Don't tell the whole story

Birth control is good, actually

Experts say a flood of social media posts about side effects don't tell the whole story.

by Anna North

One TikTok creator told viewers it took her six years to “fix her hormones” after stopping birth control. Another cut up a pack of birth control pills that she said “ruined me as a person.” A third called it “one of the most damaging things you can put in your body.” 

Hormonal contraception is getting a flood of bad buzz across social media, where posters are listing side effects like depression, anxiety, low sex drive, acne, unwanted weight changes, and more. While it’s hard to measure the size of the trend, it’s become visible enough to make its way into headlines, chats among friends, and conversations between patients and their doctors. 

The result is that if you’re an American of reproductive age, it can feel like the pill, ring, IUDs, and other hormonal methods are terrible medications that result in only bad outcomes.

It’s important not to dismiss people’s bad experiences with birth control, especially since women’s medical concerns in general have too often been devalued by doctors and ignored by researchers. Indeed, the lack of public conversation around contraception and its side effects may be part of the reason for the recent wave of critical posts. Women also have good reason to be annoyed that their birth control options haven’t changed much in decades, while male birth control seems to remain perennially five years in the future. 

But the negative posts can mask a basic truth: Birth control is a very effective way to avoid an unplanned pregnancy, an experience that also has profound effects on people’s bodies, not to mention their lives. 

No contraceptive method is perfect, but experts say people who experience side effects with one can often find another that works for them. And for many people in the aftermath of the Dobbs decision, “contraceptive access is becoming more and more important,” said Mengyang Sun, an OB-GYN in New York City and a fellow with the group Physicians for Reproductive Health.

Now, that access may be in jeopardy, with former President Donald Trump stating in an interview this week that he is “looking at” restrictions on the medications (he later walked the statement back, saying he would “never advocate” restrictions). The side effects of birth control have also been cited by conservatives as a reason to oppose the medications. 

With their availability under threat, experts say it’s crucial to remember the good the medication does for the millions of people who use it.

Hormonal birth control is very effective at preventing pregnancy

People have been sharing negative experiences with birth control for many years, but critiques of contraception are receiving a new level of attention in recent months, with creators and influencers posting horror stories or tips for stopping the medication, sometimes including misleading information. Those stories may be honest, but some users also spread deliberate disinformation to further an anti-contraception agenda, said Deborah Bartz, an OB-GYN at Boston’s Brigham and Women’s Hospital who studies depictions of birth control on social media.

In reality, hormonal contraceptives are a reliable way of preventing pregnancy: Birth control pills are about 91 percent effective with typical use, according to the American College of Obstetricians and Gynecologists, while long-acting reversible methods like IUDs and contraceptive implants are more than 99 percent effective. For comparison, condoms are about 82 percent effective (they can leak or come off), and fertility-based awareness methods, which rely on charting the menstrual cycle and avoiding sex or using condoms on the most fertile days, are around 76 percent effective.

Reliable contraception has an enormous impact on people’s ability to plan their futures. Research has shown that access to birth control boosts women’s earnings, helps them achieve their educational goals, and makes them less likely to fall into poverty.

“Every pregnancy-capable person should be able to decide if/when to have a pregnancy, and birth control really helps them to be able to plan that and make that decision for themselves,” Sun said.

Hormonal contraceptives are also used to treat a variety of medical conditions, including endometriosis and polycystic ovary syndrome. The medications have “a lot of medical benefits,” Sun said.

What doctors say about side effects

Birth control does come with side effects, the most common of which are menstrual changes such as lighter or absent periods. Some people take birth control to reduce or stop their periods, but for others, the changes can be unwelcome, said Christine Dehlendorf, director of the Person-Centered Reproductive Health Program at the University of California San Francisco.

A lot of social media posts about birth control mention weight gain, though only a few methods, like the Depo-Provera shot and contraceptive implant, have been conclusively linked with weight changes, Sun said. Other top concerns are impacts on mood and libido, which can vary by method and by patient.

For some people, IUDs can be extremely painful to insert. Anesthesia and other pain relief methods can help, but, troublingly, doctors often underestimate the pain of the procedure and do not offer pain control, the Washington Post reported.

Some critics of birth control are also concerned more broadly about the impact of taking hormones like estrogen and progestin, the active ingredients in many methods. The medications are associated with a small increase in breast cancer risk, and some carry a small risk of blood clots. However, doctors say any risk with birth control needs to be balanced against pregnancy, which carries health risks of its own.

“Whenever my patients ask me about the hormones in the birth control, I do tell them, when you're pregnant, your body secretes similar hormones in way larger quantities,” Sun said.

It’s important for doctors to honor people’s concerns about birth control, listening to them without being paternalistic or dismissive, Dehlendorf said. “There needs to be repair and restoration of trust between health care providers and communities and patients about people's experience of birth control methods if we are going to be able to give people information.” 

But experts also say that it’s especially crucial now to protect birth control access for people who want it. “Contraception is a valuable tool for people who do not want to get pregnant, one that it is absolutely essential to have access to in the context of the post-Dobbs era,” Dehlendorf said.