The pill: is it really your best birth control option?

The birth control pill fundamentally changed the way we approach reproductive health. It is both safe and 99 percent effective at preventing pregnancy (with perfect use), but despite its many benefits, the pill isn’t for everyone. Certain lifestyle factors and health issues can make taking the oral contraceptive pill (OCP) risky. But since all forms of birth control have benefits and risks, we thought we’d take a look at the pros and cons of birth control pills.

How does the pill work?

The pill works by preventing your body from releasing an egg each month, so there’s nothing for your partner’s sperm to fertilize. As an added level of protection, the pill thickens your cervical mucus to prevent sperm from reaching the uterus even if an egg is released. Finally, some kinds of oral contraception also affect the lining of your uterus to prevent a fertilized egg from implanting. The pill does all this by introducing hormones into your body — usually estrogen and progestin (the combination pill) or progestin alone (the mini-pill).

The pros of the birth control pill

The pill is a convenient way to prevent pregnancy. Once you start taking the pill, you’re protected against pregnancy within seven days. While you do need a prescription for the pill, you don’t have to book an appointment to have it inserted or removed like with an IUD — which can be quite uncomfortable. And you can choose to go off of it at any point. 

There are a number of fringe benefits to oral contraception. The pill is highly effective at reducing both inflammatory and non-inflammatory acne, for example. It can also regulate and lighten your periods and reduce cramps, which can be especially appealing for women with irregular, heavy, or painful flows. There are even certain brands of birth control pills that let you skip your periods completely. They typically involve taking the pill continuously for 84 days at a time, so you only get your period once every 12 weeks. This is particularly helpful for women with anemia, extreme PMS symptoms, or endometriosis. And, yes, it is totally safe.

The cons of birth control pills

While there are certainly many advantages to the pill, birth control pills do have certain disadvantages. For instance, the pill only works if you remember to take it. Unfortunately, research shows that when it comes to OCP, women forget to take it more often than they may realize. If you find yourself forgetting to take your pill, you may want to set up some sort of reminder system or alarm. There are also a number of apps that can help you remember. But if you know that you have difficulty sticking to a routine, you might want to consider another birth control method.

Like many prescription drugs, the pill’s efficacy changes based on interactions with some other medications. St. John’s Wort, for example, is notorious for reducing the pill’s effectiveness. Speak to your doctor or pharmacist to ensure you’re not taking anything that can affect the potency of your birth control. And if you are, make sure to use a backup method of contraception. Using a barrier method of birth control is good practice because the pill doesn’t protect against sexually transmitted infections.

The medical risks of oral contraception

Three quarters of women take the pill at some point, and the vast majority experience few negative side effects. For the most part, the pill is both safe and one of the most successful ways of preventing pregnancy. Despite this, the pill does have some risks. It can increase your risk of venous thrombosis (also known as blood clots) or stroke by three to four times. For women over 35 who smoke, however, the risks of taking the pill increase significantly, to the point where it is no longer considered safe.

Certain health conditions may also preclude safe use of the pill. If you’ve had previous heart problems or blood clots, speak to your doctor about which contraception methods may suit you better. The same goes for diabetes, migraines with aura, and breast cancer.

A recent study also confirms a link between using the pill and developing depression. While the increased risk is small, it’s worth discussing with your doctor.

More research needed

Because the pill is a hormone-based contraceptive, it can, in some cases, affect your level of sexual desire. Female sexual arousal is notoriously difficult to study, and different research studies have yielded different results. Some show that OCP lowers desire, while others indicate that the pill heightens sexual arousal. Still others show no difference. Until more research provides consensus, it’s impossible to say how the pill will affect your libido but it’s worth being aware that it is a possible side effect.

Also in need of further study, is how well the pill works for women who are considered obese. Obesity causes several physiological changes, which may affect the efficacy of the pill. One study found that obese women may have a 60 to 70 percent higher chance of getting pregnant while taking the pill than women considered to be a healthy weight. If you fall into this category, it’s crucial to discuss the issue further with your doctor.

The long-term side effects of birth control pills

Many pill users stay on it for long periods of time, leading to concerns about longitudinal consequences. Thankfully, long-term use of the pill has no effect on your ability to get pregnant once you go off of it. And when it comes to other consequences, it’s up for debate: using the pill for five or more years can increase your risk of developing cervical cancer, but this risk disappears once you’ve been off it for 10 years. And what’s interesting is that OCP use lowers your overall risk of developing endometrial cancer. 

As long as you remember to take it, the pill is safe and effective at preventing pregnancy. Given its additional benefits, it’s clear why it’s been the most popular form of birth control for over 50 years. If you’re thinking of going on the pill, have an open and honest conversation with your doctor about your lifestyle and any underlying health issues. They’ll be able to advise you on whether the pill is right for you.