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Oral Contraceptives: Risks and Benefits

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Since first introduced in the 1960s, the birth control pill ("the pill") has been a popular and extremely effective form of contraception. The pill is easy to use and, when taken correctly, it is 95% to 99.9% successful at preventing pregnancy. But, as with any medicine, there are both risks and benefits.

What Are the Risks of Taking the Pill?
Unintended Pregnancy

While birth control pills are highly reliable in preventing pregnancy, there is the possibility that you could become pregnant. This is especially true if you miss a dose or do not take the pills regularly. Being overweight or obese may also increase your risk of pregancy. The excess weight may affect how well the pills work in your body.

Blood Clots

Oral contraceptive pills can increase your risk of developing blood clots in the veins in your legs. These can become life threatening if the blood clots leave your legs and travel into you lungs. The risk of blood clots is increased more in people who smoke.

Cholesterol Levels

There are different kinds of birth control pills. Some are combination pills, with estrogen and progestin, while others are "mini-pills" with just progestin. Estrogen may affect triglyceride levels and total cholesterol levels—increasing HDL "good" cholesterol and decreasing LDL "bad" cholesterol. Progestin, though, may cause "good" cholesterol to lower and "bad" cholestorol to rise. But, for most women, these changes in blood levels are not strong enough to have a poor effect on your health.

High Blood Pressure

Taking birth control pills may increase the risk of high blood pressure . This risk may be greater if you have other conditions, like being overweight, having a family history of high blood pressure, or smoking . If you take birth control pills, your doctor will check your blood pressure. If you already have high blood pressure, talk to your doctor about other contraceptive options.

Cardiovascular Disease

Women aged 35 or older who smoke heavily and take birth control pills have an increased risk of having a heart attack or stroke . You may have an even greater risk if you have other risk factors (eg, family history of cardiovascular disease, high cholesterol , high blood pressure). If you want to take birth control pills, you should first quit smoking , since smoking increases your chance of developing many other health problems.

Cancer

Taking birth control pills for many years may increase the risk of certain types of cancer, like cervical cancer. Researchers are still investigating the link between birth control pills and breast cancer. Some studies have found that there is an increased risk, while others studies have come to the opposite conclusion. According to the National Cancer Institute, there appears to be a slight increase in risk, but the risk level goes back to normal after 10 years of stopping birth control pills. It is important to remember that there are many other risk factors for cancer. If you are at high risk for breast cancer (eg, having certain types of genes or a family history) or other types of cancer, talk to you doctor about the best contraceptive for you.

What Are the Benefits of Taking the Pill?
Cancer

While the pill may increase the risk of some types of cancer, it can also decrease the risk of other types of cancer, like ovarian and endometrial cancer . Studies have found that the more years a woman takes the pill, the better her protection. In addition, researchers are investigating whether birth control pills decrease the chance of developing colorectal cancer.

Other Benefits

Taking birth control pills may reduce your risk of:

There are many different types of birth control pills on the market. You and your doctor can decide which kind is best for you, or if a different contraceptive option would be a better choice. Just keep in mind that the pill does not protect against HIV and other sexually transmitted diseases .

RESOURCES:

American Congress of Obstetricians and Gynecologists
http://www.acog.org/

Planned Parenthood Federation of America
http://www.plannedparenthood.org/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

Birth control. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/birth-control-pill/WO00098/NSECTIONGROUP=2 . Updated May 2, 2011. Accessed June 26, 2012.

Breast cancer in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated June 4, 2012. Accessed June 26, 2012.

Burkman R. Oral contraceptives: Current status. Clinical Obstetrics and Gynecology. 2001;44(1):62-72.

Burkman R, Schlesselman JJ, Zieman M. Safety concerns and health benefits associated with oral contraception. Am J Obstet and Gynecol. 2004;190:S5-S22.

Fact sheet: Oral contraceptives and cancer risk. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives . Updated March 21, 2012. Accessed June 26, 2012.

High blood pressure and women. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/High-Blood-Pressure-and-Women_UCM_301867_Article.jsp . Updated June 6, 2012. Accessed June 26, 2012.

Hypertension. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated April 30, 2012. Accessed June 26, 2012.

Jensen JT, Speroff L. Health benefits of oral contraceptives. Obstet and Gynecol Clinics of North Am. 2000;27(4): 705-721.

Norton A. Birth control pills may lower colon cancer risk. Reuters website. Available at: http://www.reuters.com/article/idUSKIM05941720080220 . Published February 20, 2008. Accessed June 26, 2012.

Oral contraceptives. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated June 7, 2012. Accessed June 26, 2012.

Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated May 25, 2012. Accessed June 26, 2012.

Schneider HP, Mueck AO, Kuhl H. IARC monographs program on carcinogenicity of combined hormonal contraceptives and menopausal therapy. Climacteric. Dec 2005;8(4):311-316.

SOGC position statement: the birth control pill and cancer. The Society of Obstetricians and Gynaecologists of Canada website. Available at: http://www.sogc.org/media/guidelines-oc_e.asp . Updated February 19, 2008. Accessed June 26, 2012.

Victory R, et al. Adverse cardiovascular disease outcomes are reduced in women with a history of oral contraceptive use: Results from the Women’s Health Initiative Database [abstract]. Fertility and Sterility. 2004;82(2):0-130.

4/9/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Beral V, Hermon C, Kay C, Hannaford P, Darby S, Reeves G. Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46 000 women from Royal College of General Practitioners' oral contraception study. BMJ. 1999;318:96-100.
Hannaford PC, Iversen L, Macfarlane TV, Elliott AM, Angus V, Lee AJ. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners' Oral Contraception Study. BMJ. 2010 Mar 11;340:c927.

12/3/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Lopez L, Grimes D, Chen-Mok M, Westhoff C, Edelman A, Helmerhorst F. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev. 2010;(7):CD008452.



Last reviewed June 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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