A Med Thing or Two - Hormonal Contraceptives - Myths and Misunderstandings

Hormonal-Type Contraception - Common Myths and Misunderstandings of Hormonal Birth Control

Written by: Lisa Cheng

Common Myths and Misunderstandings

Previous studies have suggested a link between hormonal birth control and an increased risk of breast and cervical cancer, although results are inconclusive (1-2). To emphasize, an increased risk of breast and cervical cancer is not equivalent to a woman have breast or cervical cancer later in life; rather, the probability that one may be diagnosed with these types of cancers later in life is slightly higher than that of women who do not use hormonal oral contraceptives. There are other risk factors (e.g., familial history of cancer) that need to be considered before making strides to the incorrect conclusion that women who use will, with certainty, have breast or cervical cancer. Women need to make an informed decision regarding their method of birth control, and fear should not be the reason for not using birth control. Conversations surrounding increased cancer risks with hormonal oral contraceptives and the associated anxiety should be facilitated with a doctor. Alternative non-hormonal options including condoms and copper intrauterine devices are available for those who do not want to use hormonal therapy as birth control.

Other myths and misunderstandings about combined oral contraceptives are being circulated and this misinformation may deter women from their use.

· Women need to take a break from taking birth control pills daily so that there is no build-up in the body. -- False.

Women do not need to intermittently stop their pills because hormones do not accumulate in the body. Hormones are naturally decomposed within the body and after a period of time where the length of time varies depending on the hormone. For this reason, birth control pills need to be taken daily and when there is a break in the schedule, there is an increased risk of pregnancy.

· Oral pills only days that intercourse occurs. -- False.

Oral pills need to be taken daily regardless of whether intercourse is expected to happen or not.

· Birth control pills cause birth defects. -- False.

There is no evidence suggesting that birth control pills will cause birth defects.

· Estrogen-containing hormonal birth control pills cause cancer. -- False.

Oral contraceptives do not cause cancer, although they may contribute to an increased risk of certain cancers (i.e., breast, cervical, and liver cancers). On the contrary, they can also reduce the risk of endometrial and ovarian cancer. The overall risk of cancer remains the same between estrogen-containing contraceptive women and women who do not use contraceptives.

· A woman’s libido will change after use of birth control pills. -- False.

There is no evidence suggesting that a change in a woman’s sexual behavior is directly associated with the use of birth control pills. Some women have previously reported that their sex drive has changed (both for better and for worse). However, it is unknown whether these changes are a factor of oral contraceptives, or if something else is affecting or helping their behavior.

· Combined hormonal birth control pills are ineffective for women who are overweight or obese. -- False.

Studies have shown that there is no difference in unintended pregnancies reported by women across different body mass indexes (normal, overweight, or obese) when using oral combined hormonal contraceptives (3).

Risks and Other Notes

Women who smoke, are diagnosed with liver disease, and have a history of high blood pressure are not advised to use hormonal pills containing estrogen. In rare cases, estrogen is associated with blood clots in the leg or lungs and in even more rare cases, there is a risk of stroke or heart attack (4). As such, women who have a history of blood clots are also contraindicated for estrogen-containing oral contraceptives (4). Other methods and devices of birth control should be considered.

REFERENCES

Gierisch JM, Coeytaux RR, Urrutia RP, Havrilesky LJ, Moorman PG, Lowery WJ, Dinan M, McBroom AJ, Hasselblad V, Sanders GD, Myers ER. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev. 2013 Nov;22(11):1931-43. doi: 10.1158/1055-9965.EPI-13-0298. Epub 2013 Sep 6. PMID: 24014598.
Cibula D, Gompel A, Mueck AO, La Vecchia C, Hannaford PC, Skouby SO, Zikan M, Dusek L. Hormonal contraception and risk of cancer. Human reproduction update. 2010 Nov 1;16(6):631-50.
Lopez LM, Bernholc A, Chen M, Grey TW, Otterness C, Westhoff C, Edelman A, Helmerhorst FM. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database of Systematic Reviews. 2016(8).
Sondheimer SJ. Oral contraceptives: mechanism of action, dosing, safety, and efficacy. Cutis. 2008 Jan;81(1 Suppl):19-22. PMID: 18338654.

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