What are the long-term effects of birth control pills?

Dear Looking for answers,

Your question is a good one and a common concern for those using birth control. Weighing the benefits and risks of long-term medication such as birth control pills can be daunting but finding reassurance in your health and safety is important. The good news is that there is now a lot of information to dispel misconceptions about long-term oral contraceptive (OC) use and evidence to support its many benefits. Read on to learn about the risks and benefits of using birth control pills.

Generally speaking, OCs are low-risk and effective for long-term use in those who are in good health. The evidence suggests that these medications can be used throughout the reproductive years, as prolonged use doesn’t typically lead to any adverse effects. To ensure the safety of OC use, it’s best for individuals to meet with a health care provider for a full health history review and check-up. Oral contraceptives may interact with your body differently based on underlying health concerns or other medication, therefore it’s imperative to communicate regularly and honestly with your health care provider.

There are a lot of misperceptions about long-term birth control use. In the past, providers suggested taking a break from OCs as a way of detoxing. This practice is no longer recommended because it may put someone at risk for pregnancy. There have also been questions about the impacts of long-term birth control use on fertility. Studies have found that many people start ovulating again within a couple of weeks of discontinuing OCs, and most are able to become pregnant within six months. In terms of the impact of OCs on menopause, these medications are sometimes used to alleviate the symptoms of perimenopause (the time period before menopause when symptoms begin to occur), such as hot flashes, acne, and vaginal dryness. That being said, OCs haven’t been shown to have an impact on the time in a person's life in which menopause begins.

Oral contraceptive use has also been associated with cancer risks, with pills potentially reducing the risk of some and increasing the risk of others. OCs have been associated with reduced risk of endometrial, ovarian, and colorectal cancer. There is even some evidence to suggest that protection against endometrial cancer actually increases with prolonged use and persists even after discontinuation of the pill. On the flip side, there may be an increased risk for breast and cervical cancer with OC use. Breast cancer risk is higher among those who use birth control pills compared to those who don’t, but the risk seems to return to pre-OC levels about ten years after discontinuing the pill. Similarly, the risk of cervical cancer increases among those who have used OCs for five or more years, though the risk is thought to decrease after discontinuing the pill.

Other risks associated with long-term OC use, such as blood clots, stroke, and heart attacks, increase depending on certain risk factors. These factors include:

• Use of tobacco products, especially for those over 35 years old
• Uncontrolled, high blood pressure
• Blood clotting disorders
• Obesity
• Prolonged bed rest or immobilization
• Vein problems
• Heart problems, including history of stroke or heart attack
• Heart or liver disease
• Elevated eye pressure
• Family or personal history of uterine, breast, or liver cancer
• Family history of glaucoma
• Diabetes
• Breastfeeding
• Migraine headaches

There are so many different birth control pills with varying chemical compositions on the market, so for questions about a specific product, it’s a good idea to talk to your health care provider, especially if you have any risk factors. For information about other contraceptive options, check out the Go Ask Alice! Birth Control Basics fact sheet or Planned Parenthood for additional information and research updates.

Hope this gives you some peace of mind,