Is Birth Control as Bad as They Say? The Real Side Effects Supported By Research
Hormonal birth control does have documented side effects such as mood changes, libido shifts, and a real (though small for most people) increase in clotting risk.1-6 But claims that it "destroys" your gut, liver, or long-term fertility aren't supported by the evidence. As is the case with every claim made on social media, nuance matters. Especially for women managing PMOS (formerly known as PCOS), PMDD, or endometriosis. These are conditions where stopping birth control without a plan can have real and negative consequences.
In our last article, we broke down why stating that "the pill causes depression " oversimplifies real research, and why "birth control just masks your symptoms" is a harmful framing for women who genuinely need it to manage health conditions. Today we’ll dive deeper into the side effects that are well documented, and what happens when you stop hormonal contraception, especially if you're managing PMOS, PMDD or endometriosis.
We're not here to tell you your symptoms aren't real. They are. We're here to help you tell the difference between a documented clinical effect and a claim that sounds convincing but doesn't hold up.
What Are the Birth Control Side Effects That Are Backed by Research?
Mood changes, libido changes, and a small increase in blood clot risk are all documented in the clinical literature.1-6 What's not documented is gut microbiome destruction, "adrenal fatigue," or a need to "detox" your liver after the pill.
Keep on reading to find out what the research does have to say.
Does Birth Control Affect Your Mood?
We covered this in depth in our last post, so briefly: the most-cited study followed over one million women and found an association between hormonal contraceptive use and antidepressant prescriptions or depression diagnoses.4
An association is not the same as causation.
Ice cream sales and shark attacks are associated with each other because both tend to happen in the summer but saying that eating ice cream increases your risk of being attacked by a shark is false. Some studies find mood effects in certain populations, while others find no significant link once other factors are controlled for.4
Does Birth Control Lower Libido?
In some formulations, yes.
Some hormonal contraceptives raise sex hormone-binding globulin (SHBG), a protein that binds to free testosterone.6 Less free testosterone circulating in your body can mean lower libido for some users. This effect is formulation-dependent, meaning it varies significantly depending on which pill or method you're using, and it varies from person to person.6 Levels typically return to normal after you stop hormonal contraception, though the timeline isn't identical for everyone.6
Does Birth Control Cause Blood Clots?
Combined oral contraceptives are associated with a documented increase in venous thromboembolism (VTE) risk but the absolute risk is small for most users.5,6
Yes, the risk increase is real, and it deserves a place in every conversation about birth control. But two things are almost always missing from the content that goes viral:
- Absolute vs. relative risk. Relative risk can sound incredibly alarming without context, but it tells you nothing about absolute risk. What matters is the absolute risk and for most healthy users, that number is small, and it needs to be weighed against the VTE risk of pregnancy itself, which is higher than that of most combined oral contraceptives.7-9
- Who's at elevated risk. Risk is meaningfully higher in specific groups: smokers (especially over 35), people with a personal or family history of clotting disorders, and people who experience migraine with aura. Applying one risk number to every user of every formulation isn't accurate and it isn't fair to the people trying to make an informed decision.
Does the Pill Overload Your Liver, Wreck Your Gut, or Cause Adrenal Fatigue?
No. These claims circulate widely online, but they aren't established in peer-reviewed research.
"Adrenal fatigue" is not a recognized clinical diagnosis. Claims of permanent gut microbiome damage or a need for liver "detoxification" after stopping birth control are not supported by scientific literature. This doesn't mean the people sharing these experiences are lying or imagining things, it means the specific mechanism being offered to explain what they're feeling isn't what the evidence supports.
Your experiences from birth control depend heavily on which formulation you use, and your body might respond differently than another woman who is taking the exact same pill. It’s never as simple as announcing that the pill is completely risk free or that it is single handedly destroying women’s health. Both extremes fail the women trying to make a real decision.
What Happens to Your Body After You Stop Birth Control?
For most people, ovulation returns quickly after stopping hormonal birth control, and fertility is not permanently affected.10 Post-pill amenorrhea (missed periods after stopping) does happen, but it's uncommon and usually resolves on its own.10
This is one of the most persistent myths in anti-pill content that hormonal birth control causes long-term or permanent fertility damage. The evidence here is largely reassuring.
Is "Post-Pill Syndrome" a Real Medical Condition?
“Post-pill syndrome" is not a recognized clinical diagnosis but the cluster of symptoms women describe after stopping birth control is real and deserves to be taken seriously.
Some symptoms after discontinuation have a plausible biological explanation: your body is adjusting to the return of its own hormonal cycle. The more dramatic "detox" claims, don't have that same evidence base.
We aren’t here to dismiss what you're feeling. However, it is our duty to be precise about what we know is happening in your body versus what's being sold to you as an explanation.
Speaking of being sold something: an entire wellness industry (the members of which have no oversight or responsibility to “do no harm”) has sprung up around "getting off the pill". Many of these individuals promote seed cycling, liver detox supplements and cycle syncing protocols to name a few. Let us reassure you that if your liver and kidneys are not detoxing as they should be, you would find yourself in an emergency room.
Should I Use Birth Control If I Have PMOS, PMDD, or Endometriosis?
If birth control was managing your symptoms, stopping it without a follow-up plan often means those symptoms return. The underlying condition is still there, because the contraceptive you were using was medical therapy.
We don’t tell patients to stop taking their anti-depressants or insulin because it’s “masking” a problem.
If you were prescribed hormonal birth control to manage PMOS, PMDD, or endometriosis, and your symptoms come roaring back after you stop, that is not your body "finally releasing what the pill was suppressing." It's the underlying condition reasserting itself, unmanaged. The pill was the treatment. Confusing those two things has the potential to harm women who deserve better.
Discontinuing hormonal birth control can absolutely be the right call for you. It's a legitimate clinical decision. But it should be a decision made with information about what the medication was doing for your body, not one made because of a TikTok video and without a conversation about what comes next.
Where Does July Health Fit into This?
You deserve information that doesn't ask you to choose between being dismissed and being scared.
We're not here to tell you the pill is without risks, and we're certainly not here to tell you it's dangerous. We're here to give you the evidence. Clearly, with informed consent so that whatever you decide about your birth control, your PMOS management, or your endometriosis care, you're deciding with real information instead of a comment section.
That's what evidence-based means: not certainty, but honesty about what we know, what we don't, and what that means for you specifically.
If you're navigating a birth control decision, especially alongside PMOS, PMDD, or endometriosis, you deserve unbiased medical advice.
Book a session today with one of our nurse practitioners to find out more.
This is Part 2 in our series on birth control misinformation. Catch up on Part 1 if you missed it.
This article is for informational purposes only and isn't a substitute for individualized medical advice. Talk to your doctor before starting or stopping any medication.
References:
1. Pfender EJ, Devlin MM. What Do Social Media Influencers Say About Birth Control? A Content Analysis of YouTube Vlogs About Birth Control. Health Communication. 2023;38(14):3336-3345. doi:10.1080/10410236.2022.2149091
2. Rosenberg MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives: Risk indicators for poor pill taking and discontinuation. Contraception. 1995;51(5):283-288. doi:10.1016/0010-7824(95)00074-K
3. Pfender EJ, Caplan SE. The Effect of Social Media Influencer Warranting Cues on Intentions to Use Non-Hormonal Contraception. Health Communication. 2024;0(0):1-15. doi:10.1080/10410236.2024.2402161
4. Keyes KM, Cheslack-Postava K, Westhoff C, et al. Keyes et al. Respond to “Hormonal Contraception and Mood.” American Journal of Epidemiology. 2013;178(9):1392-1393. doi:10.1093/aje/kwt187
5. Black A, Guilbert E, Costescu D, et al. Canadian Contraception Consensus (Part 1 of 4). Journal of Obstetrics and Gynaecology Canada. 2015;37(10):936-938. doi:10.1016/S1701-2163(16)30033-0
6. Teal S, Edelman A. Contraception Selection, Effectiveness, and Adverse Effects: A Review. JAMA. 2021;326(24):2507-2518. doi:10.1001/jama.2021.21392
7. Hormonal birth control blood clot risks. The women’s health activist. 2017;42(5):4-.
8. Moon MA. Hormonal birth control: doesn’t induce VTE recurrence. Internal medicine news (Short Hills, NJ 1995). Published online 2016:25-.
9. Wansbrough G. Birth control formulation linked to elevated VTE risk. Medical Post. 2012;48(2):37-
10. Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018 Jul 23;3:9. doi: 10.1186/s40834-018-0064-y. Erratum in: Contracept Reprod Med. 2023 Apr 21;8(1):29. doi: 10.1186/s40834-023-00226-y. PMID: 30062044; PMCID: PMC6055351.
