Is birth control safe? Are certain brands best?
Heather Corinna replies:I've been wondering if using birth control is safe? And is there a certain brand of birth control that I can use that will be the best to use?
"Birth control" or "contraception" simply means any number of methods a person may or does use in order to try to prevent pregnancy. So, condoms are birth control. The pill is birth control. IUDs are birth control. The Depo-Provera shot is birth control. Withdrawal is birth control. If you choose not to have sex or certain kinds of sex with the aim of preventing pregnancy, that's birth control, too. I can't answer your question specifically without knowing what form of birth control you're asking about.
That said, on the whole, methods of birth control are safe. If they are prescription medications or surgical procedures they have had to pass the rigorous review process any other kind of medication or procedure must to assure they are safe and effective. Over-the-counter methods which can be purchased must also go through thorough intensive review procedures before they can be sold. How much or for how long a given method has been tested and reviewed generally depends on how long it has been around for and what a given countries' standards are for drug and medical review and approval. You can get a basic idea of what that process is like for medications of all kinds in the United States here, and can find out what that process entails for medical devices (like condoms or cervical barriers) here.
Often, when a user here says "birth control" they're referring to one of the combined hormonal methods: to the pill, patch or ring. Know that the pill is actually one of the most studied medications we've got: resistance (mostly of the political or religious variety) to it when it first was in development resulted in more rigorous testing and study than we've seen with nearly any other medication I can think of, so we can be very sure it is safe overall, surer than we can for many other medications out there. You can even find information on clinical trials of the pill just by looking online dating as far back as the early 60's.
On the whole, hormonal and surgical birth control methods (like the IUD or a tubal ligation) pose more potential health risks from the method itself than non-hormonal methods do. How safe any method is, though, differs both from method to method and from person to person. For example, for certain people with specific health conditions (like an existing cardiovascular problem) or health history, or who are members of a given group (like women over 35 and/or who smoke, or who already use other medications where using a hormonal method could potentially create a dangerous interaction) a method like the combined pill poses greater risks than it would for people not in those groups and/or for people not using that method. The risk of some types of heart disease, for instance, for users of the pill was shown in one recent study to be 2.5 times higher than for non-users. However, that was much more likely for women using the pill who are over 35 and/or who smoke. For those who aren't in one or both of those categories, there may be little to no elevation in those risks at all compared to non-users.
I think it's important to point out that pregnancy and childbirth also present health risks, side effects, and potentially serious impacts on health. Preventing pregnancy, in and of itself, protects a woman from many possible or actual health risks, some of which are very serious. Most methods of contraception, are, in a broad way, safer than pregnancy.
I appreciated that the health writer for this piece at ABC made the connection between serious risks of hormonal contraceptive use and that of pregnancy. She points out that:
Studies show pregnancy is linked to a two- to three-fold increase in the odds of heart attack, an eight-fold increase in the odds of stroke, and as high as a 50-fold increase in the odds of blood clots. Hormonal birth control pills look quite safe by comparison.
Here's a basic overview of some very typical temporary health effects of pregnancy most women experience: things like nausea and vomiting, dizziness and light-headedness, hemorrhoids, yeast and bacterial infections, increased headaches, swelling of joints and joint pain, difficulty sitting or standing, shortness of breath, higher blood pressure, hair loss, post-partum depression and pain with delivery. Some typical permanent health/body changes many women experience with pregnancy are stretch marks, pelvic floor disorder, varicose veins, scarring from episiotomies or c-sections, increased proclivity for hemorrhoids and loss of dental and bone calcium. Some less common health issues or complications which occur for women with pregnancy include hyperemesis gravidarum, temporary or permanent back injury, pre-eclampsia, placenta previa or placental abruption, obstetric fistula, anemia, gestational trophoblastic disease, blood clots, cardiopulmonary arrest, mitral valve stenosis and gastroesophageal reflux disease. And far less commonly, things like becoming infertile, developing permanent disabilities or, again, death.
Pregnancy, overall, carries and statistically results in more health problems than any current method of birth control does, especially if a pregnancy is carried to term and a woman gives birth, and especially if the method of birth control being used is being used properly, by someone who is in general good health, and by someone who is a good candidate for that method. Pregnancy can also carry even more risks for younger teens or older women than it can for women in their twenties and early thirties.
Around 40% of all women who become pregnant have some kind of health complication during the course of their pregnancies. People tend to forget that, forget to mention it (especially when talking about the risks of contraception), and some don't even know in the first place.
In the United States in 2004, according to the Centers for Disease Control, there were 13 per 100,000 pregnant women (540 women total) who died from pregnancy or labor. Compare that to, say, FDA reports of 17 women who had used the patch who died from heart attacks, blood clots, and possible strokes since August 2002 (in a seven year period), which may have been related to the patch (but also may not have). Or to 50 reports of deaths to the FDA which may have been connected to the Yaz or Yasmin birth control pill since 2004 (in a five year period). Even if, for both of those methods, those deaths all were directly connected to the use of those contraceptives, we'd still be looking at a much smaller rate of death as compared to pregnancy. Whether you become pregnant, or you use some methods of birth control to try and prevent pregnancy, you risk death, the risks of death are just lower for contraceptives than pregnancies. But let's be real: we do all risk death simply by living in the first place.
None of this is to say that people who want to be pregnant should all steer clear because there are some health risks, even though some of them are very serious.
Pregnancy -- like using contraception AND having sex with partners at all -- is just one of those things in life where, when it is about a choice we actively make, we weigh the things that aren't or may not be healthy, good or wanted with the outcomes or experiences that can be or are healthy, good or wanted, and make our choices based on if we think the possible good outweighs the possible bad. Many risks pregnancy poses, just like the risks some contraceptive methods do, can also be managed to some degree so that they are less likely. I'm not trying to scare anyone from wanted pregnancy, nor from contraception (or sex for that matter). I'm simply pointing out they all carry health risks, and when considering the risks contraception may pose, I think it's important to know that pregnancy poses risks, too, and usually greater or more prevalent risks than methods of birth control tend to.
Death obviously isn't the only possible health risk or side effect whether we're talking about pregnancy or contraception (or sex, for that matter). As it is with pregnancy, many contraceptives also present some risks, too. To give you a general idea, with combined hormonal contraceptives like the pill, patch or ring, we're talking about risks like the heart-related risks I already mentioned, allergic reactions, gallbladder disease, nausea, shortness of breath, mood changes (sometimes severe ones), changes in libido (sexual desire) or eye problems. Progestin-only methods like a Depo shot or implant can present those same kinds of risks or side effects. With IUDs, risks can include a higher possibility of developing pelvic inflammatory disease (especially right after insertion), perforation of the uterus, cramping or abnormal uterine bleeding. Cervical barriers, especially diaphragms, can make it more likely to get urinary tract or bladder infections. With something like condoms, spermicides or sponges, the risks from those methods directly are most often just allergic reactions or (genital) irritation. For a method like withdrawal or natural family planning, since you're not actually taking any medications or putting anything inside your body, the only real health risks for those are those associated with pregnancy: in other words, if we consider pregnancy a health risk, that's what your sole health risk is with those methods, but only if they fail. Of course, especially with any method that is not a latex barrier -- while the method itself doesn't present this risk, the sex itself does -- sexually transmitted infections are technically health risks, too.
However, just like women can reduce their health risks with pregnancy by making choices about how they take care of themselves, at what time in life they become pregnant, and how they manage their pregnancies, so can women with methods of birth control. Not all methods are the right or best choice for everyone or the safe choice for everyone.
That's why many methods need to be prescribed by a physician. That healthcare provider should sit down with you and look at your health history, your current health and lifestyle, and make sure anything they prescribe or dispense for you is as safe for you as possible. Your heathcare provider is someone you can talk to about safety even with methods they don't need to fit, perform or prescribe, too. When you're talking to them, if you're as honest as possible about your health and lifestyle, and as detailed as you can be about all of that and your health history you can play a part in helping them help you choose the safest methods for you. By all means, if you wind up with a healthcare provider who doesn't seem to take much time with all of that information, or who just tosses a method or brand out you without seeming to consider you as an individual, find yourself a better caliber of provider.
When it comes to methods that have different brands (like the pill) or types (like the two kinds of IUDs), your doctor should do their best to choose the brand they feel is the best fit for you. For example, a copper IUD can be kept in for ten years and does not lighten or result in missed periods, and also is totally non-hormonal: for women who want that kind of long-term use, don't want hormones, and/or want to continue menstruating, that's going to be the best choice of IUD. But that kind of IUD can also make periods heavier or cramps more intense, so for women with painful or heavy periods already, or for those who want less periods, lighter periods, or pain relief from cramps and are okay with an IUD they'll need to replace in less time, the Mirena will be the better choice.
When we're talking about brand differences, we are usually talking about birth control pills: most other methods don't have any or a lot of different brands and types (with the exception of condoms). Combined oral contraceptives differ when it comes to the specific level, kind and combination of hormones. Those differences in dosage and kind are usually pretty minor with pills these days (and all current pills are "low-dose" if that's a term you've heard), but those tiny variations can make a big difference with some women. If you're choosing a method where there are different types or brands, what is best for you is going to depend on you, and a good healthcare provider will do their best to choose a brand they think will suit you best as an individual. If you want a general reference for yourself, menstrual cramps or acne, it's great to mention those things during a birth control consultation. Know that sometimes, when we're talking about pills or methods in general, it can sometimes take more than one try to land on the method or pill that you really like most.
It should also be mentioned that some methods of contraception have or may have protective or positive effects: this isn't all about risks of negatives. Obviously, preventing pregnancy and the risks associated with pregnancy is one of them. But oral contraceptives, for example, can or may also help prevent "cancers of the uterus and ovary; ovarian cysts; pelvic inflammatory disease; bone loss; benign breast disease; symptoms of polycystic ovary syndrome; ectopic pregnancy; and anemia (iron-poor blood)." (from the ACOG). As you probably already know, condoms can protect you from all known sexually transmitted infections. Methods of birth control can also have some extra health bonuses: for example, many women with painful periods can have some or all of their pain relieved with some methods, others can help clear up some kinds of acne or help with endometriosis. To keep this balanced, pregnancy can or is suspected to pose some protective factors per women's health, too. For instance, pregnancy is known to decrease the risk of breast cancer, may result in a period of remission for those with rheumatoid arthritis, and can sometimes provide relief from multiple sclerosis symptoms.
Long story short, whatever choices you make with partnered sex and reproductive choice -- be that with pregnancy or in preventing pregnancy -- you're looking at some potential health risks, at some things which may not be safe, or as safe as if you didn't have sex with a partner at all. By all means, it's very important to consider your health in the sexual, reproductive and contraceptive choices you make. Once more with feeling, your sexual/reproductive healthcare provider is the very best person to address those concerns with, and to look to for help in figuring out what's the most safe for you. You can pair that with some consumer research of your own, which you can do by looking at sites like ours, the manufacturer pages for a given type or brands of method, and at credible consumer reports, and with great women's health references like Our Bodies, Ourselves. We also provide a thorough walk-through of all available methods that you can do for yourself here. Doing that could be a good thing before you see your doctor (if you're going to want a method where you need to), so you can walk in with some idea of what you think you'd like to try.
The safety of contraception -- especially when you understand pregnancy generally poses even greater risks -- is one big factor to consider when making your choices. It's probably obvious, but you'll also want to consider if you do or don't want to become pregnant and/or parent at a given time, and if you do or don't want to be having sex with a partner. If you do decide you want to have the kinds of sex where pregnancy is a risk but also decide you don't want to become pregnant, then in considering methods of birth control, along with safety, risks and possible side effects, you also want to consider effectiveness, ease of proper use, cost, accessibility and a whole host of other important factors to find the very best method or methods for you.