by Sanaz Majd, MD

I saw a patient in my clinic recently who came in to discuss birth control options. She confided in me that even though she really wants to give it a try, she’s super afraid of hormonal contraceptives because of all the side effects she’s heard her friends complain about.  But at the same time, she knows she needs to start a method right away, because she is not yet ready to become a mother.

I encounter so many women who refuse or are terrified of the hormonal contraceptives. Instead, they prefer the “pull out” method or “natural family planning” methods, which are not very effective.  In fact, I often see women in my office who get pregnant using these methods. 

Every medication, including over-the-counter ones and vitamins, have side effect profiles.  Nothing is without risk.  And some medications work better for some people than others.  It’s important to weigh the risks and benefits of hormonal contraceptives and discuss these issues with your doctor before you make your choice.

Since it seems to be such a hot topic among my own patients, I have decided to devote this episode to the risks and adverse effects of contraceptives. Hopefully, it will answer some of your questions and help you make a well-informed decision.

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Most Common Side Effects of Hormonal Contraceptives

The most common side effects that I find my patients experiencing in response to initiating hormonal contraceptives are the following:

  • Nausea

  • Mild headache

  • Changes in mood

  • Breast tenderness

  • Irregular menstrual bleeding

  • Increased vaginal discharge

  • Weight gain

  • Skin changes

Now, most of these side effects are temporary and typically resolve within the first 3 months of use.  So if the symptoms are tolerable and you can hang in there, your body does typically adjust to the hormonal changes.

Combined Hormonal Birth Control

Combined hormones refer to the combination of the 2 hormones estrogen and progesterone.  By far the most commonly prescribed in this category is the pill, but the hormonal patch and vaginal ring also fall into this category.

There are various groups of patients for whom I do not recommend the combined method.  Hormonal contraceptives have been shown to increase the risk cardiovascular events, mainly heart attack and strokes, in those who are more susceptible.  Therefore, doctors typically don’t recommend the combined hormonal birth control for patients with a history of cardiovascular disease, smokers over the age of 35 who consume more than 15 cigarettes a day, those with uncontrolled elevated blood pressure, and sufferers of migraines with an “aura” (a visual cue prior to the onset of the headaches). 

It is also contraindicated for women with a history of blood clots because it can perpetuate further clot formations.  Clots in the legs are dangerous because they can travel to the lungs and become potentially fatal.  I typically do not recommend the combined method for those with a history of breast cancer either, because it’s not wise to feed a hormonal tumor with hormones that can potentially make it grow. 

The combined hormones are also metabolized through the liver and are not recommended for those with liver disease as well.

Progesterone Only Methods

On the other hand, there are various hormonal methods that contain only progesterone, without the estrogen component.

The Injection

The injection that is administered every 2 months is one of these methods.  There are 3 common adverse events that I have seen in my patients who take this injection method.

  1. There is a higher rate of irregular periods during the first 6 months of initiating the injection.  Women may have breakthrough bleeding, their periods can be heavier, or last longer.  I’ve even had women bleed for a month or longer on this regimen.  The good news is, however, that after the first 6 months, the bleeding subsides and most women have very light periods or stop getting their periods altogether.  But of course if you are someone who gets relief or enjoyment from monthly periods (and yes, some actually do), then this is not the right method for you.

  2. The second issue I encounter in women taking the injection is weight gain.  Studies show an average weight gain of 11 pounds with the use of this method after 36 months of use.  Not everyone gains weight, but I definitely see the most weight gain with the injection compared to other methods.  That is why I don’t like initiating it in those who battle obesity. 

  3. The third issue with the injection is the risk of bone loss when used over 2 years.  So even if you are doing well on this method, it’s really not recommended past the 2-year mark and you will likely need to switch methods at that time.

The Mini-Pill

The mini-pill is another progesterone-only method prescribed to those who cannot take the combined method.  It’s often given to breastfeeding women who desire the pill for birth control at the postpartum visit, when they are still in the early stages of breastfeeding.  Estrogen has been associated with decreased milk production, so that’s why the mini-pill is a good option in postpartum.  The risk of the combined pill interfering with breastfeeding after the first couple of months, once breastfeeding is well-established, is low. 

The only drawback:  it must be taken at the exact time each and every day, or else it is not as effective and risk of pregnancy is higher while taking it.  So if you are the type to simply forget to take a pill every day, it may not be the wisest choice.

Intrauterine Device

The IUD is a soft, flexible “T-shaped” device that is inserted by a trained clinician in a short office procedure similar to a pap smear.  There are 2 types: one with progesterone and one without any hormones.  Check out my previous episode with all the details on IUDs. 

Have you experienced any peculiar side effects from birth control?  If so, log onto my GirlfriendMD Facebook page, and share your thoughts! 

Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.