Your guide to birth control side effects

Since the birth control pill came out in 1960, family planning has been about empowerment. Contraception gives you more control over your life.

But over the years, some people have raised concerns about the safety of hormonal birth control. And with so many options available today, you may wonder if the potential side effects of hormones are worth it.

It’s normal to want to understand what you’re putting in your body and how it might affect you. While some people experience negative side effects from hormonal birth control, for most, it’s a safe and effective way to prevent pregnancy. And it can have positive side effects, too.

Having all the facts can help you choose a birth control method you’ll feel good about using consistently. Lynn Ngo, MD, an ob-gyn at Kaiser Permanente in Southern California, encourages her patients to find contraception that works for their health and lifestyle. “You want to pick something that’s going to be effective for you.”

Here are the physical and mental birth control side effects people worry about most — both common and rare. Learn about your risks and when to talk to your doctor. We’ll also look at some of the positive effects of hormones, and what other birth control options are available.

What causes birth control side effects?

Most hormonal birth control has 2 hormones: estrogen and progestin, which is the synthetic version of your body’s natural progesterone. Both can cause side effects, though people may have side effects from estrogen more often. These hormones are in most oral contraceptive pills, called combination birth control pills, as well as the birth control patch and vaginal ring.

Your experience with birth control can depend on the type you use and the dose of hormones. For example, the ring might work well for your friend but not feel right for you. Or you might react to one type of pill but not another.

If you already deal with symptoms like headaches or depression when you’re not on birth control, adding hormones might make those symptoms worse. But if you get these symptoms each month before your period, hormones may actually help.

Physical side effects

The pill had much higher levels of estrogen and progestin when it came out 65 years ago. That meant its physical side effects were more serious — and more common.

Today’s hormonal birth control uses lower doses, and not everyone experiences negative side effects. For most people, any side effects are usually mild and temporary. They should fade as your body adjusts to the hormones. These minor side effects include irregular bleeding, breast tenderness, bloating, headaches, nausea, and dizziness. People may feel them for a few days up to a few months. If yours last longer than 3 months, talk to your doctor.

Bloating

You might feel bloated, puffy, or like you’ve gained a couple of pounds when you first start taking hormonal birth control. This is temporary water retention. It’s similar to what happens the week before your period when you’re not on birth control. Water retention should go away on its own within 3 months.

Weight gain

Bloating is commonly mistaken for weight gain. But most birth control methods aren’t linked to an increase in body fat.

The one exception is the birth control shot. The shot has high levels of progestin, which can make some people hungrier.¹ This increase in appetite may cause people to eat more and gain weight. About 2 in 3 people who get the shot gain an average of 5 pounds the first year.

Progestin is in several kinds of birth control, but in smaller amounts than the shot. While studies don’t show people gaining significant weight on other types of birth control, it’s possible your appetite might increase if you’re on progestin.

Keep in mind that it’s normal for people to gain 1 or 2 pounds a year in their 20s and early 30s. This is a natural part of aging, as your body matures and your metabolism slows down. If you’re worried about weight gain, ask your doctor if lifestyle changes or a weight management plan would help.

Headaches

Some people may get new or worsening headaches. You’re more likely to experience this if you get headaches or migraines around your period when you’re not on birth control.

Your doctor can recommend prescription or over-the-counter medication. If you’re on birth control pills, skipping your last week of placebo pills might also help.

If your headaches don’t get better after 3 months, you may need to switch to a different type of birth control, or one with less estrogen. Your doctor can go over your options with you.

Get medical help right away if you have a sudden, severe headache or vision changes with a headache.

Nausea

An upset stomach is one of the most common side effects of birth control. Nausea can feel like a queasy sensation or an urge to throw up.

You’re more likely to feel nauseated the first few days or weeks. Eat bland foods or candied ginger to calm your stomach. If you’re on oral contraceptives, it might help to take the pill after dinner or closer to bedtime.

Dizziness

People may sometimes feel lightheaded or off-balance after they start hormonal contraception. Like nausea, you’re more likely to feel dizzy when you first start taking birth control, but it should go away in about a month.

Sexual changes

Most people on hormonal birth control won’t see a change in their desire to have sex or sexual arousal. But some may see either an increase or decrease in libido.

Some people develop a higher sex drive because they don’t have to worry about an unplanned pregnancy. The feeling of freedom can make them want to have sex more.

It’s also possible that changes in hormones may lower sexual desire or arousal.² Some people may suddenly feel less interested in having sex. Or they may feel less pleasure during sex.

Like most other physical side effects, libido changes are usually temporary and should return to normal within 3 months. But that can feel like a long time to be less interested in intimacy. Talk to your partner about how you’re feeling. Let them know these changes aren’t about them or your relationship. And try to give your body time to adjust to the hormones.

Blood clots

Developing a blood clot in your leg or lungs can be a serious side effect of estrogen — but it rarely happens. Before you start birth control, talk to your doctor about your health history. If you have a high risk of blood clots, they’ll likely recommend contraception without estrogen.

Like other physical side effects, you’re more likely to have a blood clot within the first few months of starting hormonal birth control. Get medical attention right away if you have severe leg pain, chest pain, or are short of breath. These may be signs of a blood clot moving into your lungs.

Mental and emotional side effects

Unlike physical side effects, mental health effects are more difficult to study. It isn’t clear when they’ll occur.

As with sexual changes, mental side effects can be positive or negative.

Positive mental effects

Birth control can help with severe premenstrual syndrome (PMS) and premenstrual mood disorders (PMDD), Dr. Ngo says. The pill stops you from ovulating. That can help relieve symptoms related to your cycle — like anger, irritability, and headaches. Dr. Ngo recommends people with PMS or PMDD who are on the pill skip their inactive week to have as few hormone fluctuations as possible.

Having access to safe, effective birth control is an important mental health safeguard for many people, says Dr. Ngo. It can relieve anxiety and fear about having an unwanted pregnancy. That’s especially true for younger people or those who may not have access to emergency contraception or legal abortion.

Negative mental effects

Some people on hormonal birth control report being irritable, having mood changes or mood swings, or feeling like they’re not themselves. It’s also possible to develop new or worse depression or anxiety.

There aren’t any significant studies showing a connection between birth control and mental health issues like depression, says Dr. Ngo. While that’s a good sign emotional side effects may not be common, it doesn’t mean they don’t happen.

“I listen to the patient,” Dr. Ngo says. “If they tell me that’s what’s happening to them, then that is what’s happening to them.”

You may be unlikely to have a negative emotional side effect. But taking that risk is a personal decision. Talk to your doctor about your mental health history, any history of trauma, and your family’s mental health. People who have a mood disorder may be at greater risk of emotional side effects.³

Health benefits of birth control

The biggest health benefit to contraception is preventing unwanted pregnancy. But by minimizing hormonal fluctuations, birth control can have other positive side effects. In fact, 45% of women on the pill take it for another reason than just pregnancy prevention.4 Birth control isn’t a cure, so you’ll only see these benefits while you’re taking it as prescribed.

Here are some ways hormonal contraception can help improve your overall health.

Makes menstruation less uncomfortable

Over time, your periods may become lighter, shorter, and less painful. Also, your menstrual cycle gets more regular, so you know when to expect your period.

Manages certain conditions

Hormonal birth control can help relieve:

• Acne
• Excessive body hair
• Pain from endometriosis
• Symptoms of polycystic ovary syndrome (PCOS)
• Excessive bleeding from uterine fibroids
• Emotional and physical symptoms of PMS and PMDD
• Menstrual migraines
• Perimenopause symptoms like hot flashes, brain fog, and sleep problems

Lowers risk of diseases

The birth control pill, patch, and ring can help prevent certain health issues, including:

• Anemia from heavy bleeding
• Ovarian cysts
• Ovarian, uterine, and endometrial cancers 

If you have an ongoing health condition or are at high risk for one, talk to your doctor about which birth control method is best for you.

Is it healthier to be off birth control?

Not necessarily, says Dr. Ngo. Birth control isn’t unhealthy and won’t negatively affect your body. If you get pregnant after going off the pill or another form of hormonal birth control, it won’t increase your risk of miscarriage or harm your baby.

Another misunderstanding is that birth control can hurt your fertility. With almost every method, you can start trying to get pregnant as soon as you go off it. The only exception is the birth control shot, which usually lasts 3 months. While some people can get pregnant right after that, it can take up to 10 months to wear off.

What happens to your body when you come off birth control?

With most hormonal contraception, pregnancy prevention wears off within 24 hours. (That’s why it’s important to take birth control pills at the same time each day.) Mild side effects like nausea can also clear up that quickly.

Any hormonal issues you had before birth control, including acne or PMS, will start to come back. Your periods may be irregular for a few months.

If you have decreased libido, mental side effects, or weight gain, your body’s hormone levels may take up to 6 months to return to their normal baseline, Dr. Ngo says.

Other types of birth control

Many people respond well to hormonal birth control. But there are other effective ways to prevent pregnancy. Consider a variety of factors when choosing a birth control method. Side effects are important, but so are your daily lifestyle, health history, and any plans you may have to start a family.

“I always encourage patients to be open,” says Dr. Ngo. “There’s a variety of nonhormonal to hormonal methods that may work for them.”

Here are some birth control methods without estrogen for you to explore. Some have progestin, and others have no hormones.

• Intrauterine device (IUD) — A small device placed in your uterus by a clinician. An IUD can last between 3 and 12 years, but you can take it out earlier if you want to try to get pregnant. There are 2 types: copper or hormonal. Copper IUDs are hormone-free and aren’t recommended if you have heavy periods. Hormonal IUDs are a low-hormone method with progestin. Many people like hormonal IUDs because they can make periods stop.
• Arm implant — A small, flexible rod placed under the skin in your upper arm by a clinician. It can last up to 5 years. Like an IUD, you can take it out anytime if you want to try to get pregnant. It contains progestin, so you may experience some mild side effects, including irregular bleeding.
• Progestin-only pill (or “minipill”) — A daily oral contraceptive that’s available over the counter (Opill) or with a prescription. You must take it at precisely the same time every day, so it’s less effective than the combination pill. It also has fewer side effects and is safe for people with a higher risk of blood clots.
• Diaphragm — A silicone cup you put into your vagina before sex. If you’re used to using a menstrual cup, you may be comfortable using a diaphragm. You can combine it with contraceptive gel or spermicide for greater protection.
• Contraceptive gel — A vaginal gel approved by the Food and Drug Administration (FDA) in 2020. It comes in a prefilled applicator with a plunger that you insert into your vagina before you have sex. It’s more effective than spermicide and is available only by prescription (Phexxi). You can combine it with most other birth control methods, including condoms.
• Natural family planning — A method of tracking your fertility, either on your own or with an app. You either avoid sex or use a nonhormonal birth control method when you’re fertile, like contraceptive gel or condoms. Dr. Ngo doesn’t recommend natural family planning for most people. It’s often less effective for those with irregular cycle lengths. And, she says, it’s hard to gauge fertility by temperature, because your temperature increases after you’ve ovulated. That means you may not realize you’re fertile until after you’ve already had sex.

Birth control that suits your life

When it comes to choosing contraception, your doctor should listen to your preferences and help you decide what’s right for you. Whether you’re concerned about side effects, convenience, or effectiveness, you should feel confident speaking up for what you want.

If you’re a Kaiser Permanente member and want to discuss your birth control options, you can find an ob-gyn and make an appointment without a referral.