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

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Oct 23, 2024.

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 or serious blood clots.

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 Many women are able to take the birth control pill with few or no side effects.

However, the risks associated with taking oral contraceptives 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 clotting disorders, heart attack, stroke, angina pectoris, cancer of the breast or sex organs, jaundice, or malignant or benign liver tumors. All oral contraceptives carry the following US Boxed Warning:

• 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 includes serious or fatal events like a blood clot, heart attack or stroke.

Benefits of the pill

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

• 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. With typical use, it's usually effective about 93% of the time (meaning 7 out of 100 women unintentionally become pregnant).
• 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.
• Some birth control pills can help prevent sudden mood changes during a woman’s cycle due to changing hormone levels.
• Studies have shown the birth control pill leads to lower rates of pelvic inflammatory disease and cancer of the endometrium (uterine) and ovaries.
• 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 pills that contain both an estrogen and a progestin are common, affordable and have been used safely for years.
• Progestin-only versions of the pill ("mini-pill") 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 (like Seasonique or Seasonale) or continuous-cycle (i.e., Amethyst) pills can allow you to have fewer periods or no periods at all.

Weight gain is not a common side effect with low dose combination birth control pills in use today. Many years ago the pill contained higher levels of estrogen which may have caused weight gain. Birth control pills may cause slight fluid retention, but that effect is usually temporary.

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 expected to be available in March 2024 online and on pharmacy, grocery and other retail shelves.

Learn more: What is Opill, where can I get it and how much does it cost?

It is also possible to completely eliminate periods by taking only the active pills continuously (each day) from certain combination birth control pills and skipping the inactive pills. Ask your healthcare provider if this would be a good option for you and which options you can use. You may require additional pill packs and your insurance may not pay for more than 12 packs per year, so be sure to check with your insurance, as well.^1,2

Risks of the pill

For most women the pill is very safe option for birth control. 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 may include:

• Blood clots
• Heart attacks
• Stroke
• High blood pressure
• Gallbladder disease
• Liver tumors
• Cancer 
• Elevated triglycerides (a fat in the blood)

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

Birth control pills can lead to a higher risk for 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. 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 (i.e., 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.

The birth control pill does not protect against sexually transmitted diseases. 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 or herbal 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 worse with extended- or continuous-cycle birth control pills or with progestin-only pills.

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 suspect you are 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

The birth control pill may require a monthly cost or copay, and therefore may not be affordable for all women. Generic birth control pills are less expensive, but just as effective. Most insurance plans will cover birth control at no cost in the US; check with your plan to see which pills are covered on their formulary. If you don't have insurance, ask your doctor or pharmacist about low-cost or free options for birth control.

Warnings for birth control pill use

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

Cardiovascular (heart and blood vessel) risks increase with age, weight, family history of heart disease, and number of cigarettes smoked per day.

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

• Heart disease, heart valve disease, chest pain, 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
• 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
• Pregnant or think you might be pregnant
• Allergy to the active or inactive ingredients of your birth control regimen.

Tell your health-care 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 or other 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

Breastfeeding mothers should avoid estrogen in combination hormonal birth control (which contain both estrogen and progestin) in the first 4 to 6 weeks of breastfeeding as it may reduce milk supply. Progestin-only pills ("mini-pills") can be started right after childbirth.⁷

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

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

Other side effects

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

If any of these side effects bother you, call your doctor or health-care provider.

Serious side effects with the pill

• Blurred vision
• Severe stomach pain
• Severe headache
• Blood clots
• Swelling or pain in the legs
• Chest pain
• Gallbladder disease
• Liver tumors
• Heart attack which may be fatal
• Stroke which may be fatal.

Call your doctor immediately or get emergency help if any of these effects 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, 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

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

See also

• Birth Control Pills (Oral Contraceptives)
• Birth Control Pills and Your 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?

Further information

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

Medical Disclaimer