Birth Control Pills Pros & Cons: What You Need to Know When Choosing Contraception

First available to women in 1960, “the pill” has a long history. It used to be one of the only options available for preventing unwanted pregnancy. But the pill is no longer the go-to birth control method for teens who are sexually active.

We asked women’s health specialist Heather Payne, NP, to share birth control pills pros and cons. A nurse practitioner, Payne also tells us about other more effective ways to prevent pregnancy. This will help you and your teen decide which birth control is the right choice.

Birth Control Pills: Pros

The pill has changed over time. “New formulations are always coming out,” says Payne. Most contain a combination of 2 female hormones:

• Estrogen
• Progestin (a lab-made version of the natural hormone progesterone)

Together, these hormones prevent pregnancy by stopping ovulation and thickening cervical mucus to slow sperm movement. The pill offers the following benefits.

Lighter, More Regular Periods

The hormone progestin thins the uterine lining. This reduces bleeding. Typically, someone takes the pill for 3 weeks and has 1 week off. This is when they have a light period. However, because the pill prevents the buildup of the uterine lining, women can also take the pill continuously or for longer periods for fewer or no periods. “It’s a misconception that you have to have a period. Taking the pill continuously — without the 7-day dose of placebo pills — does not cause any long-term health issues,” says Payne.

Helps Prevent Cancer

Using birth control pills can decrease your risk for some cancers. This includes endometrial, ovarian, and colorectal cancer.

Relief for PCOS Symptoms

Women with polycystic ovarian syndrome (PCOS) produce higher levels of the male hormone testosterone. However, the pill’s estrogen can help even out hormone levels. This reduces related symptoms like abnormal hair growth and acne. “Women with PCOS are also at risk for abnormal buildup of the uterine lining. This can increase the risk of uterine cancer. But the hormones in oral contraceptives can help lower this risk,” says Payne.

Clearer Skin

The pill helps lower androgens or male hormones in the body to prevent acne and pimples.

Helps Regulate Mood Swings

Mood swings that come with premenstrual syndrome (PMS) and the more severe premenstrual dysphoric disorder (PMDD) occur in some women because of the hormone fluctuations caused by ovulation. However, the pill stops ovulation and helps keep these mood swings in check.

Prevents Pregnancy

When used perfectly, the pill is a reliable way to prevent pregnancy. The success rate is around 99%. The key, of course, is using it exactly as prescribed (see cons below).

Birth Control Pills: Cons

You may have concerns about the pill’s many myths and misconceptions. Research studies have proven most to be false, such as the increased risk for infertility. But the pill can have some negative side effects and the risk for pregnancy is real.

High Failure Rate

The pill is only effective when taken daily, ideally at the same time. “This strict routine is the biggest disadvantage of the pill for teens,” says Payne. “They may forget to take the pill or start a pack late.” This impacts the pill’s effectiveness.

Around 10% of women get pregnant while on the pill. That’s a fairly high failure rate. “This is why the pill is considered a ‘second-tier’ option in terms of pregnancy prevention,” Payne adds.

Rare Risk of Blood Clots & Stroke

Women on birth control have an increased risk for blood clots and stroke compared to women who are not taking the pill. However, this side effect is still very rare, says Payne. The risk is highest in women who have:

• Migraine with aura
• Uncontrolled high blood pressure
• Personal or family history of blood clots

Nausea

Some women experience nausea when beginning the pill. “Taking a pill with a lower dose of estrogen or without estrogen can help,” says Payne.

Spotting

This unexpected bleeding between periods is a common side effect of the pill, especially in the first few months of use. “Taking the pill at the same time every day can help,” says Payne.

Not Suitable for Everyone

“There is a progestin-only birth control pill for women who prefer not to take or cannot take estrogen,” says Payne. These 'mini pills' don’t prevent ovulation. Moreover, they may lose effectiveness if not taken at the same time every single day.

Better Option than the Pill?

More teens today are choosing not to use the pill, says Payne. Instead, they’re using long-acting reversible contraception (LARC). "For most teens, LARC is the best option,” says Payne. The biggest pro? They're easier for teens to manage. But they are also:

• Better at preventing pregnancy
• Superior to tubal ligation or “getting your tubes tied” (a surgery to cut, tie, or block the fallopian tubes to prevent pregnancy)
• Not as risky because they don’t contain estrogen, which can cause blood clots

What Are LARC Options?

Hormonal Implants

The most common of these, Nexplanon®, releases progestin to thin the uterus and prevent pregnancy. Doctors insert this tiny, rod-shaped implant under the skin in the arm. It’s approved by the FDA for 3 years of use. But studies show it may last as long as 5 years. In addition, periods may stop completely for some women. Others may have spotting that can be managed with a short course of estrogen or ibuprofen.

Intrauterine Device (IUD)

A doctor inserts this T-shaped device inside the uterus. It helps prevent a fertilized egg from implanting. There are a few different types of IUD. Some have the hormone progestin and some don’t. The IUD with progestin thickens cervical mucus to help prevent the sperm from reaching the egg. It also can help reduce blood flow, often stopping periods altogether. Women on the non-hormonal IUD, on the other hand, may have heavier periods.

Most importantly, IUDs are 99% effective and can stay in place for between 3 to 10 years, depending on the hormone dosage.

If your teen is sexually active, talk with them about birth control pill pros and cons and other contraceptive methods. Or schedule an appointment with a pediatrician or gynecologist who can help decide the best option.