{"url":"https://whatshealthyandwhy.com/birth-control/side-effects-and-risks","path":"/birth-control/side-effects-and-risks","alternates":{"json":"https://whatshealthyandwhy.com/api/articles/birth-control/side-effects-and-risks.json","markdown":"https://whatshealthyandwhy.com/birth-control/side-effects-and-risks.md"},"topic":{"slug":"birth-control","name":"Birth Control","url":"https://whatshealthyandwhy.com/birth-control"},"slug":"side-effects-and-risks","order":2,"title":"Side Effects and Risks","question":"Does hormonal birth control raise the risk of depression and blood clots?","answer":"Hormonal birth control likely raises blood clot risk (3–4 times with combined pills) and antidepressant use, though absolute risks stay modest.","description":"The documented side effects of hormonal birth control — nutrient depletion, mood changes, blood clots, and more","confidence":3,"confidenceNote":"Two large observational studies: over 1 million Danish women (antidepressant prescriptions) and a UK primary-care case-control study (clots); neither is a randomized trial.","evidenceSummary":{"rctCount":0,"observationalCount":2,"metaAnalysisCount":0,"totalParticipants":"1 million+","replicated":false,"newestStudyYear":2016},"category":{"categoryTitle":"Your Body","categorySlug":"your-body","subcategoryName":"Medicine & Your Body","subcategorySlug":"medicine","url":"https://whatshealthyandwhy.com/explore/your-body/medicine"},"actions":["Tell your prescriber if you smoke, are overweight or have a family history of clotting; clot risk is highest in these groups [3].","Ask about a B-complex (especially folate), magnesium and zinc, which the pill can deplete; folate matters most before pregnancy [2].","Report persistent low mood to your doctor, especially for teenagers, who showed the largest rise in antidepressant use [1]."],"cautions":["Newer progestins (desogestrel, gestodene, drospirenone) carried about double the clot risk of older ones like levonorgestrel [3].","Absolute clot risk for healthy young women is still low: roughly 3–9 per 10,000 a year on the pill versus 1–5 in non-users [3].","Antidepressant prescriptions are an imperfect proxy for depression, and the absolute risk increase is modest [1]."],"simpleText":"Hormonal birth control is generally presented as safe and well-tolerated. For many women it is. But \"generally safe\" doesn't mean \"no side effects,\" and the list of documented effects goes well beyond what most prescribers discuss. This isn't about fear-mongering -- it's about knowing what to watch for and what the research actually shows.\n\nEvery woman responds differently. Some take the pill for years with no noticeable issues. Others experience significant changes in mood, energy, libido, or health. Both experiences are valid.","mediumText":"Nutrient Depletion\n\nHormonal birth control has been shown to deplete several key nutrients [2]:\n\n- B vitamins: B6, B12, and folate are consistently depleted in oral contraceptive users. This is particularly concerning for folate, since women often go straight from the pill to pregnancy, when folate demand is highest for preventing neural tube defects [2].\n- Magnesium: Already the most common mineral deficiency in developed countries, and the pill makes it worse. Magnesium is involved in over 300 enzymatic reactions including mood regulation, sleep, and muscle function. (See: Magnesium)\n- Zinc: Essential for immune function, thyroid health, and hormone production. The pill lowers zinc while raising copper levels, potentially disrupting the zinc-to-copper ratio [2]. (See: Zinc)\n- Selenium: Important for thyroid function and antioxidant defense.\n- Vitamins C and E: Both are depleted, reducing antioxidant capacity [2].\n\nIf you're on hormonal birth control, a quality B-complex, magnesium, and zinc supplement may help offset some of these depletions.\n\nDepression and Mood Changes\n\nThe largest study on this topic is the landmark Skovlund et al. (2016) study published in JAMA Psychiatry [1]. Researchers followed over one million Danish women aged 15-34 for an average of 6.4 years and found:\n\n- Women on combined oral contraceptives had a 23% increased risk of being prescribed antidepressants\n- Progestin-only pills carried a 34% increased risk\n- The patch showed a 100% increased risk (doubled)\n- The hormonal IUD (levonorgestrel) showed a 40% increased risk\n- Adolescents (ages 15-19) were hit hardest -- an 80% increased risk of depression with combined pills, and a 120% increased risk with progestin-only pills [1]\n\nThese are not small numbers, and this was not a small study. For years, women who reported mood changes on the pill were told it was \"in their head.\" This study confirmed what many women already knew.\n\nBlood Clot Risk\n\nCombined hormonal contraceptives (those containing synthetic estrogen) increase the risk of venous thromboembolism (VTE) -- blood clots in the deep veins (DVT) or lungs (pulmonary embolism) [3]:\n\n- The overall risk increases approximately 3 to 4 times compared to non-users\n- Newer progestins (desogestrel, gestodene, drospirenone) carry roughly double the clot risk of older progestins like levonorgestrel [3]\n- Risk is highest in the first year of use and in women who smoke, are overweight, or have a family history of clotting disorders\n\nThe absolute risk is still relatively low for healthy young women -- roughly 3-9 per 10,000 women per year on the pill versus 1-5 per 10,000 in non-users [3]. But blood clots can be life-threatening, and many women aren't adequately screened for risk factors before being prescribed hormonal contraception.\n\nReduced Libido\n\nThe pill increases sex hormone-binding globulin (SHBG), which binds free testosterone. Since testosterone is a primary driver of libido in both men and women, this can significantly reduce sexual desire. Some research suggests SHBG levels may remain elevated even after discontinuing the pill, potentially affecting libido long after stopping.\n\nAltered Partner Selection\n\nThis one is fascinating and under-discussed. Research suggests that hormonal contraception may alter women's mate preferences [4]. Naturally cycling women tend to prefer markers of genetic dissimilarity (detected partly through body odor/MHC genes), which is thought to promote immune diversity in offspring. Women on hormonal BC show shifted preferences -- sometimes toward more genetically similar partners [4]. Some researchers have speculated this could contribute to relationship dissatisfaction after discontinuing the pill, though this remains an area of active research.\n\nOther Documented Effects\n\n- Gut microbiome disruption: Hormonal contraceptives are associated with changes in gut microbial composition and increased intestinal permeability, with some studies linking long-term use to increased risk of inflammatory bowel disease\n- Cancer risk shifts: Hormonal BC modestly increases the risk of breast cancer and cervical cancer while decreasing the risk of ovarian and endometrial cancer -- a trade-off that's rarely discussed as such\n- Inflammatory effects: The pill increases C-reactive protein (CRP), a marker of systemic inflammation\n- Thyroid effects: By increasing thyroid-binding globulin, the pill can mask thyroid issues or alter thyroid hormone availability","deepText":"Evidence Review\n\nThe Skovlund et al. (2016) study in JAMA Psychiatry remains the most robust evidence linking hormonal contraception to depression [1]. Its strengths -- prospective design, national registry data, over one million participants, and adjustment for confounders -- make it difficult to dismiss. The dose-response relationship (higher risk with higher-dose progestins) and age-related vulnerability (adolescents most affected) add biological plausibility. Critics note that antidepressant prescriptions are an imperfect proxy for depression, and that the absolute risk increase is modest. However, the consistency of findings across different formulations and delivery methods supports a real pharmacological effect.\n\nPalmery et al. (2013) reviewed the mechanisms by which oral contraceptives deplete micronutrients, including altered absorption, increased metabolic turnover, and changes in tissue distribution [2]. The depletion of folate is particularly well-established and has led some countries to recommend folate supplementation for all women of reproductive age on oral contraceptives. The clinical significance of other depletions (B6, B12, zinc, magnesium, selenium, vitamins C and E) varies by individual diet and baseline status, but the pattern is consistent across studies.\n\nVinogradova et al. (2015) conducted a large nested case-control study using UK primary care data, confirming a 3-4 fold increased risk of VTE with combined oral contraceptive use [3]. Their finding that newer-generation progestins carry higher clot risk than older formulations contradicted marketing claims and has influenced prescribing guidelines. The absolute risk remains low for healthy non-smoking women under 35, but individual risk assessment before prescribing remains important.\n\nAlvergne and Lummaa (2010) reviewed emerging evidence that taking the oral contraceptive pill may alter both female and male mate choice by removing the mid-cycle change in preferences, including women's preference for genetically unrelated men during ovulation [4]. While the evidence is suggestive rather than conclusive, new findings of preference shifts are still emerging. The evolutionary and relationship implications remain speculative, but the possibility that a medication can alter something as fundamental as partner attraction underscores how far-reaching hormonal effects can be.\n\nWhere the evidence stands: The side effects listed here are documented in peer-reviewed research, not fringe claims. That doesn't mean every woman will experience them, and it doesn't mean hormonal birth control is \"bad.\" It means these are real trade-offs that deserve to be part of the conversation between a woman and her doctor -- not dismissed or minimized. Informed consent requires knowing both the benefits and the risks.","deepTruncated":false,"references":[{"id":"1","title":"Association of hormonal contraception with depression","authors":"Skovlund CW, Morch LS, Kessing LV, Lidegaard O","year":2016,"journal":"JAMA Psychiatry","pmid":"27680324","url":"https://pubmed.ncbi.nlm.nih.gov/27680324/"},{"id":"2","title":"Oral contraceptives and changes in nutritional requirements","authors":"Palmery M, Saraceno A, Vaiarelli A, Carlomagno G","year":2013,"journal":"European Review for Medical and Pharmacological Sciences","pmid":"23852908","url":"https://pubmed.ncbi.nlm.nih.gov/23852908/"},{"id":"3","title":"Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases","authors":"Vinogradova Y, Coupland C, Hippisley-Cox J","year":2015,"journal":"BMJ","pmid":"26013557","url":"https://pubmed.ncbi.nlm.nih.gov/26013557/"},{"id":"4","title":"Does the contraceptive pill alter mate choice in humans?","authors":"Alvergne A, Lummaa V","year":2010,"journal":"Trends in Ecology & Evolution","pmid":"19818527","url":"https://pubmed.ncbi.nlm.nih.gov/19818527/"}],"wordCount":1119,"source":{"path":"src/content/topics/birth-control/side-effects-and-risks.md"},"citeAs":"“Does hormonal birth control raise the risk of depression and blood clots?.” What's Healthy and Why. https://whatshealthyandwhy.com/birth-control/side-effects-and-risks","notice":"General information backed by peer-reviewed research, not medical advice."}