Part 3: The Fine Print- Do You Know the Side Effects of Your Birth Control?
By Rachel Flink, MD
As discussed previously, birth control methods have varying levels of effectiveness, but like any medication, they can also have additional effects on the body. For many women and couples, side effects are a critical factor in choosing a birth control method. Side effects can be quite varied, from method to method as well as person to person. Not every user will have every possible side effect, but it’s important to understand the possibilities, almost all of which are temporary and will resolve when the method is stopped. Side effects may be chemical (due to hormonal changes), mechanical (due to the physical presence of an IUD, implant, patch or ring), or situational (involving the need for periodic abstinence, needing to plan ahead for barrier use, or scheduling trips to the doctor’s office or pharmacy). The ideal side effect profile is dependent on the woman, her partner, and their relationship. Some women find certain side effects very troubling, while others don’t consider them major issues. It’s important for each person to weigh the different types side effects of all available options, along with the risk of unplanned pregnancy, to decide which option is the best fit for her life.
Barrier methods and fertility awareness methods have essentially no side effects, aside from effects on sexual spontaneity, because there’s no medication taken throughout your body. The copper IUD (Paragard®) has no hormones and therefore no systemic side effects, but it may cause some spotting and cramping after placement, and may make periods crampier or heavier.
Hormonal IUDs (Mirena®, Liletta®, Skyla®) have a low level of progesterone that stays mainly in the uterus, and they can cause irregular bleeding for the first few months, but then tend to make periods lighter. In the case of Mirena and Liletta, the majority of users stop getting their periods altogether. Because most of the hormone stays in the uterus, users tend not to have systemic side effects, and most people tolerate IUDs well. All IUDs can be placed during a pelvic exam in your doctor’s office, and while there are risks and discomforts to any procedure, most placements are uncomplicated and tolerated well.
The Nexplanon® contraceptive implant is placed under the skin in the upper arm and can cause irregular menstrual bleeding. Due to the low level of hormone released, it rarely causes other hormonal effects. Depo Provera is an injection of progesterone, which can cause irregular bleeding for the first 3-6 months, after which bleeding tends to stop altogether, and can cause other hormonal effects like mood changes, increased appetite and weight gain.
Most birth control pills and the patch and ring have both estrogen and progesterone, and can cause nausea, bloating or breast tenderness, but have the benefit of making periods lighter, as well as improving some premenstrual symptoms and acne. Women with certain health conditions shouldn’t use combined estrogen/progesterone contraception, because they increase the risk of blood clots and stroke. Progesterone-only pills avoid those estrogen risks, but they tend to have side effects more like Depo Provera or the implant, including irregular vaginal bleeding. Progesterone-only pills also have a very small tolerance for error, losing effectiveness if pills are taken more than an hour or two late.
While not all of these side effects are experienced by all users, and some users experience rare side effects not listed here, it is important for users to decide which side effects they are willing to risk, and which things would be unacceptable to them. The risk of side effects also needs to be balanced against the risk of pregnancy, which is more dangerous for your health than all of the above birth control methods, as well as being stressful if you’re not ready for it!
Rachel Flink, MD is an OB/GYN currently practicing in Western Pennsylvania and obtaining her Masters in Public Health at the University of Pittsburgh. Her clinical interests include reproductive health, pregnancy care, family planning, and minimizing barriers to care. Rachel’s research is focused on understanding women’s experiences with and preferences for reproductive health care. Outside of work, she enjoys reading, being active outdoors, and spending time with her husband, two-year-old son, and rambunctious dog.