Risks of the Pill: What you should know about side effects

Common side effects in detail

Most side effects of the pill are harmless and temporary. They occur because the body is getting used to the added hormones. Still, it's worth knowing them so you can put them into the right context.

Spotting and the start of use

Especially in the first months of use, spotting or breakthrough bleeding is common. This is usually no cause for concern, but a typical adjustment response that normally settles on its own. If the bleeding continues over several cycles, switching preparations can make sense.

Nausea, breast tenderness and headaches

Estrogen can initially trigger nausea, a feeling of tightness in the breasts and headaches. These complaints, too, usually improve after the first few cycles. New, unusually severe headaches or migraine with visual disturbances should, however, always be checked by a doctor.

Mood and mental health

A sensitive topic is the effect on mood. A large Danish cohort study observed an association between the use of hormonal contraception and a first-time prescription of antidepressants, particularly in younger women (Skovlund et al., 2016). Important for context: an association is not proof of a cause, and many women notice no change at all. But anyone who notices persistent low moods or a lack of drive while on the pill should take it seriously and speak up.

Libido

Some women report a decreased sexual desire on the pill, others feel no difference or even an improvement, because the fear of pregnancy falls away. The evidence is mixed and very individual. If libido noticeably suffers, switching preparations can help.

Skin, hair and weight

The pill often has a positive effect on the skin and is therefore sometimes used against acne. After stopping, however, the skin can temporarily worsen, or hair loss can occur. Weight is another topic on many women's minds. What the studies really say about it, you can read in our article on weight gain from the pill.

Effect on nutrient balance

The long-term use of oral contraceptives is being studied in connection with the levels of certain micronutrients, including certain B vitamins, folate, zinc and magnesium. A balanced diet remains the foundation. Anyone who wants to specifically support the body, especially after stopping, can pay attention to a good supply of micronutrients.

Rare but serious risks

Alongside the harmless effects, there are risks that are rare but must be taken seriously. They are the main reason why the pill should always be prescribed and monitored by a doctor.

Thrombosis and embolism

The best-known serious risk is venous thrombosis, that is, a blood clot, usually in the deep veins of the leg. Estrogen-containing combination pills increase this risk. A Cochrane review concluded that all combined oral contraceptives increase the risk of thrombosis compared with non-use, with the extent varying depending on the progestin and estrogen dose (de Bastos et al., 2014). A later meta-analysis also confirmed this increased relative risk (Dragoman et al., 2018).

Still, for context: in absolute numbers, a thrombosis remains a rare event. Personal risk depends heavily on additional factors.

Who should be especially cautious

• Women who smoke, especially over the age of 35
• Women with migraine with aura
• A known family tendency toward thrombosis or previous thromboses
• Significant excess weight as well as prolonged immobility, for example after surgery

For exactly these situations, there are clear medical recommendations. With the Medical Eligibility Criteria (WHO, 2015), the World Health Organization has published criteria that clarify which form of contraception is suitable for whom. That is why the conversation with a doctor before it is prescribed is so important.

Putting cardiovascular and cancer risk into perspective

Combined pills can, in those with a corresponding predisposition, also affect the risk of high blood pressure and other cardiovascular events. On the topic of cancer, a nuanced view is important: a large study observed a slightly increased relative risk of breast cancer with hormonal contraception, which decreases again after stopping (Mørch et al., 2017). At the same time, long-term data show that the pill can lower the long-term risk of ovarian and endometrial cancer (Iversen et al., 2017). So the pill is neither dangerous across the board nor harmless; the overall picture is nuanced.

What happens during and after stopping

After stopping, the body's own cycle first has to settle back in. For many women, this takes a few weeks to months. During this time, complaints that were previously masked by the pill can appear, such as blemished skin, cycle irregularities or temporary hair loss. How to support yourself well through this phase, you can find out in our guide to coming off the pill.

Important to know: this adjustment is usually temporary and not a sign that the pill leaves lasting damage. A good supply of micronutrients and a little patience help the body find its own rhythm again.

When you should seek medical advice

The vast majority of side effects are harmless. But there are warning signs where you should not wait, but have them checked by a doctor promptly:

• Sudden pain, swelling or warmth in one leg
• Shortness of breath, chest pain or coughing up blood
• New, very severe headaches or visual disturbances
• Persistent depressive moods or severe low moods

These symptoms don't automatically mean that something serious is going on, but to be safe they should always be checked.

What alternatives are there?

If the pill isn't right for you, there are numerous alternatives, both hormonal and hormone-free: from the copper coil, condom and natural cycle tracking to the hormonal IUD, patch or ring. A direct comparison of two popular methods can be found in our article the pill versus the hormonal IUD. Which method fits best depends on your health, your daily life and your preferences, and is ideally discussed with a doctor.

Conclusion

For most women, the pill is a safe and reliable form of contraception. The common side effects are usually harmless and temporary, while serious risks like thrombosis are rare but should be known. What matters is knowing your own risk profile, watching for warning signs and taking complaints seriously.

In the end, it's not about fear, but about an informed decision. If you're unsure whether the pill still suits you or how best to come off it, you can talk it through in a free intro call with the Hormonic team.