Picking a birth control can seem scary, especially if you’re worried about the more extreme side effects. You may have heard the horror stories about the risks of organ perforation using intrauterine devices, or claims that birth control is linked to migraines. However, extreme side effects are rare, and usually only occur if you have a pre-existing condition that might trigger them.
As for the common side effects, the good news is that because there are so many options on the market, there’s likely a form of birth control out there that minimises the effects you’re most concerned about. The bad news is that there is no exact science for predicting how a certain birth control will affect any one person.
The likelihood of experiencing side effects
Lists of side effects on packages can look long and scary, like the 21 possible side effects listed on the label for Yaz, a popular birth control pill: irregular periods, headaches, changes in your menstrual period, fatigue, nausea, bloating, mood swings, breast tenderness, cramps, changes in weight, and a disclaimer of severe side effects like depression, blood clots, strokes and heart attack. Other common side effects for most forms of hormonal birth control include a chance of changes to your physical appearance such as worsened (or improved) acne, changes in hair growth patterns or swelling in your hands and feet.
The more severe side effects, like blood clots and increased risk of deep vein thrombosis or stoke, are generally linked to previous risk factors like smoking, obesity or family medical history, says Brett Worly, MD, an associate professor of Obstetrics and Gynecology at The Ohio State University.
Luckily, physicians agree that current research disproves two commonly listed associations of birth control: that it causes depression in people who weren’t previously depressed, and weight gain.
“I looked as hard as I possibly could to try and figure out if hormonal contraception causes depression,” says Worly, who authored a 2018 meta-analysis on the topic. “I couldn’t find anything that was a convincing suggestion that one thing directly causes the other.”
Current studies similarly disprove the association between hormonal birth control and weight gain, with the exception of the Depo-Provera shot.
“Most studies that have been done show there’s no difference in weight in women using hormonal methods of contraception,” says Amy Bryant, MD, and assistant professor of Obstetrics and Gynecology at the University of North Carolina-Chapel Hill. “People gain weight over time, in this country.”
However, that doesn’t mean you should ignore other side effects of your birth control. If you’re unhappy with how you’re feeling after 3-4 months, Bryant recommends revisiting your physician to search for a better solution.
“Unfortunately, despite years and years of research and lots of progress, we don’t have the perfect method of birth control that works for everyone or that works equally well for everyone,” she says. “I try to emphasise that none of these choices are permanent, so if it doesn’t work out for you we’ll try something else.”
The key to picking the best birth control for you, Bryant adds, is knowing what you want out of the product—whether that’s a more regular period, better skin, or a method of preventing pregnancy that you never have to think about.
Here’s a breakdown of what we know about the side effects of popular hormonal birth control options on the market, to make that choice a little easier.
The pill
There are several brands of oral contraceptive available, but all work similarly. Combination pills contain both an estrogen and a progestin—the synthetic version of the hormone progesterone—but you can also choose the “mini pill” which is progestin-only. When taken correctly, the pill is 99 per cent effective, but that goes down to 91 per cent if taken inconsistently.
Why you might choose it: Many women choose the pill because of its ease, reliability and because it regulates their periods, Bryant says. Combination birth control pills are also the only FDA-approved hormonal treatment for acne. You can get pregnant right away after you stop taking the pill.
Why not to choose it: The pill is user-dependent, meaning you have to remember to take it every 24 hours in order for it to be fully effective. People whose lifestyles don’t fit this model might want to explore other birth control options, Bryant says. Patients who smoke or are at risk of heart attack, liver disease or breast cancer should also consult their doctor before taking pills containing estrogen.
Long Acting Reversible Contraceptives (LARCS)
The intrauterine device (IUD) and the Nexplanon arm implant have both increased in popularity over the last decade, as technology for the devices has improved—from 3.7 per cent of birth control users in 2007 to 10.6 per cent in 2017. Both are progestin-only birth control options, but the amount varies depending on the device.
Nexplanon is the only arm implant currently on the market, and releases 35-45 micrograms (mcg) of progestin a day the first year, but IUDs come in different sizes and release varying levels of progestin. The most common are:
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Mirena, which releases 20 mcg of progestin a day
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Kyleena, which releases 17.5 mcg a day
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Liletta, which releases 18.6 mcg a day
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Skyla, which releases 14 mcg a day
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ParaGard – the copper IUD, and the only non-hormonal IUD option on the market
Why you might choose it: IUDs and the Nexplanon are 99 per cent effective during their first few years of use (LARCS last from three to twelve years, depending on the brand). People who choose a LARC often want to “set it and forget it,” said Worly. Once removed, you can get pregnant right away.
Why not to choose it: To insert the IUD, a doctor or nurse must pass an applicator tube through your cervix and into your uterus. This can cause mild to severe cramping. One in 20 IUD users also experience expulsion, when the IUD exits the uterus on its own. ParaGard users also often experience heavier periods and cramps, and hormonal IUD users will generally find that their bleeding patterns change—whether to a lighter period, more frequent spotting, or to getting no period at all.
The Depo-Provera shot
The Depo-Provera shot is a progestin injection given every 12-14 weeks by a nurse or physician that prevents pregnancy. As long as doses are administered routinely, the shot is 99 per cent effective. But because some people miss appointments, the overall efficacy is 94 per cent.
Why you might choose it: The shot appeals to people who want the effectiveness of long-acting birth control, but aren’t comfortable with having a device inserted, Bryant says.
Why not to choose it: If you’re needle-averse or don’t think you can consistently make your appointments for reinjection you may want to look at other options, Bryant said. Additionally, she added, due to its high influx of hormones the shot is the one hormonal birth control option correlated with some weight gain.
The patch and the ring
While not as popular as other hormonal birth control options, the patch and NuvaRing are available as hormonal contraceptive alternatives. Both deliver a combination of estrogen and progestin. The patch is changed out once a week, the NuvaRing every three weeks. Efficacy is 99 per cent for both patch and ring when used correctly, but user error drops that overall rate down to 91 per cent for each.
Why you might choose it: Both are effective alternatives to the pill that are still short-acting, but require less active participation than oral contraceptives, Bryant says.
Why not to choose it: Because both are not permanent fixtures, you must remember to change both out on time and double check that neither has fallen off or moved before they have intercourse.
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