From the Guidelines
Prolonged birth control use is generally safe and offers several benefits, including effective pregnancy prevention and reduced risk of certain cancers, but it also carries some risks, such as increased risk of blood clots and stroke, particularly in smokers over 35, as noted in the 2024 guideline for the primary prevention of stroke 1. The benefits of prolonged birth control use include:
- Highly effective pregnancy prevention
- Menstrual cycle regulation
- Reduced menstrual pain
- Decreased risk of ovarian and endometrial cancers
- Management of conditions like endometriosis and PCOS Common hormonal methods like combined oral contraceptives and progestin-only options can be safely used for many years. However, risks vary by method and individual factors. Some key points to consider:
- Combined hormonal contraceptives slightly increase the risk of blood clots, stroke, and heart attack, particularly in smokers over 35, as seen in studies such as the one published in 2024 1
- The risk of stroke is higher with higher doses of estrogen in combined hormonal contraceptives, as found in a meta-analysis 1
- The incidence of venous thromboembolism is higher among oral contraceptive users aged 45-49 years compared with younger oral contraceptive users, but an interaction between hormonal contraception and increased age compared with baseline risk was not demonstrated 1
- Most women can safely use birth control long-term, but regular healthcare visits are recommended to monitor for side effects and reassess contraceptive needs, as suggested by the U.S. selected practice recommendations for contraceptive use, 2024 1
- Upon discontinuation, fertility typically returns quickly, though timing varies by method, with some IUDs and implants allowing immediate return to fertility after removal. It is essential to weigh the benefits and risks of prolonged birth control use and consider individual factors, such as age, health status, and lifestyle, when making decisions about contraceptive use, as recommended by the American College of Obstetricians and Gynecologists and the North American Menopause Society 1.
From the Research
Benefits of Prolonged Birth Control Use
- Reduced risk of endometrial and ovarian cancer 2
- Improved menstrual regularity, with less dysmenorrhea and blood flow 2
- Reduced acne and hirsutism when using low-dose combination oral contraceptives 2
- Decreased risk of bacterial pelvic inflammatory disease 2
- Improvement in medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder 3
Risks of Prolonged Birth Control Use
- Increased risk of venous thrombosis, particularly in carriers of the coagulation factor V Leiden mutation 2
- Risk of arterial thrombosis, such as myocardial infarction or stroke, particularly in women who have hypertension, smoke, or are >35 years old 2
- Changes in menstrual bleeding patterns, which can be a common complaint in women using progestin-only pills 4
- Potential for weight gain, particularly with depot medroxyprogesterone acetate (DMPA) injection, especially in obese adolescents and black patients 5
- Bone mineral density loss with DMPA injection, which is reversible after discontinuation 5
Considerations for Prolonged Birth Control Use
- Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences 3
- Counseling women interested in using progestin-only pills about the variable bleeding patterns associated with this method may improve compliance and acceptance 4
- Progestin-only implants and injections are effective and have few contraindications, but may have adverse effects such as changes in bleeding patterns and bone mineral density loss 5