How to manage birth control pill side effects

Written by Sophia Yen, MD, MPH

The birth control pill was officially approved in 1960 in the US and is used widely worldwide. Its main ingredients are progesterone, which was discovered in 1928 –in rabbits!) and estrogen. However, when manufacturers researched how to make a commercial pill at an affordable price, they used yams. The wild Mexican yam (Cabeza de negro) made commercial production possible, because it contains progesterone precursors.

Today, 14% of the female population aged 15-49 in the USA  take the birth control pill. In the US, 63% of women in the 15-49 age group use contraception, including the birth control pill. Although the pill is 99% effective with perfect use, with typical use it fails 7% of the time. Some people experience side effects.. 

Fortunately, you can manage or avoid most of these side effects. At Pandia Health, our CEO/Founder Dr. Sophia Yen, a clinical Associate Professor at a major medical school, studied birth control pills and their side effects and has come up with an algorithm to minimize side effects that we have trained all our expert birth control doctors to use.

Nausea

Nausea is one of the more common birth control pill side effects due to estrogen, a hormone that occurs naturally in the body.  Estrogen can irritate the stomach lining and, the larger the dose, the more nausea an individual may experience. 

Thankfully, there are 2 simple ways to prevent nausea. Dr. Yen recommends:

• Don’t take your medication on an empty stomach. Instead, take your pill with your largest meal of the day.
•  or take the pill right before bedtime. 

If you have had heterosexual sex in the previous 5 days, you should not stop taking the pill if you are nauseous, because you could become pregnant. If you haven’t had sex in the past 5 days, then you can stop the pill but use a backup method if you have sex once you stop the pill.

If you are on the pill and get nausea, the following can help:

• Ginger herbal tea might help.
• Eating plain food such as crackers
• Eating smaller portions more frequently
• Avoiding being active after eating

However, the best way to avoid nausea is to take the pill right before you go to bed or with the largest meal of the day. 

If you continue to feel nauseous after a few weeks of taking the contraceptive pill at night or with your largest meal, speak to your doctor. Your doctor can consider decreasing the estrogen. 

However, there is a risk that less than 30mcgs of estrogen in someone under 30 years old is not best for your bone health, so you will need to discuss the risks and benefits with your doctor.

See our CEO/Co-Founder’s video “First Time Taking Birth Control Pills? Here Are Some Tips.”  

https://www.youtube.com/watch?v=3-Pzapgs68s

Breast Tenderness

Breast tenderness is common in people who take the birth control pill, particularly when they first start taking it. It is caused by hormonal changes and fluid retention. Breast tenderness is more common in the first 3 months of taking the birth control pill.

You can help reduce breast tenderness and pain by doing the following:

• Avoiding salty food, because it leads to fluid retention
• Taking painkillers such as ibuprofen, which can be effective for breast pain
• Wearing a supportive bra

If breast pain is a continual problem, speak to your doctor about changing to another type of birth control and see whether there is another cause. For example, dropping to a lower estrogen dosage such as 20mcg can help. An alternative is a pill with a lower progestational effect. Examples include Estarylla, Orthocyclen, Sprintec, Mono-Linyah, Previfem, Estarylla, Norgestimate / Ethinyl Estradiol, Femynor, Mononessa, Sprintec, and Mili. 

Mood Changes

Mood changes, including tearfulness, anxiety, and sometimes depression, are other common side effects of the birth control pill. Research has found that the pill affects some of the neurotransmitters, which can lead to emotional problems.

If you have anxiety, you can support yourself by engaging in activities such as mindfulness and relaxation techniques. Talking to a therapist or psychologist can help, especially with processing information so you are not overly distressed by things. If you find your mood problems worsen and affect your behavior and health, speak to your doctor. They can help with antidepressants and access to psychologists. You can also review the birth control medication you are taking,  and consider switching to a lower progestational effect pill such as Estarylla, Orthocyclen, Sprintec, Mono-Linyah, Previfem, Estarylla, Norgestimate / Ethinyl Estradiol, Femynor, Mononessa, Sprintec, or Mili.

Weight Gain

Research has shown that if there are 50 women on the pill and 50 women not on the pill, those on the pill weigh 1 pound less. This is likely because women on the pill don’t bloat up and down; they just stay stable. However, if you experience increased hunger and/or weight gain, changing your progesterone may help. Androgens can give people munchies, so you end up snacking. For some women, estrogen in the contraceptive pill can sometimes lead to weight gain. However, you can do a few things to avoid the weight gain that will also help improve your general health.

• Avoid/Decrease sugary foods — Sugary foods lead to quick/easy weight gain.
• Avoid/Decrease salty foods — Salty foods result in water retention/bloating = water weight.
• Exercise regularly — Exercise helps you maintain a healthy weight. But it does a lot more. For example, whenever you participate in activities such as walking, swimming, or running, your body releases endorphins which improve your mood.

If you continue to gain weight and have tried healthy eating and exercise, see your doctor to discuss if your birth control pill needs to be changed. For example, if you are snacking a lot, consider a lower androgen effect pill. Examples include Gianvi, Loryna, Nikki, Vestura, Yaz, Ocella, Syeda, Yasmin, Zarah, NuvaRing, Estarylla, Norgestimate / Ethinyl Estradiol, Femynor, Mili, Mono-Linyah, Mononessa, Orthocyclen, Previfem, Sprintec, and Vylibra.

Sometimes the estrogen causes weight gain, in which case, your doctor may prescribe a lower estrogen pill. 

Spotting Between Periods

The contraceptive pill is one of the biggest reasons why birth control users bleed between periods. Birth control pills contain estrogen and progesterone. There’s also a progesterone-only version. The hormones work by blocking the release of an egg which causes ovulation. They also change the consistency of mucus in the cervix, making it harder for sperm to penetrate. The way the pills work is that they keep your hormone levels up for 3 weeks. Then the 4th week, you take sugar pills, no pills, and the hormones drop. This dropping of hormones causes your uterine lining to shed and you have a withdrawal bleed. Bleeding is more common when you change your birth control pill, have just started taking it, or have skipped doses.

You can prevent spotting by taking your pill regularly and at the same time every day. Sometimes the birth control pill is prescribed for gynecological disorders such as polycystic ovaries (PCOS) or fibroids, and the breakthrough bleeding is due to the condition.

If you experience spotting between your periods and you did not miss a pill, you should discuss this with your doctor in case it is due to another medical disorder. Your birth control pill may need to be changed. For example, you may need a tablet with a higher progestational activity such as Apri, Desogen, Emoquette, Enskyce, orthoepy, Reclipsen, Demulen, Zovia, Kelnor, Ocella, Syeda, Yasmin, Zarah, or NuvaRing. For those 30 years or older, the following can be considered: Blisovi 1/20, Gildess 1/20, Junel 1/20, Junel Fe 24, Larin 1/20, Loestrin 1/20, Microgestin 1/20, Kariva, Mircette, Viorele.

 Headaches

A possible birth control pill side effect is headaches. The fluctuation in hormone levels can lead to some birth control users developing headaches. While some experienced improved headaches once they start taking the contraceptive pill, others get headaches because of the drop in estrogen that can lead to headaches developing during the withdrawal bleed week. If this always happens on the sugar pill/placebo/withdrawal bleed week, consider skipping the monthly bleed. Talk to your doctor if you get new or worsening headaches on the pill. 

Also, some contraceptive pills can cause you to pee a little more (anything with drospirenone), so drink 8 glasses of water daily to avoid a headache from dehydration. 

You should also take your medication at the same time each day because if you don’t, the gap can cause a hormonal change leading to a headache.

Estrogen in pills can cause headaches. So if you didn’t get headaches before taking the pill and now you do, tell your doctor because the medication may need to be changed. Your doctor might consider a lower estrogen 20 mcg pill ( Blisovi 1/20, Gildess 1/20, Junel 1/20, Junel Fe 24, Larin 1/20, Loestrin 1/20, Microgestin 1/20, Kariva, Mircette, Viorele.) or the NuvaRing or Annovera. However, if you are 30 yrs or younger, you should stay on a 30 mcg estrogen pill to maintain your bone health.

Missed Periods

A missed period can happen when you are taking the birth control pill. The most common reasons for this include:

• Pregnancy. The birth control pill typically fails 7/100 women in a year. If you have a skipped period, get a pregnancy test in case you are pregnant. 
• Stress. Excessive stress affects the hypothalamus in the brain, which is responsible for hormone control. 
• Too much exercise can lead to a missed period. Although exercise is recommended, it can disrupt hormonal cycles when done to excessive levels. 
• Low body weight and losing or gaining weight can also result in skipped periods. 
• Low estrogen pill. 
• Other medications: antipsychotics, and chemotherapy. 
• Finally, continuous birth control (skipping the bleeding week on the pill, patch, or ring) is another reason why people with a uterus might not bleed each month. It’s perfectly OK to not bleed every month if you are on hormonal birth control and you are skipping the placebo pills/week off to have a withdrawal bleed. In fact, it decreases your risk of ovarian and endometrial cancer. See our founder/CEO Dr. Sophia Yen’s TEDx talk at the bottom of this page.

A missed period could be due to several reasons, but you should speak to your doctor if it continues. 

Less Desire for Sex (Decreased libido)

Another birth control pill side effect that sometimes happens is less desire for sex. Changes in libido can occur due to a lowered testosterone level in the body. 

A decreased sex drive can also be due to anxiety and stress. If the problem continues, speak to your doctor as you may need a birth control pill with more androgen. You and the doctor need to weigh the side effects, decreased libido versus increased snacking or acne and you decide which is more important to you. 

Many women have a greater sex drive on birth control because they don’t have to worry about getting pregnant!

Changes in Vaginal Discharge/Vaginal Dryness

Hormonal changes with some birth control pills can lead to vaginal discharge or dryness. Estrogen keeps the vagina lubricated, so when it is lowered, dryness and irritation occur. If you have this problem, there are simple things you can do, such as using a lubricant with sex.

If dryness continues to be a problem, see your doctor as you may need your medication reviewed. 

Sometimes, a higher androgen content pill can increase wetness/lubrication and libido. 

Conclusion

When you decide on the right birth control for you, it is essential to be aware of potential side effects. Generally, the birth control pill is safe and highly effective. You can manage minor side effects, but it is important to know when to seek help. So reach out to Pandia Health with our expert birth control doctors so we can help find the right birth control for you.

The following information is for general informational purposes only and is NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.