What are women's biggest concerns about using the pill?

Reviewed by Dr Bhavini Shah

The contraceptive pill is one of the most popular and reliable methods of birth control. The NHS class the pill as a safe and effective mode of preventing pregnancy. But not all women feel confident using it especially when it comes to side effects.  

In this article we explore your biggest concerns about using the pill. We’ll also dive into the results from our Women’s Health and Wellness Survey*. In which we asked questions on a range of topics, including STIs, menopause, body image and mental health.  

Women’s biggest concerns about hormonal contraception

Side effects are one of the biggest concerns when it comes to using hormonal contraception. As part of our survey, we asked: “What are your concerns when it comes to taking the pill or other hormonal contraception?”, the most common answers were:

• Weight gain (58%)
• Hormonal imbalance (40%) 
• Mood swings (39%) 
• Safety (24%) 
• Effectiveness (19%) 
• Lower libido (19%) 
• Reduced fertility (11%) 

These results are interesting because more people responded to this part of this survey than declared that they use hormonal contraception. This suggests that many women have been put off using hormonal contraception altogether, either by using it in the past, or simply by hearing negative things.

In total, 430 respondents declared that their preferred type of contraception was hormonal e.g. the pill, the IUS, the implant, the injection, the contraceptive patch, or the vaginal ring. By contrast, 610 people reported that they were worried about the link between the pill and weight gain. 

1. The pill and mental health

Hormones can cause an array of emotions, and can impact your mood and state of mind, so it makes sense that hormonal birth control may affect these too. It’s something that has been heavily researched over the years, with the conclusion of whether it affects your mental health being yes… and no. 

Studies carried out have been inconsistent and contradictory in comparison to one another. Some have shown that women who used hormonal birth control were more likely to be diagnosed with or treated for depression.  

In a 2023 study the most common side effect reported was mood changes: 

• 43.6% of participants experienced mood changes related to their hormonal contraception at some point in their life. 

While other studies have reported less symptoms of depression and anxiety - proving that different people will experience different side effects. Find out more about the link between birth control and depression.

2.  The pill and weight gain 

In our survey 58% reported that they were concerned about weight gain. While there’s some anecdotal evidence for this (i.e. you may know women who have gained weight after taking the pill) there’s little science to back this up. It’s far more likely that weight gain simply happens naturally over time. 

Studies have found that after participants used the pill for six months, they didn’t gain any more weight than people who weren’t using any birth control. On average participants gained 0.88kg (1.94lbs). Find out more about the link between birth control and weight gain.

3. The pill and blood clots

While concerns about the safety of hormonal contraception are valid, the risks associated with the pill such as blood clots are very low. The risk of blood clots in people using the combined contraceptive pill is three times higher than in people who don’t take them. The European Medicines Agency reported in 2014 that they would expect between five and 12 people in every 10,000 to get a blood clot when taking combined contraceptives for one year. They would expect two cases of blood clots among 10,000 people not using these contraceptives. 

Find out more about the link between birth control and blood clots. 

Dr Bhavini Shah; “Some of the rare risks associated with combined contraceptive methods include the development of a blood clot in your leg or lungs, a heart attack, or a stroke The risk of getting a blood clot is very small, but your doctor will check if you have certain risk factors before prescribing the pill.”  

4. The pill and breast cancer

If you have a family history of certain cancers like breast cancer the combined pill may increase your risk. Researchers analysing data at Oxford Population Health’s Cancer Epidemiology Unit have found evidence to suggest that current or recent use of either combined or progestogen-only contraceptives are associated with a 20-30% higher risk of breast cancer.

However, 10 years after you stop the pill your risk of developing cancer returns to a normal level. It’s also important to remember there are other things, like smoking, that can increase your risk of cancer more than the pill can. Find out more about the increased risks of breast cancer when taking the pill.

5. The pill and lower libido

You may have heard people say that their sex drive changed when they started taking the pill. Some find that their sex drive is lower and some find it’s higher. The hormones in the type of contraceptive you’re taking can alter your mood and libido. Find out more about the link between the pill and lower sex drive. 

6. The pill and fertility

In our Women’s Health and Wellness Survey 11% reported they were concerned about reduced fertility when taking hormonal contraception. But there is no evidence that hormonal contraception can affect your ability to get pregnant. 

Dr Bhavini Shah: “If you’ve been taking the pill for several years and find it difficult to get pregnant once you stop, it is less likely to be related to the number of years you’ve been using contraception.” 

It may be that your body takes some time to readjust after you come off your contraception before you can conceive. Find out more about how quickly you can get pregnant after stopping the pill. 

What should I consider when choosing contraception?

As we’ve seen from this survey, women have lots of concerns and considerations when it comes to choosing and using contraception.

When we asked respondents “What do you prioritise when it comes to finding the right contraception for you?” the most popular answer was “convenience”, which was chosen by 461 respondents (44%). The next most popular answers were: “impact on hormones” (34%) and “changes in mood” (26%).

Finding the right contraception will be a personal journey. It may take you some time to find the perfect type, and you may try some along the way that aren’t right. 

When you’re choosing your contraception, here are some things to bear in mind:  

• Convenience – the most “convenient” types of contraception are typically those that you don’t have to worry about every day e.g. the IUS, IUD and implant. These can be left in for several years, providing reliable contraception without needing any up-keep. However, you’ll need to get these fitted by a medical professional. 
• Effectiveness – the most effective types of contraception are the IUS, IUD and implant, along with sterilisation (99%+). Other types that rely on regular correct use, like the pill, are around 99% effective when used perfectly and 91% effective when used almost perfectly. The least effective type of contraception is the diaphragm or cap 92-96% with perfect use, 71-88% with typical use.  
• Cost – contraception is available through the NHS, however if you use an online service, like Online Doctor there may be costs involved. Condoms are also available to buy in supermarkets and pharmacies. They’re free from sexual health clinics. 
• Safety – there are some risks associated with combined types of contraception, but these are very low. If your doctor thinks you aren’t appropriate for using a certain type of contraception they won’t prescribe it – it’s that simple.
• Side effects – hormonal contraception can cause side effects like mood swings and breast tenderness, but for most women these will be minor and short-lived. Talk to your prescribing doctor to find out about these side effects if you’re concerned.

Conclusion

There are lots of things to consider when it comes to contraception. From side effects to safety. The best pill for you may be a different one to the one your friends are using.  Our clinicians can help you find the right contraception for you, making sure it’s safe and effective.

For more guidance, check out this page from the NHS: Which method of contraception suits me? You’ll also find plenty of guidance in our contraception advice hub.

References

https://www.ncbi.nlm.nih.gov/books/NBK441582/ 
https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/
https://www.nhs.uk/conditions/contraception/contraceptive-diaphragm-or-cap/
https://www.nhs.uk/conditions/contraception/which-method-suits-me/  
https://patient.info/news-and-features/when-will-fertility-return-after-using-hormonal-contraception
https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9842494/
https://pubmed.ncbi.nlm.nih.gov/7851580/
https://pubmed.ncbi.nlm.nih.gov/11672550/
https://patient.info/news-and-features/does-the-contraceptive-pill-increase-your-risk-of-blood-clots
https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk  

*Survey conducted by River on behalf of LloydsPharmacy Dec 2020-Jan 2021, 1,050 UK adults