Hormonal birth control isn’t without side effects. As with all drugs, there are beneficial effects and potential risks that affect everyone differently.

Most believe that hormonal birth control serves one purpose: to prevent pregnancy. While hormonal birth control is very effective compared to barrier and lifestyle methods, the effects aren’t just limited to pregnancy prevention.

Each type has similar benefits and risks, although everyone responds differently to the hormones.

If you’re interested in birth control, talk with a healthcare professional about which type is most effective for you. Effectiveness is based on how consistent your birth control use is.

annotated anatomical illustration of a female body with markers pointing to various areas that are affected by hormonal birth controlShare on Pinterest
Written by Tess Catlett and illustrated by Andrew Nguyen

Anxiety

A 2004 review found that hormonal birth control users experienced higher levels of anxiety compared to non-users. Similarly, a 2018 study revealed that people using hormonal IUDs also had increased rates of anxiety.

Combined pills, which contain synthetic versions of estrogen and progesterone, and progestin-only minipills are generally linked with higher rates of depression and anxiety compared to other methods.

Between 4% to 10% of users report negative mood changes while using the combined pill. Still, most users are satisfied with the pill.

In fact, a review of studies conducted over the past 30 years found that the majority of users of combined hormonal contraceptives — including the pill, patch, and vaginal ring — experienced either no change in mood or a positive effect.

Depression

A 2023 study found that pill users may face up to a 130% increased risk of depression, especially during the first 2 years of use.

One of the largest studies on this topic was conducted in Denmark in 2016. Researchers analyzed 14 years of data from over 1 million women ages 15 to 34, excluding those with a history of depression or antidepressant use.

Researchers used this data to estimate that 2.2% of people who start using hormonal birth control are prescribed antidepressants within a year, compared to 1.7% of people not using hormonal contraception.

People with hormonal IUDs were found to be 1.4 times more likely to be prescribed antidepressants than those not using any hormonal birth control, with the risk being higher for users ages 15 to 19.

However, other research has not found a consistent link between hormonal birth control and depression.

A 2018 review of 26 studies on progestin-only birth control, including 5 studies on hormonal IUDs, found that only 1 study linked hormonal IUDs to an increased risk of depression. The other 4 studies found no such association.

Stress

A 2023 study found that the pill may impair your stress response, making it harder for your body to adapt to stress.

The study also found that pill users have elevated levels of the inflammatory cytokine TNF-alpha before and after a stress test, which might be linked to a more “male-typical” stress response.

In contrast, users with natural menstrual cycles showed higher levels of interleukin-6, a cytokine associated with a more “female-typical” response to stress.

The pill may reduce the body’s production of progesterone, which is converted into allopregnanolone, a hormone known for its calming effects.

Sleep-wake cycle and circadian rhythm

The pill might impact your sleep-wake cycle due to its effect on estrogen, which helps regulate your circadian rhythm or internal 24-hour clock.

Disruptions to your circadian rhythm can influence various aspects of daily functioning, including sleep patterns, hormone levels, eating habits, digestion, and body temperature.

Research indicates that disturbances in this internal clock can increase the risk of anxiety and depression.

Headaches and migraine

Research has shown a link between hormonal birth control, headaches, and migraine episodes.

Estrogen changes throughout your cycle can trigger menstrual migraine. Hormonal birth control can alter your natural estrogen levels, potentially leading to headaches.

If you have a history of migraine with aura, your healthcare professional may advise against combined birth control. Higher estrogen levels may increase your risk of stroke.

Weight gain

Some hormonal methods may be associated with slight weight gain over several years of use. This includes the following:

Cycle

Hormonal birth control interferes with ovulation. Ovulation usually occurs halfway through your menstrual cycle when an ovary releases an egg into a fallopian tube to prepare for fertilization.

If an egg is not released or fertilized by sperm, pregnancy cannot occur. The uterine lining sheds, leading to menstruation, which marks the start of a new menstrual cycle.

Simply put, menstruation can’t occur without ovulation. However, many people experience period-like bleeding — commonly known as breakthrough or withdrawal bleeding — in place of menstruation.

Breakthrough bleeding

A 2016 review found that 30% to 50% of combined pill users experience breakthrough bleeding in the first 3 to 6 months of use. This drops to 10% to 30% percent by the third month.

Breakthrough bleeding is more likely with continuous or extended-cycle pills. It’s also the most common side effect of the progestin-only minipill.

Although breakthrough bleeding is more commonly associated with the pill, all hormonal methods can impact the timing, amount, and duration of period-like bleeding. These effects typically lessen with time.

Libido

Hormonal birth control is associated with a range of physical side effects, including fatigue, nausea, irregular bleeding, and cramping, that can negatively impact sexual desire or libido.

Hormonal changes can also create conditions that diminish sexual interest or arousal. For example, many people experience vaginal dryness, discomfort during penetration, and reduced sensitivity.

A 2013 review of 36 studies on sexual desire and combined pill use found that 1,238 (15%) out of 8,422 participants reported a decrease in libido. However, 1,826 people (21%) experienced an increase in libido, while the majority reported no change.

A 2016 review of 103 studies on birth control and sexuality highlighted several positive outcomes:

  • The hormonal IUD may lead to reduced pain during sex and increased libido after a year of use.
  • Hormonal and nonhormonal (copper) IUDs may enhance libido, physical arousal, sexual satisfaction, and frequency of sexual activity.
  • The vaginal ring has been associated with increased libido, arousal, and sexual satisfaction, as well as increased vaginal lubrication and improved orgasm.
  • The implant may improve arousal, sexual satisfaction, and orgasm while also reducing pain during sex and anxiety about sex.

Vaginal discomfort

Decreased libido can make it difficult to become physically aroused. This can result in less naturally occurring vaginal lubrication.

A 2023 study found that taking the pill can decrease blood flow to the genital area, which can further reduce lubrication.

Acne

Hormonal birth control is commonly prescribed to treat acne. Estrogen is said to decrease testosterone, which may lead to decreased oil (sebum) production and potentially fewer breakouts.

Premenstrual syndrome (PMS) and dysphoric disorder (PMDD)

Many people experience bloating, fatigue, and other symptoms commonly known as PMS in the week leading up to menstruation.

PMDD is considered a more severe form of PMS. It’s associated with depression, anxiety, and other mental and emotional effects.

While the exact cause of PMS and PMDD is not fully understood, they’re likely linked to hormonal fluctuations during your cycle.

Hormonal birth control works by “tricking” your body into mimicking pregnancy. This disrupts your menstrual cycle and related hormonal changes.

The IUD and implant lead to the most stable hormone levels. However, the pill, patch, and ring can also be effective.

Endometriosis, fibroids, and polycystic ovary syndrome (PCOS)

Artificial hormones can help regulate your body’s natural hormonal fluctuations, reducing the extreme highs and lows that can worsen symptoms.

Progestin-only methods, such as the IUD and shot, are often recommended for those with endometriosis, whereas the combined pill is typically the initial treatment for PCOS.

Anemia

Heavy menstrual bleeding can increase your risk of anemia. Anemia occurs when there are not enough red blood cells to transport oxygen throughout the body, leading to symptoms like weakness and fatigue.

Hormonal birth control methods that allow you to skip your period can help prevent associated anemia.

Ovarian cysts

Ovarian cysts are small, fluid-filled sacs that form during ovulation. While they are typically not harmful, they can cause pain or discomfort.

By preventing ovulation, hormonal birth control can help prevent cysts from forming or reoccurring.

Pelvic inflammatory disease (PID)

Older research from 1991 suggests that progestin may help protect against PID. Progestin helps thicken cervical mucus, leading researchers to theorize that this could prevent bacteria from entering the cervix.

A 2001 study found that using the pill can reduce the risk of PID by 50% to 60%.

Ovarian cancer

According to the National Cancer Institute (NCI), people who have used the pill have a 30% to 50% lower risk of developing ovarian cancer than people who have not.

This protective effect is said to increase alongside the duration of use. These effects may continue for up to 30 years after you discontinue use.

Hormonal IUDs also appear to reduce the risk of ovarian cancer.

Endometrial cancer

The pill can reduce the risk of endometrial cancer by at least 30%.

An older 1999 study found that people who used the combined pill for at least 10 years had an 80% lower risk of developing endometrial cancer. This protective effect lasted for at least 20 years after discontinuing use.

Hormonal IUDs thin the uterine lining. As such, they may be used to help prevent or treat early endometrial cancer.

Colorectal cancer

According to the NCI, some studies suggest that the pill may lower the risk of colorectal cancer by 15% to 20%. More research is needed to better understand the potential protective effect.

Vitamin deficiency

A 2013 review linked the pill to lower levels of several vitamins and minerals, including:

Deficiencies in these nutrients can lead to fatigue, brain fog, and low mood.

Ovarian cysts

Although hormonal birth control is usually associated with a decreased risk of ovarian cysts, the IUD may have the opposite effect.

About 22 out of 100 people (22%) using Kyleena develop an ovarian cyst, compared to about 14 out of 100 people (14%) using Skyla. About 7.5% of Mirena users and 4.7% of Liletta users develop a cyst.

Hypertension (high blood pressure)

The combined pill, patch, and vaginal ring can increase your blood pressure.

Although the shot doesn’t appear to affect your blood pressure, it may increase your cholesterol levels, which can increase your risk of cardiovascular disease.

Blood clots

Estrogen doesn’t cause blood clots, but it does increase the risk slightly — particularly for deep vein thrombosis (clots in the leg) and pulmonary embolism (clots in the lung).

Each year, 3 to 9 out of every 10,000 people who use combined birth control methods develop a blood clot.

Stroke

According to the American College of Cardiology, the risk of stroke related to combined pills is lower than the risk of pregnancy-related stroke.

Researchers in a 2019 meta-analysis observed a ~20% increase in the risk of ischemic stroke and total stroke for every 10 micrograms of estrogen or every 5-year increment of use.

Osteoporosis

Some research suggests that low dose combined pills can negatively impact bone mineral density (BMD) in adolescents and young adults.

The implant and shot may have a negative impact on BMD in adolescents and premenopausal adults.

Breast cancer

According to the NCI, people who have used the pill may have a slightly increased risk of breast cancer compared to people who have not. The risk is considered temporary as it declines after you discontinue use.

Research is mixed on whether the IUD increases the risk of breast cancer. Any potential risk appears to be slight.

The patch and vaginal ring don’t appear to be linked to an increased risk of breast cancer, but data is limited.

Cervical cancer

According to the NCI, people who have used the pill for at least 5 years may have an increased risk of cervical cancer compared to people who have never used the pill.

The longer you use the pill, the higher the risk. However, the risk appears to decline over time after you discontinue use.

Gallbladder disease

Long-term use of the combined pill use may slightly increase the risk of gallbladder disease.

Estrogen can increase the concentration of cholesterol in bile and decrease gallbladder movement, both of which can lead to gallstones.

Progestin can also decrease gallbladder motility, which can impede the flow of bile and result in gallstones.

Hormonal birth control is highly effective at preventing pregnancy when used consistently and correctly.

It’s generally safe to use long term, although people with certain underlying conditions or risk factors may need to avoid certain methods to reduce the risk of adverse effects.

Consult with a healthcare professional to learn more about your options. They can help you identify the safest method depending on your individual health history.

Tess Catlett is a sex and relationships editor at Healthline, covering all things sticky, scary, and sweet. Find her unpacking her inherited trauma and crying over Harry Styles on Twitter.