Birth Control has been extremely effective in decreasing unwanted pregnancies and delaying childbearing. This allows professional women to complete their education and establish careers. However, now many women are starting birth control shortly after puberty and remaining on it for ten or twenty years. This raises the question- “What are the long term effects of birth control?”
Effect on Fertility
The long term effects of birth control on fertility is most people’s primary concern. After years without ovulation, will their bodies resume ovulation when the extra hormones are removed? Should they take a birth control “holiday” every few years to allow their ovaries to ovulate? Is this a “use it or lose it” type of situation?
Birth control has no negative effect on long term fertility.
As I mentioned in a previous article, most birth control methods have a short delay of return to fertility. This can range from a couple weeks to a year or longer (in the case of the Depo shot). However, once the effects of birth control have passed, fertility returns.
It is important to note that fertility may not return to the same level it was before you started birth control. For example, if you were 22 when you started birth control, you were likely extremely fertile before starting birth control. If you are stopping birth control at 35, your fertility would naturally be lower due to age. If you are concerned about your future fertility you may want to consider freezing your eggs.
The Studies that say Birth Control doesn’t Affect Fertility
Old studies, looking at the long term effects of birth control, showed a decrease in fertility in women who used birth control. This was because birth control masks problems with a woman’s menstrual cycle. When taking hormonal birth control, your body is tricked into following a 28 day cycle. The hormones from birth control override your natural hormones. So if you had an issue, such as polycystic ovarian syndrome (PCOS), or anovulation (absence of ovulation) you may not know when taking hormonal birth control. In these studies, when women stopped their birth control, they suddenly discovered they had issues getting pregnant. In fact, these issues were present all along, but the birth control masked them.
Today, studies are done taking this bias into account and the research has found that birth control use does not cause infertility. In fact, some studies have even reported a slight increase in fertility in women who had a history of hormonal birth control use. Not exactly sure how to explain that.
Negative Long Term Effects of Birth Control
Among the long term risks of birth control is a slight increase in the risk of breast cancer in the first two years of birth control usage. However, this risk is very small. One recent study in the New England Journal of Medicine followed 1.8 million women for 11 years and found that women who used birth control had a slightly increase chance of birth control. That meant for every 7,690 women using hormonal contraception for 1 year, 1 woman would get breast cancer. This is small considered a very small risk.
There is also a slight increase in the risk of human papilloma virus (HPV). This is the virus that can cause cervical cancer. However, the reason that long term birth control use increases risk of HPV isn’t clear. It is possible that women on birth control have more sexual partners and this in turn increases the risk of HPV. The birth control pill doesn’t protect against STDs. HPV is the most common sexually transmitted disease and the risk of contracting HPV can be decreased by using condoms. Today you can also get the Gardasil vaccine, which will protect you from the cancer-causing strains of HPV. If you haven’t already received the Gardasil vaccine I highly recommend it.
Progestin-only forms of birth control, such as the Depo shot are also associated with decreased bone density. This can lead to osteoporosis overtime. However, studies have found that after stopping the depo-shot, bone mineral density returns to baseline within 2 years. Combined hormonal contraception, which is the most common type of the birth control pill, does not significantly decrease bone density and therefore does not increase the risk of osteoporosis.
Positive Long Term Effects of Birth Control
The long term effects of birth control include some positive effects as well! Birth control has also been shown to decrease a woman’s risk of endometrial, ovarian and colorectal cancers. While the protective mechanism of hormonal birth control is not clear, these relationships have been observed in many studies.
Research has suggested a slight increase in fertility to women who have a history of birth control use.
That isn’t an indication to start birth control, but it should provide you with some reassurance. The increase is very small, and I mention it just to emphasize the fact that birth control does not cause infertility.
It is also important to the weigh the most obvious benefit of birth control –preventing an unwanted pregnancy. Pregnancy is a significant stress on the body, especially when a woman is not ready for it. Pregnancy can also lead to complications putting the woman’s health at risk. Some examples of include surgery (cesarean section), steroids, ectopic pregnancy (which can impair future fertility) and psychological stress.
Do You Need a Break from Birth Control?
Overall the research is clear that birth control is safe. If a woman is having unprotected sex and does not desire to become pregnant, the benefits far out weight the risks.
Women do not need to take a break from their birth control, unless they desire to.
If you aren’t having sex, it might be a good opportunity to stop your hormonal birth control to see what your menstrual cycle will do. You can see if your period occurs regularly, if you experience signs of ovulation. You will want to give your body a couple months for all the added hormones to leave your body.
If you identify issues you could address them with your doctor or midwife or just go back on birth control. It is important to understand that these may be issues you will need address if you do decide to try to become pregnant in the future. If at any time you begin having unprotected sex, make sure you use a back-up method or resume your birth control.