Understanding and managing side effects of the pill

Breakthrough bleeding

Spotting or breakthrough bleeding refers to vaginal bleeding that happens in between periods. While it is more common when taking the mini-pill, it can happen on the combined pill too.

You are more likely to experience breakthrough bleeding if you take your pill packs back-to-back, rather than having a break and allowing a withdrawal bleed to occur.

Headaches

Hormonal headaches can occur whether you’re taking hormonal contraceptives or not. However, among women taking the combined pill, headaches are one of the most commonly reported symptoms.

Headaches are most common during the pill break, due to a withdrawal of oestrogen. For some women, these headaches are mild and tolerable. But for others, they can develop into monthly migraines.

Breast changes

The combined birth control pill can cause temporary changes in your breasts, including:

• increased sensitivity and tenderness
• soreness or aching
• enlargement

Sometimes these symptoms occur at the same time. However, breast soreness and other symptoms are temporary and likely to go away after several months of pill use.

Improved period symptoms

By changing your hormones to prevent pregnancy, the combined pill can improve difficult period symptoms. You may notice:

• less pain during menstruation
• lighter bleeding
• a more regular cycle
• fewer mood swings

In fact, some women and teenagers start taking the combined pill to cope with difficult periods rather than for contraceptive purposes.

Acne

Acne tends to be controlled by your hormones. For some women, the contraceptive pill helps.

However, other women may notice that their skin worsens once they start taking the combined pill.

If you notice an increase in acne particularly when you start taking the pill, it’s likely your body’s reaction to newly fluctuating hormones. Try to wait several months before considering a different type of pill.

Changes in libido

Libido refers to your interest in sex. While it’s normal for your libido to go up and down, some women find that their libido changes when on the combined pill.

Many birth control pills lower your levels of testosterone, a hormone that’s responsible for increasing sexual desire. This can result in a lower libido, either temporarily or long-term.

That being said, many women do not experience changes in libido when on the pill. Every woman will react differently to their contraception.

Fluid retention

One last common side effect of the combined pill is fluid retention. This is when parts of the body swell due to a build-up of fluid.

Fluid retention can leave you feeling bloated and bigger than normal. But it’s important to note that excess water weight isn’t the same as fat gain.

While it’s commonly believed that the pill makes you gain weight, most studies do not support this. Water weight usually clears after a few days - so if you’ve noticed a change in the scales since starting your pill, it’s likely water you’re holding onto, not fat.

Blood clots

One serious side effect to note is the link between the combined pill and blood clots.

Taking the combined pill puts you at a higher risk of developing a blood clot, compared to not taking it. Blood clots can block vessels and cause serious health problems. They can occur in veins or arteries.

However, the increased risk of a blood clot when taking the pill is very small:

• Out of 10,000 women not taking the pill, 2 will develop a blood clot in one year.
• Out of 10,000 women taking the pill, 5-7 will develop a blood clot in one year.

Nevertheless, it’s important to know the signs of a blood clot. If you experience any of the following signs, get emergency medical help:

The pill and cancer

There is no direct link between the combined pill and cancer. That being said, an increased risk of cervical cancer in long-term pill users has been reported in some studies.

Breast cancer has also been found slightly more often in women who take the pill versus non-pill users. However, it is unclear if the pill itself is the cause. It may be that women who take the pill are examined more often and therefore, their breast cancer is noticed sooner.

Although very few, some women using the pill have reported malignant and benign liver tumours. If you have persisting pain in your upper stomach that won’t go away, tell your doctor.

Lifestyle changes

Some side effects can be managed by making lifestyle changes. For example:

• Taking your pill at the same time every day reduces your chances of spotting.
• Eating anti-inflammatory foods may help reduce breast tenderness.
• Consuming less salt may also prevent water retention.

Change to a different type of pill

Some types of combined pills may not work for you - and that’s perfectly normal. It often takes several different brands before finding one that suits you.

The table below shows some commonly used COCPs, along with their hormone doses:

Ask your doctor for advice if you’re not sure which pill to switch to. Alternatively, you can try a different type of contraception, such as:

• the contraceptive ring (NuvaRing)
• the contraceptive patch (Evra patch)
• the contraceptive implant
• the contraceptive injection

Switch to the mini-pill

The mini-pill is another daily pill that prevents pregnancy, however, it only contains progesterone. Due to this, there is no increased risk of blood clots.

You may find that a birth control pill without oestrogen leaves you with fewer side effects. That being said, the mini-pill must be taken at the same time every day to remain 99% effective. There is also no break between packs of mini-pills.

Switch to the intrauterine system (IUS)

Like the mini-pill, the intrauterine system (IUS) does not contain oestrogen. So for those who struggle with side effects on the pill, they may prefer the IUS.

The IUS is highly effective. Like the IUD, it is a t-shaped device that only needs to be inserted once and its effective for up to 8 years. You don’t have to remember to take a pill every day.

Rely on non-hormonal contraception instead

Hormonal contraception doesn’t work for everybody. If you’re struggling with a variety of different symptoms since starting the pill - and you’ve tried multiple different brands - the best idea may be to stop taking it entirely.

There are several non-hormonal contraception methods you can choose from instead:

• barrier contraceptives (male and female condoms)
• the copper intrauterine device (IUD)
• fertility awareness (avoiding intercourse during fertile windows)
• female sterilisation (a permanent procedure)