Debunking common birth-control misconceptions

The spread of medical misinformation on social media has resulted in misconceptions about the safety and efficacy of hormonal birth-control methods.

The long-standing lack of physician transparency about some of the serious but rare side effects has prompted patients to seek advice from unqualified online communities. The underfunding of women’s health research also leaves many questions unanswered because of the dearth of quality scientific studies, allowing misinformation to fill the gap. (President Biden signed an executive order March 18 to strengthen data collection and funding for women’s health research.)

The false narratives that birth-control pills and intrauterine devices (IUDs) cause infertility and other health problems lead some women to make contraceptive decisions based on fear rather than facts.

As a consequence, women may face unintended pregnancies or other health complications amid continued efforts by Republicans to restrict reproductive health options in the United States.

Here’s what to know about birth control.

What is the most effective birth-control method?

The Nexplanon implant and IUDs are two of the most effective forms of birth control available. Called long-acting reversible contraceptives, both release hormones to prevent pregnancy. The implant is placed in a woman’s upper arm and an IUD in the uterus (copper IUDs act without hormones and are just as effective).

“I call them ‘get it and forget it’ methods as there’s no need to remember to do anything (take a pill, change a ring, get a shot, etc.), so there’s no user error which, we know, is the main reason why other methods fail,” Alexandra Hall, a family physician who teaches human sexual biology at the University of Wisconsin at Stout, said in an email.

While no form of birth control is 100 percent effective, both Nexplanon and IUDs are more than 99 percent effective at preventing pregnancy. In contrast, the birth-control pill is 91 percent effective with typical use.

What are the side effects of hormonal birth control such as the pill or IUD?

Birth-control pills and IUDs are generally safe and effective, but like many other medications, they can be associated with some side effects. The most common include nausea, headaches, breast tenderness and bleeding between periods.

Many of these side effects can be mitigated by switching to another type of birth control or just waiting a few months for symptoms to subside.

“Just because you’re having minor side effects doesn’t mean the method that you’re using is not safe,” said Kathryn Gray, an OB/GYN who is the director of maternal fetal medicine research at the University of Washington School of Medicine. “If they stay on the birth control for a few months, a lot of times the side effects will go away.”

More-adverse side effects, which are rare, are blood clots and stroke - but not all forms of hormonal birth control increase these risks. Talk to your medical provider about your medical history before going on birth control; they may recommend different forms if you have a history of migraines with aura or smoking.

Many birth-control methods on the market have decreased the amount of estrogen, to lower the risk of blood clots. Opill, the over-the-counter pill that will soon be available in stores and online, contains only progestin - meaning it does not have the blood clot risk.

How effective is ‘natural’ family planning as a form of birth control?

Natural family planning, also known as “fertility awareness-based methods,” is a set of practices used to track a person’s menstrual cycle to identify when they are most likely to conceive. Measuring basal body temperature and cervical mucus for signs of ovulation can help determine when a person should abstain from sex if their goal is pregnancy prevention.

This method can be up to 98 percent effective with perfect use, but it can have a failure rate of up to 23 percent. Franziska Haydanek, an OB/GYN from Rochester, N.Y. said the effectiveness of this method depends on many factors, including regular menstrual cycles and accurate ovulation tracking.

This method of birth control is less effective for people who have recently given birth or had an abortion, are breastfeeding, have recently stopped using hormonal birth control, have a medical condition such as polycystic ovary syndrome (PCOS) or are nearing menopause, because those hormonal changes make it harder to accurately track when people are ovulating.

Does hormonal birth control make you gain weight?

Studies show no definitive link between birth control and weight gain. A 2011 Cochrane review, considered the top-tier systematic review of scientific evidence, analyzed data from 49 clinical trials related to the effects of combination contraceptives - a combination of two hormones, estrogen and progestin - on weight changes. The experts did not find sufficient evidence to show that contraception impacts weight gain.

The one exception physicians pointed to is Depo-Provera, an injection containing progestin. Women who receive the shot - administered every three months to prevent ovulation, thicken cervical mucus and thin the uterine lining - can gain an average of five pounds in the first year.

Many women gain weight as they age, regardless of whether they use contraception.

Physicians say they recognize the importance of dispelling the misconception that women gain weight on birth control, a reason many patients give for stopping the pill. Michael Belmonte, an OB/GYN in D.C., tells patients the scientific evidence shows that their weight gain is unlikely to be related to their birth control, but offers them the option of switching methods.

Does hormonal birth control cause depression?

Doctors say that oral contraceptives are safe in women with mood disorders and that most women using birth control do not experience a negative impact on mood. While the side effect is rare, women with a history of depression may be more likely to encounter mood effects. Doctors say women who experience mood changes should talk to their physician.

“When people have actually looked at the evidence,” Gray said, “most individuals who are on hormonal birth control do not have a negative impact on their mood.”

Can birth control cause personality changes or impact whom you’re attracted to?

Researchers say the studies that influencers cite when discussing this phenomenon have small sample sizes or are otherwise flawed because they are retroactive chart reviews, where researchers analyze existing medical records. Influencers may selectively choose data from those reviews, which can show correlation but not necessarily causation.

Haydanek, the OB/GYN from Rochester, said the gold standard for research studies is randomized controlled trials, where a control group and an experimental group are compared to determine any differences for a particular treatment.

“Social media influencers’ job is to get followers … but that doesn’t mean what they’re presenting is evidence-based,” said Gray, the University of Washington OB/GYN. “I’m not saying for any given person it doesn’t have any effect, but what’s important to think about, for most individuals, is that the evidence suggests there is no impact.”

“It’s important for patients to get information from reliable sources, which is not TikTok and Instagram,” Gray said.