You could say I have a uniform. Others might call it a "capsule wardrobe", but I’m not a fan of labels. When I find something that fits, I buy it in every colour. I’ve been known to purchase back-up pairs of the same jeans, just in case the brand discontinues the style. I hate trawling through my closet every morning trying to piece together a new look. I stick with what I know looks good. Clearly, I’m a creature of habit.
When it comes to contraception, I adopt a similar approach. The old saying, “if it’s not broken, don’t fix it” sums me up pretty well. Doing the same thing I’ve always done has worked well up until now, so why change it?
But birth control isn’t the same as picking an outfit. As we age, the way our body processes medications can change and our needs might shift as well.
We might develop new health conditions or our lifestyle might make taking the Pill an inconvenience, and the side effects could even start to outweigh the benefits.
Regardless of your situation, it’s important to understand the risk vs. reward trade-off when taking the Pill as a means of long-term birth control (and when you should seek alternative options).
What are the side effects of the Pill?
The oral contraceptive Pill is the most popular type of birth control among Australian women. In fact, between 50-80% of us will use the Pill at some stage in our lives. This once-daily pill is both affordable and effective, using hormones to stop ovulation, thicken the mucus on the cervix and block fertilisation. As far as preventing pregnancy goes, the Pill is one of the easiest methods to follow (as long as it’s taken correctly).
But it’s not all sunshine and roses for many women. There are a bunch of common side effects linked with the Pill, including:
● Irregular bleeding or spotting (often between periods)
● Nausea
● Sore or tender breasts
● Headaches
● Bloating
Typically, these uncomfortable side effects ease after two or three months, and the severity of these symptoms will differ from woman to woman. However, these symptoms can be managed by changing your particular dosage (such as moving to progestogen-only prescriptions) as well as exploring other options of contraception (such as contraceptive implants or non-hormonal copper intrauterine devices).
Make sure to speak with a GP before changing your birth control to discuss what option might be best for you.
Is it safe to use the Pill as a long-term birth control option?
For those who haven’t experienced adverse side effects, continued usage of the Pill in the long-term might be an attractive option. And in most cases, long-term use of the Pill is safe for many women. But, it’s important to continually check-in with your GP on a regular basis to ensure this remains a safe choice both now and in the years to come.
However, there are a few exceptions to this.
For smokers (particularly those over the age of 35), the combination Pill should not be used as a form of contraception. This is because this Pill contains the hormone estrogen which can increase the risk of blood clots and heart attacks for smokers. Plus, this risk is also heightened for women with high blood pressure, a history of heart disease, and diabetes.
As a long-term birth control option, the Pill’s effectiveness is dependent on whether it continues to suit your needs and lifestyle. Be sure to talk to your GP and gynaecologist on a regular basis to assess how your body is processing the Pill to ensure it’s still the most appropriate option for you.
The Pill is only most effective with consistent use, which means missing doses regularly can increase your chances of unwanted pregnancy. If you’re struggling to remember to take the Pill daily, it might be wise to consider other birth control options, too.
Remember, all of us have different experiences on the Pill. Seeking personalised advice from your doctor, or GP, will help you make an informed decision based on your own circumstances.
Are there any serious side effects of long-term usage?
Along with the common side effects, there are also rare cases of more serious implications of long-term usage of the Pill.
A small increase in the risk of venous thromboembolism (the disease that causes deep vein thrombosis, or DVT) has been linked to the Pill. Studies have shown a three-fold risk increase in DVT during Pill usage in comparison to non-users. However, this is still lower than the risk women experience during pregnancy and the immediate period after giving birth.
For new mothers, using the combined Pill is not recommended within three weeks of delivery (as your risk of DVT is heightened immediately after childbirth). It’s important to speak with your doctor to understand your individual level of risk to ensure you’re making the safest choice.
There is also a low chance of increased risk of arterial disease (such as myocardial infarction and ischaemic stroke). This is usually very low with between 2 to 20 per million women affected depending on age. Those with a history of arterial disease, obesity, smoking, migraines with aura, diabetes with vascular complications, or uncontrolled hypertension should look for other contraception options.
There has been lots of debate about the link between the Pill and cancer. Two recent UK studies have noted that the Pill isn’t connected with an overall increased risk of cancer. In fact, they’ve found some positive stats when it comes to long-term usage of the Pill.
The combined Pill reduces the risk of uterine (in particular, endometrial) and ovarian cancers, with women who took the pill for three years seeing a 50% reduction in their risk of developing these cancers (reaching an 80% reduction for those taking the pill for 10 years or more). Plus, these protective effects are said to last for at least 20 years after stopping the Pill.
However, studies have found a small increase in the risk of cervical cancer among long-term users of the Pill (over 5 years of continued usage). The level of risk is shown to elevate with duration (meaning the longer you take the Pill, the higher your level of risk). But, interestingly, once a woman stops taking the Pill her level of risk returns back to normal levels.
Women with a history of liver cancer are not advised to take the combined oral contraceptive Pill. Research has revealed a four-fold increase in the risk of liver cancer among long-term users of the Pill.
What about skipping the sugar pills?
Skipping our periods indefinitely sounds like a pretty brilliant idea. But is it safe to ditch the sugar pills entirely? Using the Pill continuously (i.e. never having your period) is shown to be completely safe and won’t cause long-term issues.
In fact, women who experience painful periods or severe menstrual systems (such as seizures, dizziness, asthma, headaches or mood disturbances) may be advised by their doctors to do so.
However, taking the Pill continuously can increase the chances of breakthrough bleeding (or spotting) that can last for two to three days. If you notice moderate or even heavy bleeding that lasts more than four days, taking a break from the Pill for 4 days can be a wise strategy to allow your body to experience a normal period. After that time, you can recommence taking the Pill as usual.
If you’re unsure about your symptoms while taking the Pill continuously, make sure to have a chat with GP who will be able to advise the best approach for your situation.
As you can probably tell, there’s no one-size-fits-all approach to birth control. Unlike my beloved pair of jeans that I’ll continue to wear for a season to come, sticking to the same type of contraceptive as we age isn’t always the smartest (or safest) option. If you're planning to use the Pill over the long-term, it’s important to keep in touch with your GP to ensure this option is still suitable for you.
Resources (in order of appearance)
● https://www.ncbi.nlm.nih.gov/pubmed/27373543
● https://www.plannedparenthood.org/learn/birth-control/birth-control-pill
● https://www.ncbi.nlm.nih.gov/pubmed/14696713
● https://www.nps.org.au/australian-prescriber/articles/choosing-a-combined-oral- contraceptive-pill
● https://www.fpnsw.org.au/sites/default/files/assets/COMBINED%20PILL%20AN D%20CANCER.pdf
● https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157129/
● https://www.ncbi.nlm.nih.gov/pubmed/20223876
● https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1995533/
● https://www.ncbi.nlm.nih.gov/pubmed/10652981
● https://www.fpnsw.org.au/factsheets/individuals/contraception/combined-pill-an d-cancer
● https://www.ncbi.nlm.nih.gov/pubmed/17993361
● https://www.healthline.com/health/birth-control-side-effects#risks
● https://www.thewomens.org.au/health-information/contraception/contraceptive- pills ● https://healthywa.wa.gov.au/Articles/A_E/Contraceptive-pill-the-pill