Guide to Birth Control Side Effects

Some people initially experience side effects when they start on combination birth control (which is birth control containing the hormones estrogen and progestin), such as nausea, breast tenderness, and irregular bleeding. It is common for your body to need a couple of months to adjust to the new hormones. Most often, these side effects get better with time.

Please check out this link for more information and tips on managing different side effects.

If these problems become more than just annoyances, please message our clinical team. If you just started your pill, see if you can stick it out for a few more weeks. The side effects should get better with time!

Nausea

Nausea is one of the most commonly reported side effects of birth control pills, but it’s almost never a sign of any medical issues. Because birth control alters the hormonal makeup of the body, having some mild side effects — even ones as uncomfortable as nausea — is completely normal.

If the nausea isn’t particularly severe and you started your birth control fewer than 3 months ago, your body just may need more time to adjust to the hormones in the pills. It may be frustrating to hear, but sit tight and be patient. The nausea is very likely to subside over time. 

To help prevent nausea, don’t take your birth control pill on an empty stomach; opt for taking it after dinner or with a snack. If you’re hoping to dampen the effects of nausea after you take a pill, drink clear liquids, consume light, plain foods like crackers, and avoid activity after eating. 

If nausea persists past 3 months or is particularly severe, contact your doctor to discuss other contraceptive options.

Headaches:

For some people, headaches are a birth control side effect, especially at first. The estrogen in combination birth control can cause a sudden flurry in headache or migraine activity, but they tend to subside as your body gets used to the increased overall hormone levels. While you should try to be patient, headaches that persist past 3 months are a sign you should ask your doctor for an adjustment to your prescription.

Decreased Libido:

Libido is such a complex thing and a change in your sex drive is rarely caused by a single factor.  There’s no conclusive research proving that birth control pills increase or decrease the female sex drive. However, many people who aren’t on hormonal birth control experience increased sexual urges around ovulation and you won’t experience that on the pill since pills prevent ovulation. On the other hand, being anxious about getting pregnant can kill the mood too, so being protected and help improve your sex life.

If you have a distinct noticeable difference in your libido within the first few months of taking a new birth control — you have the same partner and nothing else has changed and your sex drive has completely plummeted — then you should definitely look into switching methods.

But if your birth control prescription isn’t new, and your libido has decreased over time, it’s likely that other factors are responsible — like stress, relationship issues, or another prescription medication (certain antidepressants are known to dampen sex drive). It’s also pretty natural for your sex drive to decline somewhat with age, and with longer relationships, or after pregnancy, and with parenting and all of life’s changes. So make sure to take a look at all these factors as well.

What should you tell your provider if you want to switch? You know your body the best, so if you feel that your pill has changed your sex drive or caused any unwanted side effects — acne, weight gain, anything — there’s no harm in switching prescriptions and trying something different. It could be that you feel better on a pill with a different type of progestin or level of estrogen.

Breakthrough bleeding is defined as any unscheduled bleeding during the active pills of your cycle. Don’t stress! This is not abnormal. Breakthrough bleeding (anything from light brown discharge, to bleeding like your regular period, to even heavier than your normal period) is the most common side effect for people beginning birth control. Just continue using your birth control as normal and give your body time to adjust to the birth control you are using. Breakthrough bleeding typically goes away with time and the second cycle is usually much better than the first, but it may take up to 3 or 4 full cycles for breakthrough bleeding to go away for good.  

Here are the questions we usually ask people who have been on the same method of birth control for longer than 4 cycles and are still experiencing breakthrough bleeding: 

Have you missed any pills or taken any pills late?

Missed or late pills are a common cause for this kind of breakthrough bleeding (BTB). It is very important to take your birth control at the same time every day. This helps prevent breakthrough bleeding and ensures the best pregnancy protection from your birth control (when used perfectly, hormonal birth control is more than 99% effective in preventing pregnancy!). The better you are about taking your pill at the same time every day, the better it will work. Try setting a daily alarm on your phone to help remind you to take your pill at the same time each day.  Make it a part of your daily routine.

Have you tried skipping your period by skipping inactive pills?

Unscheduled bleeding and spotting are more common when trying to skip periods. You should plan to take your inactive pills (or take a 4-7-day hormone break) at the end of any combination pill pack or cycle in which you’ve had unscheduled bleeding. This allows your body the break it needs to get the lining all cleared out of the uterus at once, instead of little by little.  In order to prevent unscheduled bleeding when regularly skipping periods, it’s a good idea to take a break from the active pills for 4-7 days every 2-3 months and plan to get a period.  The goal is to plan for a scheduled period instead of being surprised.

Are you using a progestin-only pill?

Progestin-only pills (POP’s) are prescribed for people who have certain health conditions that prevent them from taking combination pills.  These include a history of deep vein thrombosis, uncontrolled high blood pressure, or migraine with aura, to name just a few. Irregular bleeding is the most common side effect of progestin-only pills. Fortunately, this side effect usually decreases or stops altogether with time (usually within about 6 months). Over time, POPs may reduce menstrual bleeding or stop your period altogether. If you’ve been using your POP for less than 6 months, we encourage you to stick with it as the irregular bleeding will most likely improve.  This same bleeding pattern may be seen with other progestin-only methods such as the Depo Provera shots, the Nexplanon arm implant, and the progestin IUDs.

If the bleeding is severe:

If the bleeding is heavy enough to fill 1 tampon or pad per hour for 2-3 hours in a row or you are feeling dizzy or lightheaded, we recommend you go to an Urgent Care locally. Make sure to tell them you’re using birth control and be prepared to tell them the name of your birth control. Please let us know if this occurs so we can ensure we are prescribing you a safe and appropriate medication.

If it has been more than 6 months with this birth control and you’re still experiencing breakthrough bleeding:

 If breakthrough bleeding is only an issue when you try to skip periods, it may be a good idea to take each pack in its entirety or complete a hormone-free week to have a monthly period. Some people have breakthrough bleeding for a long time when trying to skip periods while others do not. It all depends on your body.  Your chances of successfully skipping periods are best if you work up to it.  That is why we suggest you have at least 3 regular and predictable periods before trying to skip.  We can send you instructions on building up time between periods slowly and successfully.  If breakthrough bleeding is a persistent issue despite completing monthly hormone-free intervals, it may be time to switch to another birth control. At Nurx, we offer many different types of birth control pills. Our medical team can help you change to another birth control that may cause less spotting. Get started here.

If irregular periods persist even though you’re using birth control, you should contact us.   Keep in mind “irregular” can mean periods too often AND periods not often enough.  Please let us know what the issue is so we can work it out with you. 

There isn’t strong evidence that birth control pills cause depression or anxiety. However, many people report changes in mood especially in the first few months of using a new pill. As your body gets used to changes in hormonal levels, however, these mood changes tend to even out over time. Certain birth controls are actually FDA-approved for treating PMDD (premenstrual dysphoric disorder), an extreme form of PMS.

When it comes to finding the right pill that suits your mood the process may require some trial and error, however the good news is that there are many options to choose from. 

If you’re considering starting birth control but are worried about developing depression or anxiety as a result, talk to your doctor. 

Acne can be a common side effect when starting any hormonal birth control, but typically improves within about 6-8 weeks. If you find acne has not improved after about the 3rd month of using your pill, reach out to us and we can help you select a different option. Finding a pill that works well for you may take some trial and error.

There are several medical conditions such as anemia and thyroid disease which may contribute to hair loss. Medications, including birth control, may also be a cause. It is important to know why you are experiencing hair loss so that it can be managed. If birth control is suspected to be the source of hair loss, there are different options that the medical team can choose that may be less likely to cause this side effect. Be sure to mention this to the medical team if this is a concern for you.

“Missing a pill” when taking combination pills means missing the normal time you take it by 24 hours or more.

If you’ve missed one pill: Don’t panic! Take your pill as soon as you remember it, which may mean taking two pills at the same time (that’s totally safe)

If you’ve missed two pills in a row, and you’re still in the first or second week of your cycle, you can take two pills the day you notice you’ve missed them and two pills the following day before returning to your regular schedule. But use backup protection, like a condom, for seven days.

If you’ve missed three pills at any time, in any week of your pack, take two pills as soon as you realize you’ve missed three pills, then take another two pills the next day, and two pills the third day. Use backup contraception for seven days. Keep in mind that taking 2 or 3 pills at a time may cause nausea. This is because the dosage is higher, but is not harmful.

If you miss two or more pills near ovulation (usually between five and 12 days after the last day of your period according to AmericanPregnancy.org), and you have sex without a condom, you might want to use emergency contraception like Ella or Plan B to prevent pregnancy.

Blood clots can be a serious health emergency. They can cause illness, a hospital visit, permanent harm, and even death. There are several risk factors for blood clots including smoking (especially over the age of 35), increased age, obesity, prolonged immobility (like recovering from surgery), pregnancy, diabetes, high blood pressure, and a family history of blood clots, just to name a few. Combined hormonal contraception (birth control that contains estrogen) can also increase this. Certain combined birth control pills that contain the progestins drospirenone and desogestrel (such Yaz, Nikki, and Apri) may have a higher risk in people with higher than normal BMI. Because of this, we do not prescribe these to patients that are already at a higher risk.

It’s important to recognize that blood clots are rare. You are much more likely to get a blood clot during pregnancy than while taking birth control. It is important to reduce the risks when possible. You can do this by not smoking and maintaining a healthy weight. If you have any specific concerns, please reach out to our medical team.

Smoking and vaping increase your risk of blood clots. This risk can continue even after you quit smoking, so it is important to tell us if you have ever smoked. Birth control with estrogen can increase this risk also.  For patients that are over the age of 35 and are currently using nicotine in any form, the CDC recommends contraception that does not contain estrogen. Nurx has several progestin-only options available. You can discuss this with your medical team.