Birth Control Pills Advantages and Disadvantages
by eMedExpert staff
Medical references reviewed: August, 2018
Oral contraceptives contain synthetic forms of two female hormones: either progestin alone or estrogen and progestin. Estrogen and progestin regulate a woman's menstrual cycle, and the fluctuating levels of these hormones play an essential role in fertility.
Health benefits and advantages
Birth control pills provide several extra health benefits in addition to preventing pregnancy.
- Highly effective reversible contraception. Birth control pills provide highly reliable method of contraception - the protection exceeds 99%. Even when imperfect use (skipping an occasional pill) is considered, the BCPs are still very effective in preventing pregnancy.
- Menstrual cycle regulation. Birth control pills cause menstrual cycles to occur regularly and predictably. This is especially helpful for women with periods that come too often or too infrequently. Periods also tend to be lighter and shorter.
- Less severe menstrual cramps. Birth control pills can offer significant relief to women with painful menstrual cramps (dysmenorrhea) 8.
- Decreased risk of iron deficiency (anemia). Birth control pills reduce the amount of blood flow during the period. Less blood loss is helpful in preventing anemia.
- Reduce the risk of ovarian cysts. The risk of developing ovarian cysts is greatly reduced for birth control pills users because they help prevent ovulation. An ovarian cyst is a fluid - filled growth that can develop in the ovary during ovulation (the release of an egg from an ovary).
- Protection against pelvic inflammatory disease. Birth control pills provide some protection against pelvic inflammatory disease (PID). Pelvic inflammatory disease is a serious bacterial infection of the fallopian tubes and uterus that can result in severe pain and potentially, infertility.
- Improved acne. Birth control pills can improve inflammatory and non-inflammatory acne 17. For moderate to severe acne, which other medications can't cure, birth control pills may be prescribed. The hormones in the pill can help stop acne from forming.
- Reduces the risk of symptomatic endometriosis. Women who have endometriosis tend to have less pelvic pain and fewer other symptoms when they are on the Pill. Birth control pills won't cure endometriosis but it may stop the disease from progressing. The pills are the first-choice treatment for controlling endometriosis growth and pain. This is because birth control hormones are the hormone therapy that is least likely to cause bad side effects.
- Improves fibrocystic breasts. 70 - 90% of patients see improvement in the symptoms of fibrocystic breast conditions with use of oral contraceptives.
- Improved excess hair (hirsutism). Women with excessive facial or body hair may notice an improvement while taking the Pill, because androgens and testosterone are suppressed by oral contraceptives20. High androgen levels can cause darkening of facial and body hair, especially on the chin, chest, and abdomen.
- Prevents ectopic pregnancy. Because birth control pills work primarily by suppressing ovulation, they effectively prevent ectopic pregnancy as well as normal pregnancy. This makes the pills an excellent contraceptive choice for women who are at particular risk for ectopic pregnancy, a potentially life-threatening condition.
- Helps prevent osteoporosis. Several studies show that by regulating hormones, the pill can help prevent osteoporosis, a gradual weakening of the bones. However, the results of different studies are conflicting 1-3.
- Does not affect future fertility. Using the pills will not affect a woman’s future fertility, although it may take two to three months longer to get pregnant than if a woman did not take pills.
- Easy to use. Does not interrupt foreplay or sexual intercourse.
- Safe for many women. Research for over 40 years has proven long term safety.
Risks and disadvantages
About 40% of women who take birth-control pills will have side effects of one kind or another during the first three months of use. The vast majority of women have only minor, transient undesired effects. Some side effects are uncommon but may be dangerous.
- Heart attack. The chances of birth control pills contributing to a heart attack are small unless you smoke. Studies have demonstrated that cigarette smoking considerably increases the risk of heart attack in women age 35 years or older. That's why the pills are generally not prescribed to women in this age group who smoke.
- Stroke. Women who take oral contraceptive and have a history of migraines (particularly migraines with aura) have an increased risk of stroke compared to nonusers with a history of migraine4. Birth control pills containing levonorgestrel and 30 mg of estrogen are the safest form of hormonal contraception with regard to risk of myocardial infarction or ischemic stroke 14.
- Blood pressure. Women taking birth control pills usually have a small increase in both systolic and diastolic blood pressure, although readings usually remain within the normal range. Blood pressure should be closely monitored for several months after a women starts taking oral contraceptives, and followed yearly thereafter.
- Blood clots (Venous thromboembolism). Women who use birth control pills are at a slightly increased risk of having a blood clot in the legs or lungs. Studies consistently show that the risk of venous thromboembolism (VTE) is two to six times higher in oral contraceptive users than in nonusers. The risk of blood clots is highest in women with clotting disorders or who have previously had a deep venous thrombosis or pulmonary embolism. Other risk factors include obesity13, older age, having several family members who've had blood clots before old age, air travel, and having to lie or sit for a prolonged period, as you might after major surgery. The highest risk of venous thromboembolism carry the pills containing newer progestogens -- desogestrel and cyproterone15.
- Headaches. Headaches may start in women who have not previously had headaches, or can get worse in those who do.
- Depression, irritability. Depression (sometimes severe), irritability and other mood changes may occur11.
- Nausea and vomiting. This side effect usually goes away after the first few months of use or can be prevented by taking the pill with a meal.
- Breast tenderness. Your breasts may become tender or may get larger. Breast tenderness is relatively common during the first month of BCPs and uncommon thereafter.
- Breakthrough bleeding or spotting. Spotting or bleeding between menstrual periods is very common in the first cycle of pills or if pills are missed or taken late.
- Decreased enjoyment of sex. Women may experience a decreased interest in sex, decreased ability to achieve orgasms, and increased pain during sexual intercourse10.
- Weight gain. Some women report slight weight gain. Weight gain is often caused by fluid retention or estrogen-induced fat deposits in the thighs, hips, and breasts. Weight gain may also be related to a reduction in physical activity or increased intake of food. In some women the androgenic effects from the progestins in their OCs can increase their appetite.
- Chloasma (spotty darkening of the skin on the face). Darkening of the skin on the upper lip, cheeks, forehead, or under the eyes (chloasma). This may slowly fade after you stop taking the pills, but in most cases, it is permanent.
- Poor periodontal health. Women who use oral contraceptives experience a significant increase in gingival inflammation and are more likely to have periodontitis12.
- Drug interactions. Birth control pills may not be as effective if you are taking certain medications. Some antibiotics, antifungals, anticonvulsants, herbs like St. John's Wort, can change the amount of the contraceptive hormones absorbed by the stomach and the metabolism of these hormones.
- Not suitable for everyone. Some women should not take pills if they have specific health conditions, including some types of diabetes, liver disease, cardiovascular disease. Women with risk factors for heart disease, such as those with high blood pressure or who are obese, are also at higher risk when on the Pill.
- Sexually transmitted diseases. Birth control pill does not offer any protection against sexually transmitted infections.
- Inconvenience. You must remember to take the pills at the same time every day. Pills must be taken every day, even if a woman does not have intercourse that day. Must use a secondary form of birth control for the initial seven days of use.
- Diarrhea or vomiting. Anything that makes the pill go through your system too fast can make the pill not work as well because the medication was not absorbed or, worse, if it is lost in the vomit.
- Glaucoma. Taking oral contraceptives for more than 3 years significantly increases the risk of glaucoma7.
- Nutrient depletion. Taking oral contraceptives contributes to nutrient deficiencies, including vitamins B2, B6, B12, and C; folic acid16, magnesium, selenium, and zinc9.
- Diabetes. Long-term use of oral contraceptives during reproductive age may be a risk factor for developing diabetes after menopause19. Progestogen-only contraceptives may worsen the results of the glucose tolerance test.
Long-term use and risk of death
Latest 2014 study revealed that risk of death did not significantly differ between women who had ever used birth control pills and those who had never used them6.
- 1. Corson SL. Oral contraceptives for the prevention of osteoporosis. J Reprod Med. 1993 Dec;38(12 Suppl):1015-20. PubMed
- 2. Cooper C, Hannaford P, Croft P, Kay CR. Oral contraceptive pill use and fractures in women: a prospective study. Bone. 1993;14(1):41-5. PubMed
- 3. Lindsay R, Tohme J, Kanders B. The effect of oral contraceptive use on vertebral bone mass in pre- and post-menopausal women. Contraception. 1986 Oct;34(4):333-40. PubMed
- 4. Allais G, Gabellari IC, Mana O, Schiapparelli P, Terzi MG, Benedetto C. Migraine and stroke: the role of oral contraceptives. Neurol Sci. 2008 May;29 Suppl 1:S12-4.
- 5. Schindler AE. Non-contraceptive benefits of oral hormonal contraceptives. Int J Endocrinol Metab. 2013 Winter;11(1):41-7.
- 6. Charlton BM, Rich-Edwards JW, Colditz GA, Missmer SA, Rosner BA, Hankinson SE, Speizer FE, Michels KB. Oral contraceptive use and mortality after 36 years of follow-up in the Nurses' Health Study. BMJ. 2014 Oct 31;349. PubMed
- 7. American Academy of Ophthalmology. 2013 Annual Meeting. Presented November 18, 2013.
- 8. Lindh I, Ellström AA, Milsom I. The effect of combined oral contraceptives and age on dysmenorrhoea: an epidemiological study. Hum Reprod. 2012 Mar;27(3):676-82. PubMed
- 9. Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. 2013 Jul;17(13):1804-13. PubMed
- 10. Battaglia C, Battaglia B, Mancini F, Busacchi P, Paganotto MC, Morotti E, Venturoli S. Sexual behavior and oral contraception: a pilot study. J Sex Med. 2012 Feb;9(2):550-7 PubMed
- 11. Poromaa IS, Segebladh B. Adverse mood symptoms with oral contraceptives. Acta Obstet Gynecol Scand. 2012 Apr;91(4):420-7. PubMed
- 12. Brusca MI, Rosa A, Albaina O, Moragues MD, Verdugo F, Pontón J. The impact of oral contraceptives on women's periodontal health and the subgingival occurrence of aggressive periodontopathogens and Candida species. J Periodontol. 2010 Jul;81(7):1010-8. PubMed
- 13. Sugiura K, Kobayashi T, Ojima T. Risks of thromboembolism associated with hormonal contraceptives related to body mass index and aging in Japanese women. Thromb Res. 2015 Dec 2. PubMed
- 14. Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev. 2015 Aug 27;8:CD011054. PubMed
- 15. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2015 May 26;350:h2135. PubMed
- 16. Shere M, Bapat P, Nickel C, Kapur B, Koren G. Association Between Use of Oral Contraceptives and Folate Status. J Obstet Gynaecol Can. 2015 May;37(5):430-8. PubMed
- 17. Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2012 Jul 11;7:CD004425. PubMed
- 18. Petersen N, Touroutoglou A, Andreano JM, Cahill L. Oral contraceptive pill use is associated with localized decreases in cortical thickness. Hum Brain Mapp. 2015 Jul;36(7):2644-54. PubMed
- 19. Kim SW, Jeon JH, Lee WK, et al. Long-term effects of oral contraceptives on the prevalence of diabetes in post-menopausal women. Endocrine. 2016 Sep;53(3):816-22. PubMed
- 20. Orio F, Muscogiuri G, Giallauria F, et al. Oral contraceptives versus physical exercise on cardiovascular and metabolic risk factors in women with polycystic ovary syndrome: a randomized controlled trial. Clin Endocrinol (Oxf). 2016 Nov;85(5):764-771. PubMed
Last updated: March 20, 2019
Created: May, 2007
- Neuroscientists at UCLA18 have found that oral contraceptives shrink two important regions of the brain (the lateral orbitofrontal cortex and the posterior cingulate cortex). It could account for mood swings and depressive symptoms experienced by women taking the pill.