Shortly after I turned thirty, I realized another major milestone was coming up. It was also my ten-year-anniversary with the pill, my trusty method of birth control, which has been in my life longer than my husband, most of my friends and my career. I’m a relatively informed person, but I realized after a decade together, I still had questions about the pill—despite devouring that little book of side effects that came in the box of my first pack all those years ago. And this isn’t because I hadn’t done the research. There are so many myths and so much misinformation about the birth control pill that it’s hard to separate fact from fiction, not to mention that the sheer volume of people using the pill results in many different experiences. So, perhaps a decade too late, I decided to ask the pros about oft-believed myths and risks of the birth control pill.
Myth #1: The pill makes you gain weight
Unsurprisingly (if disappointingly), this is a big concern for many people who are first-time pill users, but this one is easy to suss out. Both of the experts I consulted, Dr. Yolanda Kirkham, OB/GYN at Women’s College Hospital and St. Joseph’s Health Centre, and OB/GYN Dr. Kristina Dervaitis, agree that there is no scientific evidence to suggest that taking the pill will make you gain weight. “When compared to women who are not using birth control, there is no difference in weight gain,” says Dr. Kirkham.
Myth #2: The pill can cause cancer
I’ve also heard that the pill can prevent cancer, so this one is a bit of a doozy. In terms of causing cancer, people often draw a line to breast cancer specifically. “The risk of breast cancer associated with the pill is 13 in 10,000,” says Dr. Kirkham who cites a 2017 study conducted by The New England Journal of Medicine. “Breast cancer is much more likely to be caused by other health and genetic factors.” By comparison, in Canada the likelihood of breast cancer is one in eight, so not taking the pill doesn’t really reduce your risk. In the past year, I needed to assess my own risk of breast cancer thanks to a diagnosis in my family and the expert I spoke with at the time said she wouldn’t recommend I go off the pill to reduce my risk of breast cancer.
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But has the pill been proven to prevent cancer? It turns out it has. “The pill does protect against both uterine and ovarian cancers,” says. Dr. Kirkham who cites a 50 to 70 percent reduction in uterine and ovarian cancer in women who use the pill for five to ten years. “This is actually a well-established fact in the medical community that needs more publicity,” she says. “The ovarian cancer risk by taking the pill is even lowered in women with BrCa genes that predispose them to (breast and) ovarian cancers.” Dr. Kirkham also points out that women are more likely to die from uterine and ovarian cancers than breast cancer. It’s important to also note that IUDs (the current doctor-recommended form of birth control and the most effective form) can also reduce ovarian cancer risk by 32 percent.
Myth #3: The pill makes you infertile
Feel free to breathe a big sigh of relief if you’ve been on the pill forever but are still keen to start a family in the future. “There are a lot of myths and misconceptions about contraceptive options and infertility,” says Dr. Dervaitis, “and none of the currently recommended contraceptives such as the pill and the IUC have been associated with future fertility problems.” Dr. Kirkham goes a step further and notes that in some cases the pill can actually protect your fertility. “Many people use the pill to regulate their periods in conditions such as Polycystic Ovarian Syndrome (PCOS) and the birth control pill also reduces painful periods or sex and the progression of endometriosis,” she notes. “Both untreated PCOS and endometriosis are related to subfertility.” Subfertility refers to a delay in conceiving (as in it takes longer than expected), whereas infertility refers to the inability to conceive after trying to for a year.
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Myth #4: The pill can affect your sex drive—and your skin
It likely depends on the hormones in your pill, and some users may experience lower or higher sex drives thanks to these hormones. For example, Dr. Kirkham points out that “more androgenic progestins (testosterone-like hormones) can increase sex drive.” Estrogen and progestin amounts are what differ from pill to pill. The progestins that are more androgenic increase sex drive (and acne for that matter). Androgens are what stimulate excess sebum which could cause acne but taking birth control pills with both estrogen and progesterone (known as combination pills) lowers the amount of androgens. Here is a good chart to help determine where your own birth control pill sits in relation to estrogen, progestin and androgens. If you do notice a significant dip in your sex drive, it’s worth bringing up to your doctor who may recommend you change your pill if it looks like birth control could be the culprit. Bottom line? This one could very likely be true for you, but it’s often just a matter of changing the pill you’re on, not abandoning the birth control pill completely if works for you otherwise.
Myth #5: The pill messes with your hormones
Most forms of the pill prevent pregnancy by simulating pregnancy (but with much lower hormone levels than pregnancy—this is why the birth control pill has far fewer risks than pregnancy itself). “By providing a continuous dose of hormones, the pill sends the message to the ovaries that ovulation and subsequent hormone production isn’t necessary, so ovulation is blocked,” says Dr. Dervaitis. “That’s how the pill intervenes in the normal hormone cycle in order to prevent pregnancy.” The short answer is yes, the pill affects your hormones. But for many people this is a perk, not a side effect. “The pill regulates hormones for women who have hormonal imbalances,” says Dr. Kirkham. For example, women with PCOS or primary ovarian insufficiency (a term used to describe when your ovaries stop working normally before the age of 40, which can be due to genetics or outside factors like chemotherapy treatment) may find that balancing hormones helps their conditions and thus opt for the pill for more than contraceptive reasons.
Myth #6: The pill masks reproductive issues
If you’re using the pill to aid in conditions like PCOS and to help with avoiding missed periods, those conditions will be the same when you stop taking the pill if the underlying condition is not corrected. In other words: The pill can help with symptoms of reproductive issues like those associated with PCOS, but once you stop taking it, your original issues will return. But the pill shouldn’t interfere with receiving a diagnosis. “There isn’t any evidence to suggest that the pill has any negative impact on reproductive issues or that taking the pill would cause a doctor to not be able to diagnose any potential future reproductive issues,” says Dr. Dervaitis. While the pill can temporarily correct something like a missing period, you should always be talking to your doctor about any changes that could indicate an underlying issue.
What’s the number one side effect of the pill?
The answer to this question is made up of many anecdotal possibilities. Because everyone experiences the pill differently (and there are so many of us on it—a 2011 study concluded 1.3 million Canadian women use the pill), whatever particular side effect you experience could be the one that seems to you to be the most prevalent. The actual number one side effect of the pill? Breakthrough bleeding or spotting—inconvenient and annoying, sure, but not any of the scarier options in that little book, though a close runner up might be the “side effect” of the pill not working at all. Thanks to user error (two thirds of women surveyed in a recent online Bayer poll admitted to forgetting to take their pill once a month) the failure rate can be as high as nine percent. Does accidental pregnancy count as a side effect?