Hi birthcontrolers!

Since we've been getting so many posts about potential side effects of hormonal birth control, the other BC mods (dindin and karolijn ) and I have put together this pretty comprehensive FAQ about the different things you can experience on hormonal birth control, whether you're first starting out on HBC, switching brands, or have been on it for a while now. It covers everything we could think of, but if you still have questions, feel free to ask. This, like everything here, is a work in progress.

However, since we've worked so hard to put this together, we're going to make a few small changes to the community. We won't be allowing any posts with the following types of questions:

Do you like this brand?
What brand should I take?
What side effects did you have on this brand?
What side effects will I have on this brand?
My doctor prescribed me X, is this a good pill?
Is X brand good/bad for x side effect?

Now, what does this mean for you, if you've posted one of these questions? Not a lot, for now. You'll receive an official moderator statement directing you to this post and asking you to delete your own post within 12 hours. If you haven't deleted it by then, we'll delete it for you. If you find you have questions not answered in the community memories/FAQ, then you can post again to get clarification.

Welcome to Hormonal Birth Control (HBC)! What constitutes HBC? Birth control pills (Combination (Estrogen/Progestin, and Progestin Only), the birth control patch (Ortho Evra ), the ring (Nuvaring), the shot (Depo Provera / Depo Sub-Q) and the Mirena IUD (Progestin). Outside the United States there's also an implant (Implanon) (should be available in the U.S. by the end of the year). Its understandable when starting HBC for the first time, or starting a new form of HBC to want to know what to expect. While there are no definite answers, this post will attempt to give you some general guidelines about what to expect, what can generally be considered "normal" and what might generally be cause for concern.

*Please note that we are not doctors, and this is not medical advice. These are guidelines only. You should almost always, in almost all cases, defer to your doctor for advice.*

Below you'll see a list of the most commonly experienced side effects on hormonal birth control. These side effects are consistent and common in all hormonal birth control for their potential to be experienced. This doesn't mean that you'll experience all or any of these. What it means is that all HBC can cause each of these side effects. If you ask about any particular brand, the answer will almost always be the same: here are the potential side effects that you may experience.

Three things to remember:

1) HBC is trial and error, and a matter of individual body chemistry. What works for someone else may not work for you, and vice versa. With few exceptions, no pill, patch or ring is more or less likely to cause any specific side effect. While your doctor may be able to use his or her medical experience to judge which brands s/he feels may be better, no one else can. If we've sent you this post, it's because it will answer your question.

2) There are lots of websites out there that claim to give "reviews" of particular brands. a) Most people who have a good experience with HBC will never bother to visit one of these sites or tell you about their experience - so you're always going to read more bad then good. b) Even if you read 100 opinions, you're getting a fraction of the number of women who are actually on a particular pill. You can't judge a medication by talking to a few or even a lot of people. If any particular brand were any worse than any other, it simply wouldn't be prescribed. Drug companies want you to have a good experience on their product.

3) If you're concerned about a particularly nasty side effect, don't wait to hear if other people have had them - trust yourself! You can always call your doctor, pharmacist or clinic and ask a question.

Common Side Effects:

Acne - What's "Normal": Although some brands are advertised as being designed to treat acne, with the exception of Diane-35 (not available in the U.S.), there's nothing special about those brands that are advertised versus those that are not. All hormonal birth control (HBC) has the potential ability to help clear up bad skin/acne. If you'd like your doctor to prescribe HBC for this reason (exclusively or along with it's contraceptive purpose), be sure to mention it to her or him, as s/he may have a brand preference. It's important to wait around 3 months while your body adjusts to the new hormones to see if it's working to clear up your skin.

What May Not Be "Normal": If after 3 months, you haven't experienced a change in your skin, you may wish to talk to your doctor about this and see if she or he recommends changing brands. If within 3 months you've experienced a significant change in your skin for the worse, you should also talk to your doctor and see if a change in brands is in order. Not all acne is caused by hormones, which means that not all acne will be able to be helped by HBC. If you're being prescribed HBC for birth control purposes, and acne is a concern, you may wish to see a dermatologist separately, to discuss other treatment options for your skin. (Note that antibiotics are also commonly used to treat acne and may interfere with HBC. Always make sure to tell all your doctors about any medication you're on.)

Bleeding/Breakthrough Bleeding/Spotting: What's "Normal": Breakthrough Bleeding (BTB) or spotting can be any amount of bleeding that is not during your placebo/off-patch/no-ring week. It can be light enough that it just shows up on toilet paper or it can be heavy like a light period. During your first few months on HBC, it is particularly common and normal. It's neither good nor bad, it just is. While it's more common your first few months, it can reappear at any time, especially if you've been sick, on new medication, or had any significant change (changed your diet, your exercise routine, etc.). Occasional BTB during your first 3 months, or any other time is usually not cause for concern.

What May Not Be "Normal": If after your first 3 months, you're still experiencing significant BTB, or if your periods are consistently coming before your placebo week, this is a good time to talk to your doctor. It's not clear if consistently early periods indicate a drop in protection, so it's best to get your doctor's opinion on this.

Breast Pain/Tenderness/Growth: What's "Normal": Some amount of breast tenderness or pain is normal, especially your first few months on HBC. Some women experience nipple sensitivity, some women experience breast growth - there's no way to predict who will or who won't experience this. Sorry. Feel free to take normal over-the-counter pain relievers, try heating pads or hot water bottles, stay away from caffeine and sodium, and for longer term relief try Magnesium supplements (found in your vitamin aisle) .

What May Not Be "Normal": If after the first few months, you've tried all of the above with no relief, talk to your doctor to see if a change in brands will help. If at any point the pain is severe or unbearable, don't hesitate to talk to your doctor about switching, and if anything else is threatening to keep you from taking your pills - pick up the phone and call your doctor. A different brand may be the solution.

Depression/Moodiness/Mood Swings - What's "Normal": Ideally, if you have problems with PMS or other hormonally related mood swings, HBC can and should help with this by keeping a constant level of hormones in your system. However, things are not always ideal, and you may experience some depression or moodiness, especially during your first few months on HBC. Some of this is normal, and a B-complex vitamin supplement may be helpful.

What May Not Be "Normal": Generally, it's good to give any new HBC about 3 months to see if your system gets used to it, and the side effects mellow out. If after this time your emotions have not returned to normal, this is the time to talk to your doctor and see if she or he thinks you should switch brands. If at any time you feel your side effects are severe, you know your body best and it's important to be your own best "advocate" when it comes to your health. Never hesitate to call your doctor if you're concerned; you never have to wait three months.

Loss of Libido/Sex Drive - What's "Normal": Some women experience a decrease in their interest in sex while on HBC. As usual, it's best to give any new brand about 3 months and see if your body will adjust. If interest is not a problem, but dryness is, find some fun ways to add lube to the moment (only silicone or water based lubes are compatible with condoms).

What May Not Be "Normal": You know your body best. If after your first few months you're still experiencing a significant decrease in interest, this is the time to discuss switching brands with your doctor.

Nausea/Stomach Upset/Vomiting -What's "Normal": The new hormones can cause stomach upset in some women, and is sometimes mistaken for a pregnancy symptom. An upset stomach is a perfectly normal "adjustment" side effect; if this is happening to you, try taking your pills with food or milk, or taking them before bed. You can safely take over-the-counter stomach remedies in the short term. Methods such as Ortho Evra (the patch), Nuvaring (the ring) and Mirena IUD are less likely to cause this, because they're not absorbed through the stomach.

What May Not Be "Normal": Continued stomach upset or severe stomach upset (vomiting or diarrhea) may be an indication that the brand you're taking is not the right combination of hormone levels for you. A different brand may help, and calling your doctor to discuss the problem is the best course of action.

Shorter/Lighter Periods - One of the ways that HBC works is by thinning your endometrium (the lining of your uterus), which is what your period actually is/where it's coming from. So it's reasonable to say that if you're having shorter and lighter (and one would hope, easier) periods, your pill is doing it's job correctly. If you've taken your pills correctly during the month, a very light period is not a cause for concern or a symptom of pregnancy. There is a new pill available, Loestrin FE 24, which has been proven to reduce women's periods to average 3 days or less by their 6th cycle. While all HBC has the potential to ease a heavy or long period, if this is of particular concern to you, you may want to mention this pill to your doctor and discuss it's appropriateness for you.

What May Not Be "Normal": While it's possible to do everything correctly and miss a period on HBC, it's still a good idea to check in with your doctor at this point; if you miss two periods, you must. If you've been inconsistent with your pill taking times or missed any pills and your period is very light or missing, this may be a sign that something is off. Please check with your doctor as soon as possible.

Weight Gain/Loss- The subject of weight gain is perhaps the biggest myth about birth control: with most hormonal methods you actually have as much chance of losing weight as gaining weight. There are two main exceptions to this: Yasmin has a progestin in it which has been proven to have a diuretic effect, in other words you're less likely to retain water on it. Depo Provera, and Depo Sub-Q do have weight gain as one of its side effects. Women who complete one year on Depo Provera gain an average of 5.4 lbs, after 2 years, an average of 8.1 lbs. With Depo Sub-Q, the average 1 year weight gain is 3.4 pounds (Depo Provera is no longer recommended for more than 2 years. Depo Sub-Q should be used for more than 2 years only if other birth control methods are not available or not an option.) If weight is a significant concern for you, mention it to your doctor prior to beginning HBC.

What May Not Be "Normal": A significant increase in weight after starting HBC without any change in diet or exercise, may be a sign that the brand you're taking is not the best one for you. This is a good reason to call your doctor and discuss your side effects and possibly switching brands. Other reasons to talk to your doctor may include a significant change in appetite or constant feeling of being bloated.

New Brands and Side Effect Exceptions: There are exceptions to every rule.

Exceptions for BTB/Spotting - Seasonale & Skipping Your Periods - If you are taking Seasonale, you are skipping your periods, and having only 4 periods a year. Any time you skip your periods, you may experience breakthrough bleeding - this is normal. With Seasonale, the manufacturers state that for the first year you will wind up bleeding about the same number of days as someone not on Seasonale, although this may be spots that show up on your toilet paper, or it may be as heavy as a light period.

Seasonale is a monophasic pill. All days of hormones are the same (and all pills are the same color). If you intend to skip your periods, this type of pill is your best choice. There are ways to skip with a triphasic (three phases/hormone levels) pill see here , but they may not work as well, and you should confirm protection with your doctor before trying this.

Progestin Only Pills - Most women do not take POPs, and know if they do. POPs have a higher incidence of spotting or breakthrough bleeding, but a significant percentage of women may also lose their periods altogether on POPs. Because a POP taken more than 3 hours late is a missed pill, in general women are not prescribed POPs without having tried several "regular" combination pills first, or having a particular medical problem (such as migraines with aura) which prohibits them from taking combination pills.

Exceptions for Diane-35/Dianette - Diane-35/Dianette is a hormonal birth control pill available primarily in Canada, the UK, Australia and New Zealand, which is used for treatment of severe acne when other methods and pills have not proven effective. Diane-35/Dianette appears to have an elevated risk of blood clots compared to other combination oral contraceptives in some studies. In Canada, the following restrictions are in place regarding this pill: DIANE-35 should not be prescribed for the purpose of birth control alone, DIANE-35 should be discontinued 3 to 4 months after signs of acne have completely resolved. If you have been prescribed this pill or have heard about this pill, please discuss these restrictions with your doctor.

Exceptions for Nuvaring: Nuvaring has a few exceptions for side effects. On the one hand, Nuvaring may have a lower incidence of side effects in general because it is a very low dose (that is absorbed directly into the bloodstream through the vagina), particularly stomach upset. On the other hand, Nuvaring does have an increased occurance of vaginal discharge and an increased risk of vaginal infections. As always, if you'd like to try this very convenient method, discuss your concerns with your doctor.

Exceptions for Implanon - Changes in bleeding patterns are the most common side effects with Implanon: infrequent bleeding, amenorrhea (absence of bleeding), frequent and/or prolonged bleeding. If you're considering this method, keep this in mind and discuss any concerns with your doctor.

Severe PMS/PMDD - There is a new pill on the market, Yaz,which is a lower dose version of Yasmin. Yaz also has 24 active pills and 4 placebos (versus 21/7 for almost all other brands). In studies, Yaz was particularly good for women with severe PMS or PMDD (Pre-Menstrual Dysphoric Disorder). If this is a concern for you, you may want to mention this pill to your doctor and discuss if it's right for you.

Developing New Side Effects
It is not uncommon to develop new side-effects over time. Your body is constantly changing and as a result, it is possible to 'grow out' of a hormonal method. Many things can cause a change in how you react to a new method: diet, weight, other medication, schedule changes, stress, etc. If you believe that you have developed a new side effect from your birth control method then discuss your concerns with your doctor.

Serious Side Effects
The risks associated with hormonal birth control are lower than the risks associated with pregnancy. However, like any medication, birth control has a low incidence of serious side effects that you should be aware of. If you experience any of the following symptoms, consult a doctor immediately:

Unusual or severe chest or abdomen pain
Migranes accompanied by aura
Sudden shortness of breath
Unusual swelling or pain in the leg or arm
Unusually heavy bleeding (Protection hardly works at all; you would need to change the highest absorbency tampon or pad every hour or two.)
Any other pain or unusual problems that would normally cause you to visit a doctor but are not listed above

We hope you've found this helpful -- all of this is explored in more depth in the memories/FAQ !