Myths about the contraceptive pill debunked by a doctor
The combined oral contraceptive pill, also known as 'The Pill' is under scrutiny on social media platforms such as TikTok, with many users rushing to slate its side effect profile, in favour of 'hormone free' approaches. Doctors are seeing the knock-on effect of this with an increasing number of young women reported to be declining the pill after doing their research online, corresponding with a 20 per cent drop in pill usage in the past 10 years.
The pill is an established effective method of contraception. It contains both oestrogen and progesterone hormones which prevent an egg being released from the ovary, thus preventing pregnancy with over 99 per cent effectiveness (if taken as directed). It also keeps the lining of the womb thin, and therefore has a useful role in the management of gynaecological conditions such as endometriosis causing painful periods, premenstrual syndrome or in regulating the cycle in polycystic ovary syndrome (PCOS).
Like all medications, the pill can have some unwanted side effects such as weight gain, breast tenderness, headaches, mood changes and a small increased risk of blood clots and breast cancer. These side effects vary between users and may even go away after a few months of use.
There are also a number of misconceptions that deter women from taking the pill, and it's important to bust these myths to allow women to compare all their options and make an informed choice.
Recent evidence suggests a higher rate of asthma attacks in some women taking this progesterone-only pill. Asthma is more common in women, and often more severe with twice as many women dying from asthma attacks compared to men.
The large study in 260,000 women showed that those who were taking the progesterone-only pill had a higher rate of asthma attacks. The risk was higher in women under 35 years old, in those who used fewer asthma medications such as steroids, and those who had higher levels of inflammatory markers in their blood linked to asthma. Importantly, there was no increase in asthma attacks for women taking the combined oestrogen and progesterone contraceptive pill.
So how do women use this research?
Research into the effect of female hormones on asthma risk is ongoing but the results of this study will help both women and the healthcare professionals counselling them on their contraceptive choice. It's not a one size fits all approach, and this study further highlights the importance of tailoring the decision based on an individual's personal medical history.
Whilst taking the combined pill is associated with a slightly increased risk of developing breast cancer compared to women who don't take it, it has not been proven to directly 'cause' cancer in the absence of other risk factors.
Women with high risk of developing breast cancer, such as those with a strong family history, will be advised to consider alternative forms of contraception. But for the average female, the small increased risk is similar to the risk associated with being overweight or drinking alcohol. The risk of pill usage on breast cancer risk also decreases back to that of a non-pill taker 10 years after stopping. There is also a small increased risk of developing cervical cancer, and it's important for women to keep up with their smear tests.
However, the pill decreases the risk of developing endometrial (womb), ovarian and colorectal cancer.
There is no evidence to suggest the pill negatively impacts fertility. The likely reason for this misconception is that many women start taking the pill at a young age before they have had time to appreciate the regularity of their cycle. When they stop taking the pill, often at a time in their life when they are trying to conceive, it exposes pre-existing, underlying gynaecological conditions such as PCOS which is often associated with irregular periods and difficulties with conceiving.
It's also important to note that fertility naturally declines with age, particularly over the age of 35 and so conception may take longer than expected. Evidence shows the same number of women become pregnant one to two years after trying, regardless of whether they have used the pill or not.
A possible side effect of the pill is a change in libido; however studies show reduced libido is only observed in around 10-15 per cent of users, and actually a similar number of users report an increased sex drive. If reduced libido is experienced, it can often be improved simply by switching to a different brand of pill. For many women experiencing painful or heavy periods, taking the pill may actually help with their libido by improving these symptoms.
Some users will report mood changes and symptoms of depression after commencing the pill, but it's relatively rare and certainly not at the rate that TikTok suggests.
If this happens, your medical practitioner will review the pill choice and sometimes even just switching to a different brand of pill can fix this.
Hormonal contraception may not be suitable for everyone and other options may be preferred, but ruling it out based on opinions on TikTok that are not backed by evidence may limit options unnecessarily. It's important to consider all the science-backed facts and contraceptive options available to find the one that's right for you. Everyone will have their own experience and can be affected by side effects differently.
Unbalanced online narratives have caused many women to turn to hormone-free natural tracking methods which involve tracking body temperature, vaginal discharge and period dates, and avoiding sex on the fertile days. However, this method is not as effective and popularity in this method has been accompanied by a rise in the number of unwanted pregnancies and terminations.
When we speak to patients on contraceptive options, medical professionals will present the pros and cons of each contraceptive choice, be that the pill, condoms, fertility awareness methods or long-acting forms such as coils and implants, to allow women to make an informed choice. The danger of 'doing your research' on social media is that the information is not presented in this balanced way and is often overshadowed by an individual's biassed and unfavourable experience.
This article was originally published in October 2024 and has been updated.
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These impacts may include: body image dissatisfaction and low self-esteem anxiety and depression eating disorders and unhealthy behaviors social isolation perfectionism and obsessive tendencies distorted perception of reality impact on identity development 'True beauty encompasses overall health, confidence, and internal qualities,' Ganjian continued. 'Chasing unrealistic beauty ideals perpetuated online can be detrimental to mental well-being. Be highly skeptical of skin care content on social media platforms like TikTok. Understand that much of it is marketing-driven, often promotes unrealistic beauty standards, and may feature digitally altered images,' he said. Hales echoed this sentiment. 'I'm concerned about problematic and unrealistic beauty standards being passed off as skin 'health' or 'care,' and potentially exposing young people to skin irritation, allergy, and sun sensitivity,' Hales said. 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A diet rich in fruits, vegetables, and whole grains contributes to overall skin health. Avoid harsh ingredients: Avoid products with high concentrations of retinoids, salicylic acid, benzoyl peroxide (unless specifically recommended by a dermatologist for acne), alpha hydroxy acids (AHAs), strong fragrances, and alcohol, which can be too harsh for young, sensitive skin. Consult a dermatologist: If persistent or severe acne, eczema, or other skin conditions arise, seek professional advice from a dermatologist. 'Young skin is naturally healthy and doesn't require complex or expensive routines. A simple routine of gentle cleansing, moisturizing, and sun protection is usually sufficient,' Ganjian said. 'If there are genuine skin concerns like persistent acne, a dermatologist is the best resource for personalized, safe, and effective advice, rather than relying on social media trends.'
