The most common side effects of contraception

Like most forms of medication and drugs, contraception can have various side effects from changes to your menstrual cycle to acne or mood swings. However it’s not a one size fits all approach. One person’s experience is likely to be very different from your own. It all depends on the method you use, your medical history and other factors such as your weight, age and lifestyle. 

It’s worth noting that not all contraceptive side effects are negative. Some people experience improvements to their skin, periods and conditions such as PMDD, whereas others report worsening symptoms. Deciding whether or not these side effects outweigh the benefits of your chosen method is up to you.

In this blog we’ll discuss some of the common side effects of contraception to help you understand which method might be best for you. 

Need help choosing the right method? Take The Lowdown’s quiz ‘What Contraception Is Best for Me’ which will recommend methods to suit you based on your preferences and medical history.

Bleeding

Periods, or a lack of, are an indicator of pregnancy – so it makes sense that contraception (which protects against pregnancy) would affect your menstrual cycle. Here is how the most common types of contraception impact bleeding.

Combined hormonal contraception 

Combined hormonal contraception (the combined pill, patch or vaginal ring) is often very good at controlling bleeding. If you have heavy or painful periods, unpredictable cycles or want to control when you bleed, this may be the method for you.

Traditionally, the combined pill is taken for 21 days, followed by a 7 day break. During this time you can usually expect a light and predictable bleed, otherwise known as a withdrawal bleed. With combined methods, you also have the freedom to choose to have fewer bleeds, or none at all, by taking more than one packet of pills without a break or taking your pill continuously – which is perfectly safe to do!

Some people may experience breakthrough bleeding – bleeding while you’re still taking the pill or are using the patch or ring and not during a break. This can range from small amounts of spotting to bleeding like a period. Breakthrough bleeding can be annoying and unpredictable but usually resolves around 3 months of starting combined hormonal contraception.

If you don’t see any improvements after this time, you may wish to discuss switching your pill brand or method with a healthcare professional. Changing to a different combined pill with a higher oestrogen content, or switching to the vaginal ring, may help to make breakthrough bleeding more manageable. If breakthrough bleeding starts after you have been using combined hormonal contraception for several months, see your healthcare professional.

Progestogen only contraception 

Progestogen only contraception includes the progestogen only pill (mini pill), injection, implant and hormonal coil. These can all have a variable effect on your cycle, making you much less in control of when and how much you bleed.

Firstly, you may have no bleeds at all, otherwise known as amenorrhoea. The number of women who experience amenorrhoea is different with each form of progestogen only contraception. After 12 months, you can expect that 50% of people using the desogestrel based progestogen-only pill, 50% using the contraceptive injection and 20% of people using the implant will not have any bleeds. 

One user of The Lowdown shared: “I have been taking this pill for 5 years every day. When I first started this pill, I had a light period consecutively for the first 3 months, but I haven’t had a period, pains, or cramps since. Sometimes I get the odd spotting.”

Another reviewed: “I was hopeful my bleeding pattern would settle down, but after 6 months I was still getting spotting or a light bleed every 4-5 days. I also struggled with a low mood, loss of sex drive, dizziness, nausea and hot flushes!” 

You may also experience prolonged bleeding (bleeding that lasts more than 14 days) or frequent bleeding (where bleeding or spotting happens 6 or more times over 3 months). Prolonged bleeding (those annoying periods that last for over 2 weeks) can occur in 20% of women using the progestogen only pill or the implant, whereas frequent bleeding happens in around 10% of people using the desogestrel based progestogen only pill and less than 10% of people using the implant. 

One third of women using traditional progestogen only pills (Micronor, Noriday or Norgeston) will have a change in their bleeding patterns, with frequent or irregular bleeding being the most likely. Women are less likely to have prolonged bleeding or amenorrhoea with these pill types. 

Unfortunately there’s no way of telling which path you’ll go down, but it’s worth sticking to your method for 3-6 months to give it a fair chance.

The hormonal coil can cause prolonged and unpredictable bleeding or spotting for up to 6 months after insertion. The good news is that at 12 months, this normally comes to an end, with many women having no bleeding at all. Mirena and Levosert typically offer better control when it comes to bleeding compared to Kyleena and Jaydess which release a lower amount of progestogen.

IUD (copper coil)

The IUD (copper coil) is often associated with longer, heavier and more painful periods, so it’s best to avoid this method if you already have these symptoms. We’re not sure why this happens, but it’s thought to be down to mild inflammation caused by the copper being released into the uterus. Symptoms aren’t normally permanent and can improve after 6 months. You can also control pain with painkillers and prescription medication available from your GP.

Bleeding problems can be frustrating, so make sure to visit your GP or sexual health service if you’d like to make a switch, particularly if your bleeding pattern suddenly changes after being stable for some time. You’ll be checked for any other causes for the bleeding problems including pregnancy, sexually transmitted infections or changes on the neck of the womb called the cervix. If no other cause for the change in bleeding is found, there are medical treatments which can help manage bleeding problems. This may include changing pill brands or being prescribed more hormonal treatment. Please discuss your options with your GP or sexual health service to enable you to continue your chosen method.

Mood

Most of us experience changes to our mood throughout the month – and not just due to hormonal highs and lows. Because of this, and the many other factors that can affect your mindset (such as work, stress and relationships) it’s very difficult to research the effect of hormonal contraception on mood. 

Here’s what we do know… scientific research suggests that synthetic progestogen may be associated with feelings of irritability and depression, whereas oestrogen may increase anxiety. But despite many attempts to research the link between mood and contraception, the results often give opposite answers – confusing we know.

Some research studies suggest that hormonal contraception can worsen mood, while others suggest it can improve mood by treating conditions such as Premenstrual Syndrome (PMS) or Premenstrual dysphoric disorder (PMDD). There is no clear evidence that hormonal contraception causes depression.

What’s clear is that it’s important to recognise that some women will experience mood changes on hormonal contraception and it’s important to discuss these feelings with your healthcare professional.

If you do experience feelings of low mood or anxiety, these may get better after the first 3 months of starting a new method whilst your body adjusts to the new hormones. If these feelings do not go away, consider switching your contraceptive. For example, a hormonal contraceptive with a lower amount of progestogen such as the hormonal coil (IUS) or a non-hormonal option like the copper coil (IUD) may impact your mood less. 

If you experience mood swings while using combined hormonal contraception, combined pills that contain a lower level of oestrogen or taking the pill continuously without breaks may help. There is also research to suggest that certain pill brands including Yasmin, Lucette, Eloine and Zoely can have less effect on mood. 

It’s important to be aware of your mental health and to take care of it. If you have any concerns about your mood or anxiety, tell somebody and get help from a healthcare professional.

Weight gain

Women gain weight naturally with age, and many lifestyle factors can influence our weight from our diet to our movement and stress levels. Just like our mood, this can make it difficult to gain an accurate measure of how much contraception impacts weight. 

Forms of hormonal contraception could cause weight changes, but for most methods, research has not identified a formal link. The injection is the only form of contraception where research has proven an association with weight gain. This is more likely if you start the injection under the age of 18 and your BMI is over 30. But most women will not experience this.

Research has concluded that overall combined hormonal contraception, the progestogen only pill, hormonal and copper coils and the implant do not cause weight gain. Despite this, a small number of women may still experience abnormal weight gain whilst using hormonal contraception (but again, it could also be down to their lifestyle or influencing factors).

Changes in weight may be due to water retention which is a known side effect of synthetic hormones. This is less likely to happen with newer progestogens in certain pill brands. There isn’t much research to determine if hormonal contraception increases appetite or increases the deposit of fat cells in the body, although these are often used as explanations for weight gain on contraception.

When starting a new hormonal contraceptive, you can monitor your weight for the first 3 to 6 months and discuss any changes that concern you with your healthcare professional.

Sex drive

Sex drive or libido are terms used to describe interest in and desire for sex or sexual activity. There are tons of things that can impact your sex drive, from your lifestyle, culture and day to day mood to psychological or physical problems including illnesses and the effects of medications. There is very little research into whether hormonal contraception can directly affect sex drive, however, it is a frequently reported side effect at The Lowdown.

Combined hormonal contraception taken continuously without a break may be better for sex drive than having regular breaks. Progestogen only contraception can indirectly lower your sex drive by causing side effects such as vaginal dryness, low mood or irregular bleeding. 

Both the hormonal and copper coils (IUDs) don’t affect sex drive in the majority of women, however, a small number of women with the hormonal coil may experience a loss of drive. Research has shown that the coils seem to either improve or not affect sex drive or sexual function in the majority of women. 

“Much lighter periods. Had some emotional times & very low sex drive but unsure if that was the IUD or the post-pregnancy life.” – The Lowdown user

As sex drive is influenced by many different factors, switching contraceptive is only one part of addressing an issue with this. Vaginal moisturisers or vaginal oestrogen cream can be used to treat vaginal dryness. A pelvic health physiotherapist can help with gynaecological conditions that cause painful sex whereas your GP and local mental health service can help treat low mood. If sex drive still doesn’t return to what was normal for you before you started contraception, then speak to your healthcare professional about switching your method.

Acne

Acne is a really common skin condition that affects both women and men well into adulthood. And one recommended treatment is combined hormonal contraception.

Combined hormonal contraception 

Methods such as the combined pill, patch and vaginal ring contain oestrogen which have been shown to reduce acne. Because of this, some people are prescribed certain pill brands including Microgynon or Rigevidon to clear up their skin even if they don’t need contraception. There’s not much research on which brand is best but other brands including Yasmin, Lucette and Dianette which contain a progestogen called drospirenone are thought to be the most helpful.

“I was prescribed Yasmin mostly because I suffered from acne on my face and back. I tried so many routes to get rid of it but the only thing that worked was Yasmin.” – The Lowdown user

Progestogen only contraception 

Progestogen only contraception (progestogen only pill, implant, injection and hormonal coil) can worsen acne – this is because it doesn’t contain any oestrogen. If your skin worsens after starting progestogen only contraception, consider continuing for 3 to 6 months as your skin may improve in this time. 

If acne symptoms are affecting you, see your pharmacist or GP as they can offer acne treatment allowing you to stay on your contraception or switch to a different brand or method.

So there we have it, a quick, but hopefully helpful rundown of the most common side effects of contraception. Despite being used by 44% of women of reproductive age worldwide, there is still limited research into the side effects of contraception and how best to predict, manage or avoid them. 

If you are experiencing any symptoms and want to explore switching or trying a new method, make sure to discuss your side effects with your GP or sexual health service who can suggest better methods for you. You can also use the experiences of thousands of other women available at The Lowdown to find the right fit or speak to a women’s health doctors who specialise in contraception advice. 

This blog can help you learn more about various contraception options, but it does not give medical advice. You should always speak to a nurse or doctor when making choices about contraception and before starting a new method.