Oral contraceptive pills account for 13% of contraceptive methods of women in the US. Around 65% of the total adult women population of 72 million in the US use some birth control method, and oral contraceptive pills are the second most preferred method. Planned parenting and the need to avoid pregnancy has created a huge demand for reliable and safe contraceptive options. While the pill is considered as relatively safe, it does have its share of side effects that can pose health issues in certain instances. Here is a detailed look at birth control pill side effects and the best ways to deal with it pre-emptively.
How does the pill work and what are the common birth control pill side effects?
Birth control pills contain hormones that alter the manner in which certain organs function, resulting in prevention of pregnancy. These chemical substances exercise control over the uterus and the ovaries that have a role to play in pregnancy. Oral contraceptives are typically combination medications that contain estrogen and progesterone hormones. These hormones effectively stop ovulation from occurring, and this in turn prevents women from turning pregnant. Ovulation – the phase where the egg is released – is necessary for successful pregnancy and by preventing ovulation, birth control pills prevent pregnancy.
Before we look at birth control pill side effects it is necessary to look at the mechanism of action of the pills to understand how this could trigger side effects. Contraceptive pills also work by preventing the sperm from entering the uterus and attaching to eggs that may have still been released. This is achieved by increasing the thickness of the mucus around the cervix, and the thicker consistency works as a barrier to prevent sperm from attaching to eggs. Additionally, the pill also triggers an action wherein the lining on the uterus becomes thinner. As a consequence of this, the egg will be unable to attach itself to the uterus wall, thereby preventing pregnancy.
Types of birth control pills and advantages of combination formulations
There are different types of birth control pills – continuous dosage and extended cycle pills – that work to reduce the periods in a year. The typical packs contain a total of 28 pills – 21 active pills and 7 inactive pills. The purpose of the inactive pills is to give you a routine of taking the pill daily. The active pills are intended to be taken continuously for a period of 21 days, followed by a gap of 7 days after which the active pills need to be started afresh. As you may end up not keeping track of the gap of the seven days, there is every possibility that you may miss out on taking the pills daily. The effectiveness of the pill in birth control depends entirely on not missing the 21-day routine. This is precisely why every pack contains 21 active and 7 inactive pills. Similarly, extended dosage pills are also available, wherein, packs contain 84 active and 7 inactive pills.
Combination birth control pills are regarded as having an advantage over other methods/pills due to multiple reasons. This includes, the reversible nature of contraception, and the almost immediate return to normal fertility after stopping of the pills. These are two distinct standout advantages that need to be considered when weighing birth control pill side effects. Other clear advantages include, lesser risk of ovarian cancer, reducing possibility of benign breast diseases, and reduction in severity of menstrual cramps. Side effects of other medications include increased androgen production from polycystic ovary syndrome, whereas combination pills reduce the production of androgen. Women on combination pills are likely to experience reduced breakout of acne, apart from a significant reduction in the amount of menstrual bleeding as a result of uterine fibroids. Women typically develop anaemia (iron-deficiency) and combination birth control pills have a significant impact on iron deficiency.
A comparison of birth control pill side effects with the side effects of other methods includes increased predictability of menstrual cycles and considerable relief from premenstrual syndrome. The pills are also known to give greater control over the monthly menstruation cycle while ensuring that women in menopause experience lesser numbers of hot flashes. Women who near menopause are known to experience increased number of hot flashes, and the combination birth control pills are known to help keep the number of hot flashes in control.
Commonly reported birth control pill side effects
The pills by virtue of working on the hormone levels of individuals, are known to cause certain side effects. Most of the side effects are known to last no longer than a few months, but certain birth control pill side effects may last longer. Here is a look at the commonly reported undesirable effects of the birth control pill.
#1 Throbbing headaches – are likely to be experienced by women on combination birth control pills. This could also manifest as migraine or an increased frequency in the occurrence of headaches. These side effects are attributed to the changed levels of estrogen and progesterone and also to the actual formulation and dosage of the pill. Combination medication with lesser dosing are likely to have lesser intensity of these side effects.
#2 Breakthrough bleeding as a result of the thinning of the uterus lining – The change in the hormone levels and the thinner uterus lining causes bleeding between the menstrual cycles. There could be a brown discharge between the cycles and this is typically known as breakthrough bleeding or spotting between periods. The best method of dealing with this condition is to stick to a routine of taking the medication at the same time every day, and not missing out on the pills.
#3 Abnormal increase/decrease in weight – birth control pill side effects include a sudden increase in weight. This is mainly due to the increase retention of fluid which results in weight gain. The possibility of increase in muscle mass and/or fat exists, and this could result in a sudden increase in weight. However, it is also possible that in a section of women, the opposite effects could also be observed. For instance, there is also the possibility of women losing weight as a result of taking birth control pills. While there is insufficient data to back up either of the claims, there have been reports that indicate weight gain/loss in women on the pills.
#4 Feelings of nausea – Women on combination birth control pills are likely to have experienced nausea when initially taking the pill, and this is expected to resolve with time. While this counts as birth control pill side effects it is possible to overcome nausea by taking the pill before hitting the bed or consuming medication alongwith food. In most cases nausea is only a temporary effect, and women who experience persistent feelings of nausea need to seek medical attention to mitigate the effect.
#5 Increase in breast size and tenderness of the breasts – Women on birth control pills are likely to experience a sudden tenderness of the breasts. Additionally, there is a possibility of an increase in the size of the breasts. This typically occurs when women start taking the pill the first time, and the effects of the hormones trigger tenderness and an increase in size. The best method to resolve this is to wear supportive bras and seek medical attention if the tenderness turns to pain. Women who feel lumps in the breast are to seek medical attention at the earliest for further diagnosis.
#6 Lack of interest in sexual activities – Women are also likely to experience disinterest in sexual activities as the hormonal changes can result in reduced libido. In certain instances, the exact opposite birth control pill side effects may be true with the hormonal changes driving sex drive higher. This could also be attributed to the reduced apprehensions of unplanned pregnancy, which in turn may be manifested as increased desire in sex.
#7 Thickening of cornea – The hormonal changes triggered by the combination medication may also result in a thickening of the cornea. While this does not indicate any ailments related to the eye, it could have an effect on women who wear contact lenses. The thicker cornea may result in ill fitting contact lenses. Consequently, there could be lesser than desired vision correction from the contact lens. Individuals who experience change in vision as a result of birth control pill side effects are advised to look at corrective measures for improved vision.
#8 Sudden changes in mood – The changes in the hormonal levels are also known to bring about changes in mood. Women are sometimes known to go into depression when on the pill. Hormones are directly and indirectly linked to emotions and a sudden change in hormonal levels can bring about mood swings that are abnormal. Temporary changes in mood are among the various birth control pill side effects and women who are unable to cope with this change can discuss a change in the formulations with the treating specialist.
Birth control pills are relatively safe and effective when taken as per recommendations. Most side effects are temporary and resolve naturally. Women who experience persistent side effects can consider a change of pills or adopt a different contraceptive method to avoid birth control pill side effects.
Education: Doctor of Pharmacy (PharmD) from the University of Florida. Experience: 5 years as a pharmacist and medical writer, creating content on medication management and pharmaceutical news for healthcare blogs and patient education sites.
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