Birth Control Options for Women - Oral Contraception

Disadvantages and Complications of Oral Contraceptives

Common Side Effects. Estrogen and progesterone have different side effects and women on the combined pill may experience different effects from those on the progestin-only pill. Symptoms of serious problems include severe abdominal pain, chest pain, unusual headaches, visual disturbances, or severe pain or swelling in the legs. Of note, in spite of some concerns, combination OCs do not cause weight gain.

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[For specific side effects of estrogen and progestin, See Box Hormones Used in Contraception.]

Serious Effects on Heart and Circulation. OCs posed some serious risks when they first were introduced and estrogen and progestin levels were high. Such complications include blood clots, heart attack, stroke, and pulmonary embolism.

Most of the current low-dose OCs have reduced the risk significantly, although a risk for one or more of these complications still exists in women with certain risk factors (e.g., genetic factors, smoking, severe diabetes, and high blood pressure). Even among high-risk young women the additional risk for heart attack and stroke is still low. For example, low-dose OCs add only 9 complications per 100,000 women who smoke and have high blood pressure (which is still lower than the risk of death from pregnancy itself). Newer formulations have also reduced these risks.

The following are some observations on these complications.

Blood clots (thromboses). Oral contraceptive use increases the risk for blood clots, particularly in women with inherited clotting defects. (Unfortunately, tests for genetic abnormalities that increase the risk for blood clots are expensive and not routinely available.) The risk is highest in the first few months. The danger, however, is very slight, particularly in women with no other risk factors.
Hypertension. High blood pressure that occurs after a woman begins taking OCs can usually be corrected by discontinuing the medication, and women who use OCs should not be unduly alarmed. Of some concern was a study suggesting that OCs may cause a small but persistent increase in diastolic blood pressure (the second number in a blood pressure reading), which in turn may increase the risk for heart disease years later.
Stroke. Evidence has consistently reported a higher than normal risk for stroke in women taking OCs even if women have no other stroke risk factors. The current low-dose OCs have significantly reduced the danger. Women with high blood pressure, however, still face a higher risk for stroke, particularly in the presence of smoking and migraines. The risk for stroke, however, is still very low in absolute terms, even for these women.

Click the icon to see an image of stroke.

Heart attacks. Studies suggest a higher risk for heart attacks in certain women taking OCs, regardless of their risk for blood clots. OCs can also adversely affect cholesterol, lipids, and blood sugar levels, depending on the balance of estrogen and progestins. Smoking is the significant risk factor. In fact, some studies have found no higher risk for heart attack in healthy women who do not smoke. The chance for a heart attack is higher in OC users who have high blood pressure, unhealthy cholesterol levels, or both.