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

The contraceptive pill is one of the most popular and reliable methods of birth control, but not all women feel confident using it. Despite being classed as a safe and effective mode of preventing pregnancy by the NHS, many women are now seeking out other methods.

At the end of 2020, we carried out our Women’s Health and Wellness Survey*, which asked questions on a range of topics, including STIs, the menopause, body image and mental health. As part of this questionnaire we asked our 1,055* respondents a series of questions about contraception, and the results were really interesting.

Women’s biggest concerns about hormonal contraception

As part of our survey, we asked: “What are your concerns when it comes to taking the pill or other hormonal contraception?”.

For this question, 610 people (58%) responded with “weight gain”. The next most popular answers were: 

• 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. 

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. 

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. 

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, with some showing that women who used hormonal birth control were more likely to be diagnosed with or treated for depression, while others reported less symptoms of depression and anxiety - proving that different people will experience different side effects.

Should women be concerned about using hormonal contraception like the pill?

Every woman is different and will respond to the pill differently. 

For some people, the pill will cause no side effects at all. For others, there may be side effects that are disruptive to daily life. In certain cases, the pill won’t be a suitable type of contraception whatsoever because of age and medical history.

The main thing to remember is that there are several different types of the pill. If you've tried a combined pill (e.g. Brevinor, Femodette, Millinette 30/75 or Qlaira) and you didn't like it, you can talk to your GP about switching to another kind e.g. a low dose pill (like Milllinette 20/75), an everyday pill (like Femodene ED) or the progestogen-only pill. There are also other forms of hormonal contraception to consider, including the IUS and the implant.

It’s also worth noting that some of the concerns raised in our survey are not based on any genuine clinical evidence:

• 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. 
• 19% reported that they were concerned about the effectiveness of the pill and other hormonal contraception, however when used correctly, hormonal contraception is incredibly effective in preventing pregnancy. The IUS is over 99% effective, and the combined pill is over 99% effective when used correctly. 
• 11% reported they were concerned about reduced fertility, but there is no evidence that hormonal contraception can affect your ability to get pregnant. It may just be that your body takes some time to readjust after you come off your contraception before you can conceive. Find out more. 

What’s more, while concerns about the safety of hormonal contraception are valid, the risks associated with the pill (e.g. blood clots) are very low. In fact, the combined pill is thought to reduce your risk of certain cancers, as well as ovarian cysts and fibroids. 

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%).

For each woman, selecting 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 – the only contraception you might need to pay for are barrier types like condoms, however even these are 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. 

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/  

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