What are the side effects of birth control?

Medically reviewed on February 17, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Nausea, headaches, spotting, depression—if these sound familiar, you’re not alone. For many women, taking birth control comes with several side effects.

But is it possible to find a birth control method that works and won’t cause side effects? The answer is a hopeful yes. It just comes down to individual health needs.

Between hormonal and non-hormonal birth control, most women can find a method that fits their lifestyle and works well with their bodies. To get started, here’s our guide to contraceptives and their side effects.

Hormonal birth control types and side effects

Just a few decades back, hormonal birth control came as a singular oral contraceptive pill. Today, hormonal options span an entire medicine cabinet, including:

• Oral pills
• Patches
• Insertable rings
• Implanted devices
• Hormone injections

Women have many hormonal contraception options from implanted devices to oral pills. But what are the side effects of birth control regarding hormones? Before choosing, let’s explore each hormonal contraceptive and its possible effects [1].

Combination birth control pills

Known as “The Pill,” oral birth control is a popular and highly effective contraceptive. However, not all pills are created equal. Oral contraceptives (and all hormonal contraceptives) fall under combination or progestin-only categories.

The first generation of hormonal birth control, combination pills, use both estrogen and progestin. Some women might experience side effects like [2]:

• Breast tenderness – Estrogen increases can lead to breast soreness or tenderness.
• Nausea – In one study consisting of self-reports from women, about 15% of combination pill users experience nausea [3]. The link is not yet clear, but estrogen may contribute to this side effect.
• Increased risk of blood clots – While minimal, increased estrogen does lightly increase the risk of thromboembolism [4]. Risk increases with age and is shaped by estrogen dosage.
• High blood pressure – Studies suggest that the estrogen in combination pills can potentially contribute to increased blood pressure. This side effect most often appears within 6 months and sometimes can occur up to 6 years from initial use [5].

Progestin-only birth control pills

Progestin-only birth control delivers exactly what it states—just progestin. This hormone stops the ovaries from releasing eggs, preventing pregnancy at a 99% success rate. Progestin-only contraception typically has fewer side effects, but a few stick out above the rest:

• Irregular menstruation – About 20% to 30% of women on the mini pill experience spotting or breakthrough bleeding [6]. Unlike combination pills, progestin-only pills do not have designated menstruation weeks.
• Acne – Around PMS, progestin spikes in the body and can trigger hormonal acne. Without estrogen to temper it, progestin-only pills may similarly induce acne [7].
• Ovarian cysts – While research is not yet clear on why, progestin-only pills correlate with higher ovarian cyst risk.
• Depression and mood changes – Many women report a negative shift in mood with hormonal contraception. Turns out, that shift isn’t imaginary. One long-term study found hormonal birth control (both combination and progestin-only) increased the risk of depression from 1.7% to 2.2% [8]. In particular, higher progestin levels correlated with higher depression rates.

Birth control patch

A less popular option, the patch delivers contraceptive hormones via skin absorption. Like combination pills, it carries the side effects of estrogen and progestin—headaches, breast pain, and more [9]. The patch also has a few specific side effects, including:

• Skin irritation (at site of patch)
• Diarrhea
• Muscle spasms

Vaginal rings

Inserted into the vaginal canal, vaginal rings emit progestin and estrogen to the surrounding uterus. Since these rings locally release hormones, they attempt to minimize side effects. However, a combination of hormonal symptoms are still possible in addition to ring-specific side effects like:

• Vaginal infection
• Vaginal irritation
• Increased vaginal discharge
• Diarrhea

Birth control shot

You might know the birth control shot by its brand name, Depo-Provera. A one-and-done method, each shot includes three months’ worth of combination hormonal protection. The flipside? Depo-Provera is known for its significant hormonal side effects, particularly:

• Delayed fertility – Without continued use, the shot loses its pregnancy prevention powers. However, it can take up to ten months to get pregnant after the final shot, which may lead you to start asking how to boost your fertility.
• Weight gain – Of all the hormonal contraceptives, the shot has the highest risk of weight gain. Over one year, a study found that Depo-Provera caused more weight gain than oral contraceptives, hormonal implants, or no hormonal birth control [10].
• Bone density loss – Research shows that Depo-Provera might contribute to bone density loss in women. Accordingly, the US Food and Drug Administration recommends that women not use the shot for more than two years [11].

Hormonal IUD

Shaped like a mini “T,” hormonal IUDs are a durable and highly effective contraceptive. Medical professionals implement an IUD inside the uterus, where it releases progestin. Since IUDs release hormones locally to the uterus, side effects are typically weaker. However, many women still experience these symptoms:

• Irregular menstruation or spotting
• Insertion site pain (fades after days or weeks)
• Pelvic pain or cramping
• Pain or cramping during sex

Many women fear that an IUD will perforate their uterus or fall out. However, perforation and ejection are rare. For women with hormonal IUDs, only 0.01% experience uterine perforation and 5.5% experience expulsion [12, 13].

Hormonal implant

Similar to IUDs, hormonal implants are highly effective in lowering the chances of getting pregnant. However, implant devices lie inside the upper arm, not the uterus. Implants also release both estrogen and progestin into the bloodstream, not just progestin. As a result, women often experience more side effects with implants [14], particularly:

• Irregular menstruation or spotting
• Swelling, bruising, or tingling at the implant site
• Weight gain
• Breast swelling and pain
• Mild insulin resistance

Non-hormonal birth control methods

For some women, hormonal contraception simply doesn’t click. The cons outweigh the pros. Non-hormonal contraception offers an alternative that’s (mostly) free of symptoms. From IUDs to sponges, here are the top non-hormonal birth control methods and their side effects.

Copper IUDs

A copper IUD, also known as the Paragard [15], looks like a hormonal IUD. However, this uterine implant has zero hormones—instead, the copper naturally repels sperm. A drawback? Copper IUDs are one of the few non-hormonal contraceptives with physical side effects, such as:

• Heavier periods – Copper naturally increases vascularity, driving more blood to the uterine area. As a result, heavier periods on the copper IUD for the first three to six months can be expected.
• Cramping and back pain – Alongside heavier periods, copper IUDs also induce worse cramping and even back pain during menstruation. These symptoms also tend to fade after a few months.
• Perforation or expulsion – Like any IUD device, the Paragard could potentially perforate the uterus or fall out. Risk stays close to hormonal IUDs, sitting at 0.01% for perforation and 6% for expulsion [12, 13].

Condoms and diaphragms

For millennia, men and women have used physical barriers as contraceptives. While less effective than hormonal options, some barriers provide birth control with minimal side effects and STD protection—a huge advantage for safety. Here are the most common barriers:

• Male condoms – From latex to lambskin, male condoms are the most common form of contraception. Even when used correctly, their protection rate only rises to 85%. The only potential side effects would be allergic reactions to the condom materials, like itching, hives, or irritation.
• Female condoms – A less popular option, female condoms create a 79% effective barrier against sperm inside the entire vagina. They typically include spermicidal lube for extra protection. Like male condoms, the only side effects come from allergic reactions.
• Diaphragm or cervical caps – These small, cup-shaped barriers sit below the cervix, usually with the addition of spermicidal liquid. If unclean or left in too long, diaphragms can lead to vaginal discharge, infections, and/or irritation.

Spermicidal products

Spermicidal products are more the supporting actor than the star. Due to low effectiveness, women typically pair spermicides with other contraceptives. At best, its success rate ranges from 72% to 88%. There are a few different spermicide options:

• Foam, gel, or cream
• Suppository or tablet
• Lube
• Sponge (soaked in spermicide)

A great plus? Spermicidal products have few side effects. At most, frequent spermicide use can irritate genital tissues of either sex. Otherwise, they’re quite safe.

Unlock wellness with Everlywell

From spermicide to shots, there is no “right” birth control method. The best contraceptive is the one that fits your needs, whether that’s long-term use or limited side effects: minimum pain, maximum protection.

Evaluating your health is crucial before choosing any medication—and with Everlywell, you can evaluate from your own home. Test crucial hormone levels like estrogen, progesterone, luteinizing hormone, and more with our Women's Health Test (note that birth control methods can affect hormone levels). With one test, you can place wellness into your hands.

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References

1. Contraception. Centers for Disease Control and Prevention. URL. Accessed February 17, 2022.

2. Combination birth control pills. Mayo Clinic. URL. Accessed February 17, 2022.

3. de Melo NR. Estrogen-Free Oral Hormonal Contraception: Benefits of the Progestin-Only Pill. Women’s Health. 2010;6(5):721-735.

4. Brynhildsen J. Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks. Ther Adv Drug Saf. 2014;5(5):201-213.

5. Oparil S. Hypertension and oral contraceptives. J Cardiovasc Med. 1981 Apr;6(4):381, 384-7. PMID: 12263383.

6. Howie PW. The progestogen-only pill. BJOG: An International Journal of Obstetrics and Gynaecology. 1985;92(10):1001-1002.

7. Trivedi MK, Shinkai K, Murase JE. A Review of hormone-based therapies to treat adult acne vulgaris in women. International Journal of Women’s Dermatology. 2017;3(1):44-52.

8. Schaffir J, Worly BL, Gur TL. Combined hormonal contraception and its effects on mood: a critical review. Eur J Contracept Reprod Health Care. 2016 Oct;21(5):347-55. Epub 2016 Aug 15. PMID: 27636867.

9. Birth control patch. Mayo Clinic. URL. Accessed February 17, 2022.

10. Moore LL, Valuck R, McDougall C, Fink W. A comparative study of one-year weight gain among users of medroxyprogesterone acetate, levonorgestrel implants, and oral contraceptives. Contraception. 1995;52(4):215-219.

11. Depo Provera and Bone Mineral Density. National Women's Health Network. URL. Accessed February 17, 2022.

12. Rowlands S, Oloto E, Horwell D. Intrauterine devices and risk of uterine perforation: current perspectives. Open Access Journal of Contraception. Published online March 2016:19.

13. Madden T, McNicholas C, Zhao Q, Secura GM, Eisenberg DL, Peipert JF. Association of Age and Parity With Intrauterine Device Expulsion. Obstetrics & Gynecology. 2014;124(4):718-726.

14. Contraceptive implant. Mayo Clinic. URL. Accessed February 17, 2022.

15. ParaGard (copper IUD). Mayo Clinic. URL. Accessed February 17, 2022.