth control. If you're not feeling satisfied after a few months, Bryant advises revisiting your doctor to explore alternative options.
"Despite years of research and considerable progress, we still don't have the perfect contraceptive method that suits everyone or works equally well for each individual," Bryant notes. "I emphasize that none of these options are permanent, so if one doesn’t work for you, we can always try something else."
Bryant also highlights that the key to choosing the right birth control is understanding what you want from it—whether it's a more predictable period, clearer skin, or a form of contraception that requires no constant attention.
Here's an overview of the side effects of popular hormonal birth control methods, providing insight to help make the decision a bit easier.
Side effects of the pill
There are numerous oral contraceptive brands available, but they all function similarly. Combination pills contain both estrogen and progestin—the synthetic form of the hormone progesterone—but there's also the option of the ‘mini pill,’ which contains only progestin. When used correctly, the pill is 99% effective, although its effectiveness drops to 91% if it's not taken consistently.
Why choose it: The pill is popular because it's easy to use, reliable, and can help regulate periods, according to Bryant. Combination birth control pills are also the only FDA-approved hormonal acne treatment. Fertility returns almost immediately once you stop using the pill.
Why avoid it: The pill relies on the user to remember to take it every 24 hours for maximum effectiveness. People with schedules that don’t fit this model may want to consider other birth control methods, Bryant explains. Additionally, individuals who smoke or have a higher risk of heart attack, liver disease, or breast cancer should consult with their doctor before using estrogen-based pills.
Long-acting reversible contraceptives (LARCs)
Over the past decade, both the intrauterine device (IUD) and the Nexplanon arm implant have gained popularity as their technology has improved—from 3.7% of birth control users in 2007 to 10.6% in 2017. Both options are progestin-only, although the levels of progestin differ based on the specific device.
Nexplanon is the sole arm implant available today, releasing 35-45 micrograms (mcg) of progestin per day in its first year, while IUDs come in various sizes and release different amounts of progestin. The most widely used ones include:
Mirena, which releases 20 mcg of progestin daily
Kyleena, releasing 17.5 mcg per day
Liletta, releasing 18.6 mcg daily
Skyla, releasing 14 mcg per day
ParaGard – a copper IUD, and the only non-hormonal IUD available
Why consider it: IUDs and Nexplanon are 99% effective in the first few years of use (LARCs can last between three and twelve years, depending on the brand). Many choose a LARC because they prefer a ‘set it and forget it’ method, as Worly puts it. Once removed, pregnancy can occur immediately.
Why avoid it: Inserting the IUD requires a doctor or nurse to pass an applicator tube through the cervix into the uterus, which can result in mild to severe cramping. One in 20 IUD users may experience expulsion, where the IUD leaves the uterus on its own. ParaGard users frequently experience heavier periods and cramps, while hormonal IUD users may notice changes in their bleeding patterns, such as lighter periods, more frequent spotting, or even no periods at all.
The Depo-Provera shot
The Depo-Provera shot is a progestin-based injection given every 12-14 weeks by a healthcare provider to prevent pregnancy. If administered on schedule, the shot is 99% effective, but due to missed appointments, its overall effectiveness drops to 94%.
Why choose it: The shot is ideal for those who seek the reliability of long-term birth control but aren't comfortable with the insertion of a device, Bryant explains.
Why avoid it: If you’re uncomfortable with needles or think you might have trouble keeping up with the required appointments, you might want to consider other options, Bryant advises. Furthermore, she points out, the shot contains a high level of hormones, making it the only hormonal birth control method linked to potential weight gain.
The patch and the ring
Though less commonly chosen than other hormonal contraceptive methods, the patch and NuvaRing offer hormonal alternatives. Both release a combination of estrogen and progestin. The patch is replaced once a week, while the NuvaRing is swapped every three weeks. When used correctly, both methods are 99% effective, but user error lowers the effectiveness to 91% for each.
Why choose it: Both options are effective alternatives to the pill, providing a short-acting method with less hands-on involvement compared to oral contraceptives, Bryant explains.
Why avoid it: Since neither method is permanent, you must remember to change them on schedule and verify that neither has become dislodged before engaging in intercourse.
