What are the Benefits and Risks of Taking Birth Control Pills?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on June 11, 2025.

Key Points

There are many benefits to using the birth control pill as a means of pregnancy prevention. It's convenient, usually covered by your insurance, and has few side effects for most women. There are important risks to understand as well, including your risk if you smoke, are older or have other serious medical risks, like a history of breast cancer, blood clots or migraines with auras.

The birth control pill has been used safely and successfully since 1960 when it was first approved by the FDA. Many of today's birth control pills contain lower amounts of hormones and come in many different dosing options to allow women effective and flexible methods of family planning.^1,2 Most women are able to take the birth control pill with few or no side effects.

Some of the most commonly prescribed birth control pills in the U.S. include Sprintec, Junel FE, Apri, Lo Loestrin FE, Yaz, and Safyral.

Do birth control pills have a Boxed Warning?

Birth control pills are not safe for everyone. All oral combination contraceptives carry the following Boxed Warning:

• Warning: Cigarette Smoking and Serious Cardiovascular Events
  • Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptives (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked.
  • For this reason, COCs should not be used by women who are over 35 years of age and smoke.

A cardiovascular event may include serious or fatal events like a blood clot, heart attack or stroke. If you have questions about your risk of taking the birth control pill, discuss this further with your healthcare provider.

The risks associated with taking oral contraceptives may increase significantly if you are a smoker and over age 35, have high blood pressure, diabetes, high cholesterol, a tendency to form blood clots, or are obese.

Risks are also higher if you have or have had a heart attack, stroke, angina pectoris, cancer of the breast or sex organs, jaundice, clotting disorders or malignant or benign liver tumors.

What are the health benefits of the pill?

For most people, the pill is a safe and effective option for contraception. There are several benefits⁵.

• The pill has less than a 1% failure rate (meaning less than 1 out of 100 women unintentionally become pregnant) when used correctly 100% of the time. However, typical failure rates are actually about 3% per year, because the pill may not be used perfectly. The chance of becoming pregnant increases with each missed pill during a menstrual cycle.
• Menstrual cycles may become more regular. The birth control pill can result in lighter bleeding and decreased pain during your monthly period. It can lessen more heavy bleeding, pain and severity of endometriosis and fibroid tumors.
• Acne or premenstrual dysphoric disorder (PMDD) may improve with some birth control pills.
• Noncancerous cysts or lumps in the breast may occur less frequently.
• Some birth control pills can help prevent sudden mood changes during a woman’s cycle due to changing hormone levels.
• Ectopic (tubal) pregnancy may occur less frequently.
• Studies have shown the birth control pill leads to lower rates of pelvic inflammatory disease and cancer of the endometrium (lining of the uterus) and ovaries.  Ovarian cysts may occur less frequently.
• The combination birth control pill can safely be used to skip periods all-together. Many people who use the progestin-only pills (POP or mini-pill) don't have periods anyway.
• Effective birth control leads to less worry and is a great way to help you plan ahead for your career, social and family life. 

There are a variety of birth control pills available to fit your need. For example:

• Combination oral contraceptives (COCs) that contain both an estrogen and a progestin are common, affordable and have been used for years.
• Progestin-only pills ("mini-pill" or POP) exist if you are breastfeeding or unable to use estrogen due to medical reasons.⁴ You may have less bleeding or stop having periods altogether while taking these pills. 
• Using extended-cycle /  continuous-cycle pills (like Seasonique or Seasonale) pills can allow you to have fewer periods or no periods at all.

Many generic versions of the birth control pill are available at a lower cost than brand names and are equally effective. Ask your doctor or pharmacist if you prefer a generic birth control pill. 

In July 2023 the U.S. Food and Drug Administration approved Opill, the first nonprescription, over-the-counter (OTC) birth control pill (oral contraceptive). Opill, a progestin-only ("mini") pill, is available online and on pharmacy, grocery and other retail shelves. Ask your pharmacist for more details.

Learn more: How effective is Opill birth control?

What are the risks of the pill?

For most women the pill is very safe option for birth control. Serious side effects occur very infrequently, especially if you are young and healthy. However, there are some disadvantages to using the birth control pill, and women should consider these risks and discuss them with their health care provider.

Disadvantages of the pill may include:

• Blood clots
• Heart attacks
• Stroke
• High blood pressure
• Gallbladder disease
• Liver tumors
• Cancer 
• Elevated triglycerides (a fat in the blood) or lipoproteins (particle that carry lipids in the blood)

The choice of birth control is individual for each woman. Some women may have medical conditions (for example: breast cancer, uncontrolled blood pressure or severe migraines) that prevent them from using birth control pills, while other women may be at higher risk for dangerous adverse effects due to age or smoking status. 

Birth control pills can lead to a higher risk for serious heart side effects like blood clots, heart attack, and stroke in women who smoke, especially if older than 35 years of age. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use oral birth control pills are strongly advised not to smoke. Birth control pills should NOT be used by women who are over 35 years of age and smoke. 

Taking a pill every day may be difficult for some people. If you miss a pill, you may need to use another form of birth control (for example, a condom) during your cycle. If you think you'll have trouble taking a pill every day, an IUD or other long-acting form of birth control may be a better option for you. Speak with your healthcare provider.

The birth control pill does not protect against sexually transmitted diseases (STDs). Only a condom can protect you from sexually transmitted diseases.

There can be drug interactions that may lower the effectiveness of birth control pills (for example, rifampin, some seizure medications, St. John's wort, some HIV drugs and others). Be sure to ask your pharmacist about potential drug interactions each time you have a prescription filled. Tell them the names of all of the drugs you take, including prescription, over-the-counter, vitamins, and herbal and dietary supplements.

Spotting (breakthrough bleeding) may occur mid-cycle for the first few months of birth control use as your body adjusts to the changes in hormone levels. Breakthrough bleeding may be more common with extended- or continuous-cycle birth control pills or with progestin-only pills (vs. combined oral contraceptives).

Birth control pills can cause breast pain or vaginal dryness; these side effects may continue with use or subside.

You should not take the pill if you are pregnant, think you may be pregnant or have unexplained vaginal bleeding.

After stopping the pill, it may take several months or longer to begin ovulating again if pregnancy is desired.

A progestin called drospirenone is found in some birth control pills (examples include: Slynd, Yaz, Yasmin, Gianvi, Syeda, Safyral, Beyaz, Loryna, Jasmiel, Nikki, Ocella, Zarah) and is linked to a higher risk for blood clots than other birth control pills. Drospirenone may also raise potassium levels in the blood which may cause heart or health problems. It is important to discuss your health history with your doctor prior to using birth control pills that contain drospirenone.

Some women may find that the progestin-only birth control can affect their milk supply, especially when they first start breastfeeding. If you start using a progestin-only pill and your milk supply decreases, talk with your doctor about ways to increase your milk supply or other options for preventing pregnancy.⁶

Most insurance plans will cover birth control at no cost in the U.S. under the Affordable Care Act (ACA). Check with your insurance plan to see which pills are covered and the cost. If you don't have insurance, ask your doctor or pharmacist about low-cost or free options for birth control.

Does the birth control pill cause weight gain?

Weight gain is not a common side effect with low dose combination birth control pills in use today, but weight gain has been reported with the birth control shot. Everyone has different affects to medicines, so if you notice weight gain or loss or other worrisome side effects, talk with healthcare provider right away.

Many years ago the pill contained higher levels of estrogen which may have caused weight gain. Birth control pills may cause slight fluid retention in some people, but that effect is usually temporary. 

Weight gain has been reported in some women who use the birth control shot that contains medroxyprogesterone acetate (Depot Provera). In studies with the injection, the average weight gain was about 5 pounds (lbs) after one year, 8 lbs after 2 years, close to 14 lbs after 4 years and 17 lbs after 6 years of use. In research, about 2 out of every 100 women withdrew from studies due to weight gain. After 2 years in about 3,900 women, more than one-third of women reported at least a 10 lb weight gain.

There are many options for birth control, and some people may need to try 2 or 3 different options to find the best one. Don't stop your birth control pill right away because that can increase your risk of pregnancy. Talk to your doctor first about options or be sure to use another method of birth control like a condom.

Who should not use the birth control pill?

You should not use the pill if you have or have had any of the following conditions:

• Heart disease, heart valve disease, chest pain (angina pectoris), heart attack or stroke.
• Blood clots in the legs (thrombophlebitis), lungs (pulmonary embolism), or eyes.
• Blood clots in the deep veins of your legs.
• Known or suspected breast cancer or cancer of the lining of the uterus, cervix, or vagina or other hormonally-sensitive cancers.
• Liver tumor or disease (benign or cancerous)
• Vessel disease of the brain
• Uncontrolled high blood pressure.
• Diabetes with vessel disease
• Undiagnosed vaginal bleeding
• Yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during previous use of the pill
• Are receiving certain hepatitis C drug treatments due to possible risk of liver damage.
• Pregnant or think you might be pregnant
• Allergy to the active or inactive ingredients of your birth control regimen.

Tell your healthcare provider if you have ever had any of these conditions. Your healthcare provider can recommend a safer method of birth control.

Also, tell your doctor, nurse or other healthcare provider if you or any family member has ever had:

• Breast nodules, fibrocystic disease of the breast, an abnormal breast X-ray or mammogram.
• Diabetes.
• Elevated cholesterol or triglycerides.
• High blood pressure.
• A tendency to form blood clots.
• Migraine, migraine with aura, other type of headaches or epilepsy.
• Mental depression.
• Gallbladder, heart, or kidney disease.
• History of scanty or irregular menstrual periods.

Women with any of these conditions should be checked often by their health-care provider if they choose to use oral contraceptives. Also, be sure to inform your doctor or health-care provider if you smoke or are on any medications.

The pill and breastfeeding

According to the American College of Obstetrics and Gynecologists (ACOG), all birth control methods are safe to use while breastfeeding. However, breastfeeding mothers should avoid estrogen in combination hormonal birth control (which contain both estrogen and progestin) in the first 4 weeks of breastfeeding (until breastfeeding is established) as there may be a small chance it could reduce your milk supply. Progestin-only pills ("mini-pills" or POP) can be started right after childbirth.^7,8

You should not use combined hormonal methods during the first 3 weeks after delivery because the risk of DVT is higher in the weeks after childbirth. If you have additional risk factors for DVT, you should wait to use combined hormonal methods until after the first 4 to 6 weeks following delivery.

Other birth control options for breastfeeding women include IUDs, the implant or the birth control shot.³ Condoms and abstinence are other options, but may be less reliable in preventing pregnancy.

Side effects with the pill

Most side effects with birth control pill are not typically serious and will often go away after a few months of use.¹ These may include:

• Spotting or vaginal bleeding between periods (breakthrough bleeding)
• Possible weight gain or fluid retention 
• Breast swelling or tenderness
• Nausea, vomiting or upset stomach
• Mood changes
• Headache
• Melasma (darkening of skin, often on the face)
• Trouble wearing lens changes

Other side effects may include a change in appetite, nervousness, depression, dizziness, loss of scalp hair, rash, and vaginal infections.

The oral birth control pill does not protect against against HIV infection (AIDS) and other sexually transmitted infections. Use a condom for protection.

Many side effects, especially nausea, vomiting, and breakthrough bleeding may subside within the first few months. If any of these side effects bother you, call your doctor or healthcare provider.

To learn more about breakthrough bleeding, visit: Birth Control Pills: Why Do I Get Breakthrough Bleeding?

Smoking and birth control pill use

Women who use oral contraceptives are strongly advised not to smoke. Smoking increases the risk of serious heart side effects like like blood clots, heart attack, and stroke, which may lead to death, when using the pill. Birth control should NOT be used in women over 35 years of age who smoke due to these increased risks.

Cardiovascular (heart and blood vessel) risks increase with age, weight, family history of heart disease, and number of cigarettes smoked per day. Heart risks increase with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use oral birth control pills are strongly advised not to smoke. 

Serious side effects with the pill

Serious side effects of the pill do not occur frequently, especially if you are younger and in good health. Possible serious side effects include:

• Blurred vision
• Severe stomach pain
• Severe headache
• Blood clots
• Swelling or pain in the legs
• Chest pain
• Gallbladder disease (may be related to higher estrogen dose)
• Liver tumors which may rarely be cancerous
• Heart attack which may be fatal
• Stroke which may be fatal
• Risk of cancer

It is not known if hormonal birth control pills cause breast cancer. Some studies (but not all) suggest a small increased risk of breast cancer among current users with a longer duration of use. Other studies have found an increased risk of cervical cancer with oral contraceptives, but cannot prove that oral contraceptives are the cause.

If you are over the age of 40 years, discuss the use of the birth control pills with your healthcare provider to weight the risks compared to benefits for you.

Call your doctor immediately or get emergency help if any of these warning signs occur while you are taking oral contraceptives:

• Sharp chest pain, coughing of blood, or sudden shortness of breath (indicating a possible clot in the lung).
• Pain in the calf (indicating a possible clot in the leg).
• Crushing chest pain or heaviness in the chest (indicating a possible heart attack).
• Sudden, severe headache or vomiting, dizziness or fainting, disturbances of vision or speech, weakness, or numbness in an arm or leg (indicating a possible stroke).
• Sudden partial or complete loss of vision (indicating a possible clot in the eye).
• Breast lumps (indicating possible breast cancer or fibrocystic disease of the breast; ask your doctor or health-care provider to show you how to examine your breasts).
• Severe pain or tenderness in the stomach area (indicating a possibly ruptured liver tumor).
• Difficulty in sleeping, weakness, lack of energy, fatigue (extreme tiredness), or change in mood (possibly indicating severe depression).
• Jaundice or a yellowing of the skin or eyeballs, accompanied frequently by fever, fatigue, loss of appetite, dark-colored urine, or light-colored bowel movements (indicating possible liver problems).⁸

Read more: What are my birth control options and how effective are they? 

This is not all the information you need to know about safe and effective use of birth control pills (oral contraceptives) and is not a full list of benefits, risks or side effects. It does not replace your healthcare providers instructions. Review the full product information leaflet for your specific birth control product and review this information with your doctor or pharmacist if you have questions or concerns.

See also

• Birth Control Pills - When Should I Expect My Period?
• Birth Control Pills: Why do I get breakthrough bleeding?
• Emergency Contraception: What You Need to Know
• Emergency Contraceptives: Morning After Pills & OTC Options
• Grapefruit and Birth Control Pills: Your Questions Answered
• Missed your birth control pill? Here's what to do
• Non-hormonal Methods of Birth Control
• What are the options for permanent birth control?
• Your Guide to Types of Birth Control Pills (Oral Contraceptives)

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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