pack of birth control pills

Side Effects of Hormonal Birth Control

Hormonal birth control or HBC as I like to refer to it, has a long list of side effects that not enough people talk about. I certainly was not warned about the increased risk of depression, migraines, or breast cancer risk. If you’re wondering what hormonal birth control includes, I wrote a blog post on all of the different types and how they work in the body here. 
As I always say, I am not hating on hormonal birth control. The birth control pill was a huge step for women and truly changed the future for us. My issue is that it hasn’t progressed and women deserve better. YOU deserve better. You also deserve to be informed, especially if you’re currently taking hormonal birth control like the pill. 
Read on to learn about the potential side effects of hormonal birth control. 

Side Effects of Hormonal Birth Control

There are a number of different types of HBC that I cover in this post. Many of them have similar side effects while others have more severe side effects. Those listed below are for all types of HBC unless noted otherwise. 


Abdominal Cramps & Bloating

A lot of women are given the pill for PMS symptoms, but it turns out one of the side effects of hormonal birth control is cramps! 

Decreased Size in Clitoris & Low Libido

I’m just going to come out and say it… women don’t need any more difficulty having an orgasm. We need all of the sex and orgasms we can get and unfortunately hormonal birth control can reduce this.

You start taking something like the pill or get an IUD because you want to have sex and avoid pregnancy so it’s pretty crazy that you can actually reduce your sex drive with the pill and decrease the size of your clitoris.

A study showed that after 6 months of oral contraceptive use, the frequency of sexual intercourse and orgasm were significantly reduced. Both the IUD and pill reduce clitoris size. If someone told me this when I first went on the pill I guarantee I would have found a better option. 🤣


The most common reason for discontinuation of the pill is depression. We finally have a large and reputable study on hormonal birth control and depression/mental health. JAMA published a study titled Association of Hormonal Contraception with Depression that looked at one million women ages 15-34 for 13 years. 

Some of the biggest findings included:

  • Women who were prescribed the combined pill (containing estrogen and progesterone) were 23% more likely to be treated with antidepressants. 
  • Women prescribed the “mini pill” (progestin only) were 34% more likely to be treated with antidepressants. 
  • Teens were 80% more likely to be treated with antidepressants if using the combined pill and twice as likely if using the “mini pill.”

This is not everyone, but it’s enough women that it matters. You matter and if you’re experiencing depression and think it could be related to your HBC, then I highly recommend bringing these concerns to your doctor and looking for an alternative. 

Edema (Water Retention)

If you’re taking hormonal birth control that contains estrogen, then this can promote fluid retention in the body and cause weight gain/bloating. The progestin only or “mini pill” is also associated with fluid retention and weight gain. On average, women gain 4-6lb within the first 6 months of the pill due to water retention. 


A side effect that is common but doesn’t typically get discussed in relation to hormonal birth control is gallstones. Since gallstones are not life threatening I think they tend to be ignored. Estrogen and progesterone increase gallstone formation. The risk of developing gallstones is 35-50% higher in women who take oral contraceptives like the pill compared to women who do not. 

I have quite a few clients that have had their gallbladder removed after repeatedly having gallstones. They’ve all been on HBC. This doesn’t mean it was the direct cause, but it does make you think. 

Headaches & Migraines

One of the most common side effects of HBC is headaches and/or migraines. Research has shown that they are more severe while taking oral contraceptives, but I have also seen an increase in migraines with the Depo Provera shot. 

Side Note: When reading research articles for this blog post, I found that there was a study done on pedophiles and sex offenders that gave them Depo Provera in order to reduce sexual urges. This freaked out and is a HUGE red flag in itself. 

Increased Risk of Cancer

One of the biggest reasons I wanted to get off HBC was because of my family history of breast cancer. The pill specifically increases the risk of certain cancers such as breast, cervical, liver, and uterine cancer. Luckily, the risk reduces within a year of coming off HBC. 

Increased Risk of Stroke & Blood Clots

Oral contraceptives increase the risk of stroke and blood clots by 60% at the lowest estrogen dose, and increase as the estrogen dose increases. 


HBC increases oxidative stress in the body. This increases the need for antioxidants and raises inflammation. You can see the increased inflammation by looking at a blood marker called C-reactive protein (CRP). Inflammation is involved in every chronic disease, reduces gut health, increases the risk of autoimmune disease, cancer, and pain. 

Insulin Resistance

There are an alarming number of studies that show how hormonal birth control can cause insulin resistance. This means the body requires more insulin to balance blood sugar. This can lead to weight gain and other hormonal imbalances. This is interesting since many women are prescribed the pill for Polycystic Ovarian Syndrome (PCOS), which has insulin resistance as a root cause and major contributor to symptoms. Synthetic estrogen increases insulin resistance, however, progestin only pills or “mini pills” did not impact insulin resistance in any of the studies I found. 

Low Thyroid & Testosterone Levels

Hormonal birth control increases a protein called Sex Hormone Binding Globulin (SHBG) and Thyroxine Binding Globulins, which bind to free sex hormones and thyroid hormone. The reason the body does this is because when taking synthetic hormones you have an elevated level of hormones in the body. The body is using this as a defense mechanism to deactivate excess hormone. The issue is that this reduces testosterone levels (leads to low libido) and thyroid hormone levels. 

This often leads to low sex drive, depression, cold intolerance, difficulty losing weight, constipation, brain fog, poor memory, dry skin, hair loss, etc. Learn more about the pill thyroid connection here. 


Melasma or hyperpigmentation/dark spots typically on the face is another side effect of hormonal birth control. Research on a number of different types of oral contraceptives show that it doesn’t matter what type it is, they all contribute to dark spots

Nutrient Depletion

Hormonal birth control depletes antioxidants, B vitamins, magnesium, selenium, zinc, and Vitamin C. 

Poor Gut Health

HBC negatively impacts our gut by disrupting the balance of bacteria in our intestines. It also increases inflammation (see above), which can lead to digestive issues and increased risk of an autoimmune disease that manifests in the gut. Hormonal birth control also increases the risk of inflammatory bowel diseases. 

Vaginal Candidiasis 

Due to the disruption in gut health, a common side effect of taking hormonal birth control, especially oral contraceptives, is vaginal candidiasis. Women taking oral contraceptives have an increased risk of yeast infections. This makes sense since the gut bacteria are disrupted and this will absolutely play a role in vaginal bacteria health. 


Supporting the Body While On Hormonal Birth Control

Here’s the deal–I know some women are going to use HBC and I’m okay with that. I used it for 7 years and honestly you need to do what’s right for you. I don’t want any woman to read this post and feel guilty for being on the pill or having an IUD. This is NOT about being perfect. It’s about YOU and making the best and most informed choice for your body. 

There are a few specific recommendations I give to my clients that choose to continue with hormonal birth control and want to minimize the negative effects and preserve their health. 

Supporting Your Body on HBC

  • Nutrient Replenishment: since HBC depletes nutrients you want to make sure you are adding them back in. Here’s how I recommend replenishing them:
    • OC Companion by Vitanica contains vitamins C, E, B2, B6, Folate, B12, Zinc, Copper, and other supportive nutrients. 
    • Magnesium to help replenish that depleted by HBC and also stress. 
    • 2-3 Brazil nuts daily to provide selenium.
  • Rebalance gut bacteria with a high quality probiotic. 
  • Make sure you have a daily stress management practice and are filling your cup. Meditation, reading, dancing, etc. HBC reduces your body’s ability to handle stress. You can change how you respond to stress by picking up a daily practice. 

In my next post, I’m going to dive into how to transition off HBC if that’s the route you want to go. 


Amanda Montalvo, RD, FDN-P

Questions? Need Help?

I help women heal from hormonal birth control, balance their hormones, and improve energy for life. If you have questions about your hormones/health and want support please fill out this form and schedule your discovery call here. 



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