Can Birth Control Cause Inflammation and Other Side Effects?

Whether you’re currently on hormonal birth control, considering going on it, or trying to get off of it, you may be wondering about side effects, including if birth control pills cause inflammation.

When birth control pills first came out in the 1960s, the pills were a game-changer, putting people in the driver's seat of family planning. Roughly 10 million people in the United States are on birth control pills at any given time.

But just like with every other medication, birth control pills can have side effects. Here are some potential side effects and what non-hormonal birth control options are available.

What are birth control pills?

A birth control pill most commonly consists of a combination of synthetic estrogen and progesterone.

A progesterone-only version is used in certain cases. The FDA first approved the pill as a form of birth control in 1960. Since then, formulations have evolved to include much lower doses of hormones than they used to, making them equally effective with fewer serious side effects.

The main way the pill works is by inhibiting ovulation. This means it stops the ovary from releasing an egg into the fallopian tube each month.

When taken correctly—meaning no missed doses—the pill is extremely effective at preventing pregnancy, with fewer than 1 pregnancy for every 100 users each year.

In reality, people do forget doses, leading to about 9 pregnancies per 100 users per year.

Hormonal birth control side effects

Less serious side effects of birth control include the following.

• nausea
• spotting
• bleeding between periods
• breast tenderness
• abdominal cramps and bloating
• edema (water retention)
• heavy bleeding or missed period
• melasma (dark pigmentation on the face) which may persist
• headaches
• migraine
• weight gain
• insulin resistance
• blurred vision or nearsightedness

Some of these side effects are temporary, lasting just a few months. However, some more serious potential side effects of birth control deserve attention.

Yeast infections

Research has shown that yeast infections are more common amongst those on birth control.

Birth control pills don’t directly cause yeast infections. But they can disrupt your body’s natural hormonal balance—specifically the balance between estrogen and progesterone—which can sometimes lead to yeast overgrowth and subsequent vaginal infection.

Gum disease and Crohn’s disease

Gum disease is a more common side effect of birth control pills, and this may be because the Candida and Prevotella bacteria species that contribute to it are more abundant in the mouth when taking birth control.

Crohn’s disease, a form of inflammatory bowel disease, also occurs more often in people on birth control, possibly even three times as often.

This may be a result of the change in gut microbes and estrogen’s negative impact on gut permeability.

Mental health and depression

In one randomized controlled study of 178 participants assigned female at birth, those on birth control experienced less premenstrual depression. But during other parts of their cycle, they were more likely to be anxious and moody.

An observational study found that those who took the pill with both estrogen and progesterone were about 20% more likely to end up on an antidepressant.

Birth control pills may even impact cognitive function. According to one small study of 43 participants, those on birth control pills had worse verbal fluency than those not taking a hormonal form of contraception.

Nutritional deficiencies

Additionally, though not listed on the package insert, some research suggests that various vitamins and minerals are depleted in birth control pill users.

Studies have found lower levels of numerous vitamins (folate, B2, B6, and B12, and vitamins C and E) and minerals (selenium, zinc, and magnesium) in those taking the pills.

One study, focused solely on vitamin B12, found that birth control pill users had consistently lower vitamin B12 concentrations than non-users, independent of their dietary intake.

Inflammation

Inflammation, which is a common denominator in essentially all chronic disease, is also more likely with birth control pills.

High sensitivity C-reactive protein, a measure of inflammation that we check routinely at Parsley Health, has been shown to be high more frequently among birth control pill users than non-users.

That may help to explain the increased risk for cardiovascular events among birth control users.

Blood clots

Venous thrombosis (blood clots) is one of the more serious negative side effects of most birth control pills.

Venous thrombosis occurs when a blood clot forms in the vein, creating the potential for it to travel to the lungs and become life-threatening.

Only about 2 to 4 out of 10,000 people will develop this kind of blood clot. But for those taking birth control pills, the risk increases about 3.5 times.

Heart attack or stroke in those under 45 years old is uncommon. Nevertheless, birth control pills increase that risk by 60 percent at the lowest estrogen dose. The risk increases as the estrogen dose increases.

Newer research, however, shows that oral contraceptives are associated with a lower risk of cardiovascular disease events. Ultimately, more research is needed.

Gallstones

While typically not life-threatening, gallstones are deposits of digestive juices within the gallbladder that can cause symptoms of pain, indigestion, nausea, and vomiting.

About 5% of those assigned female at birth under the age of 40 have gallstones, but since estrogen and progesterone increase gallstone formation, the likelihood of developing gallstones is 35 precent to 50 percent higher for those who take birth control pills.

Having gallstones can impact quality of life, as gallstones can be painful and lead to surgery to remove the gallbladder. Ultimately, this has a negative and life-long impact on digestion and your microbiome.

Decreased sex drive

Another listed side effect of birth control pills is that a small percentage of people may experience a diminished sex drive.

A likely explanation is that birth control pills decrease the amount of testosterone circulating in your body.

A study validated this when comparing the sex drive of participants using a contraceptive ring, implant, or birth control pill to those using a non-hormonal birth control option, such as a copper IUD. The study found that participants using a hormonal birth control option experienced a decreased sex drive.

Benefits of birth control pills

Besides being an effective means for birth control, studies show that birth control pill users have a decreased risk for ovarian, endometrial, and colorectal cancer when compared to non-users.

The pill has also been seen as a useful method for chemoprevention across women with varying levels of cancer risk. Other potential advantages of birth control pills include lighter, less painful periods, more regular periods, and less acne (with some forms of birth control pills).

Often doctors will prescribe the pill to address symptoms such as painful periods, acne, migraine, and excessive hair growth.

But at Parsley Health, we aim to address the underlying causes.

Birth control alternatives

For those who decide they don’t want to deal with the potential side effects of birth control pills, other birth control options include condoms, non-hormonal copper IUDs, diaphragms, and various types of fertility trackers.

Here’s our take on the options we often recommend to our members at Parsley Health who don’t wish to be on hormonal birth control.

Non-hormonal IUDs

A non-hormonal IUD is typically made of copper and works by altering the way the sperm swims, preventing it from meeting an egg and therefore preventing pregnancy.

A copper IUD can last up to 12 years or be removed at any time. We see that patients find non-hormonal IUDs best for when they don’t foresee getting pregnant anytime soon, are done having children, or don't want to have them at all.

Digital fertility trackers

Apps can help you learn about your own cycle so you can predict ovulation and your next period and know when you’re most fertile.

You can also track your basal body temperature (your body temperature at rest) within some apps or use a wearable. Slight increases in your basal body temperature often signal ovulation.

We find that patients who are transitioning off of birth control pills or trying to get pregnant like using a fertility tracker app. However, keep in mind that your data may not be as private as you would like.

Final thoughts on the birth control pill

Individual and personal reasons might make birth control pills the best choice of family planning for you. But any type of medication deserves thoughtful consideration by the patient and their doctor before choosing it.

Knowing about potential side effects and benefits of hormonal contraception can help you make an informed decision.