What are the effects of long term use of the contraceptive pill?

Let’s preface this with the fact that the contraceptive pill is one of the safest and most foolproof methods in preventing pregnancy. We want to assure you that worrying about taking the pill in the long term is not necessary at all. But it’s still a medicine and it’s never bad to understand what side effects the pill has. The most popular pills have synthetic estrogen and progesterone and everybody has a different response to that. Some have to deal with water retention, others struggle with swollen and sensitive breasts. For some people the pill suppresses testosterone which makes it so that they don’t feel up for sex as much as usual. These symptoms usually disappear in about three months. It’s also impossible to predict whether you will experience any of these symptoms at all.

Physical risks

For most, it’s not a risky affair to take the pill. Chances of severe side effects such as thrombosis or heart and vascular diseases are quite low. However, for the 4th generation pills (Yasmin and Diane 35), usually taken to prevent low moods and acne, these chances are higher. People are usually advised against these 4th generation pills for exactly these reasons.

The chances of thrombosis are the highest in the first year of taking the contraceptive pill and decline after that first year. Chances of cervical cancer increase slightly with continuous use of the pill (longer than 10 years), but the difference is so small that it’s really nothing to worry about but is not zero! For people who continue to use the pill after the age of forty, the risk of breast cancer does increase. On the other hand, chances of cervical and ovarian cancer decrease slightly, but again, just slightly.

Rumor has it that the pill influences your fertility, but you can push that rumor out of your mind. As soon as you stop taking the pill, you’re (with a few exceptions) immediately fertile. If you stop menstruating for a longer period of time after stopping the pill, it’s caused by something else (and then there’s probably a good reason to contact your GP). It was also believed for a long time that skipping your period with birth control was bad, but there is no harm in doing so.

Mental risks

It has now been shown that the use of the combined pill leads to changes in the brain of the pill user, but we do not yet know exactly what and what the consequences of this are. More research is needed. But what do we know?

Some of the pill users, about 4 to 10%, experience psychological symptoms from the pill such as mood swings, reduced sexual desire and arousal or feel depressed by the pill. Especially if you have a history of dejection or depression, it is wise to keep a close eye on this because once you have had depression (and it has not been treated properly) there is a greater chance of another depression.

The pill in teenagers

Almost all women use the pill at some point in their lives and most of them start using it as teenagers. But especially among young girls, the use of the pill is not without risk, according to (limited) research. A 2019 study concludes that the use of oral hormonal contraception in young girls in particular increases the risk of depression, both in the teenage years and in adulthood.

Check your birth control method every once in a while

It doesn’t matter if you’ve taken the pill for one or for twelve years. It’s always a good idea to check every ten or fifteen years whether or not it’s still the right method of birth control for you. You might have started smoking within that period of time. In that case it’s smart to stop taking the pill because, when combined with tobacco, the risks of thrombosis are a lot higher. Also if you are around 50, it is wise to stop taking the contraceptive pill because of an increased risk of breast cancer. If you still want to use hormones to counteract the symptoms of menopause, it is advisable to switch to hormonal replacement therapy. The pill does not help against menopausal symptoms and hormone therapy is safer.

Did you notice any problems or changes in your body that you suspect are caused by the pill? Listen to your body and mind and contact your GP. That’s how you know for sure that the birth control you use is the right one for you.

Are you curious about alternative birth control methods, their side effects and whether they are reimbursed by insurance companies (in the Netherlands)? Read the ultimate birth control list here.

Sources:

Oral contraceptive use in adolescence predicts lasting vulnerability to depression in adulthood, https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.13115L Association of Hormonal Contraception With Depression - PubMed (nih.gov)

Larsen SV, Mikkelsen AP, Lidegaard O, Frokjaer VG. Depression Associated With Hormonal Contraceptive Use as a Risk Indicator for Postpartum Depression. JAMA Psychiatry 2023.

Lisofsky N, Riediger M, Gallinat J, Lindenberger U, Kuhn S. Hormonal contraceptive use is associated with neural and affective changes in healthy young women. Neuroimage 2016

Gingnell M, Engman J, Frick A, et al. Oral contraceptive use changes brain activity and mood in women with previous negative affect on the pill--a double-blinded, placebo-controlled randomized trial of a levonorgestrel-containing combined oral contraceptive. Psychoneuroendocrinology 2013.

Skovlund CW, Morch LS, Kessing LV, Lidegaard O. Association of Hormonal Contraception With Depression. JAMA Psychiatry 2016. (edited) 

Zettermark S, Perez Vicente R, Merlo J. Hormonal contraception increases the risk of psychotropic drug use in adolescent girls but not in adults: A pharmacoepidemiological study on 800 000 Swedish women. PLoS One 2018