From the Guidelines
Combined oral contraceptive pills (COCPs) can cause several side effects, including common ones like nausea, headaches, and breast tenderness, as well as more serious but less common side effects like blood clots and high blood pressure, and patients should be aware of these potential risks and benefits, as noted in the most recent guidelines 1.
Common Side Effects
- Nausea
- Headaches
- Breast tenderness
- Spotting or breakthrough bleeding
- Mood changes These symptoms typically improve after the first 2-3 months of use as the body adjusts to the hormones.
Serious Side Effects
- Blood clots (particularly in the legs or lungs)
- High blood pressure
- Increased risk of certain cancers like breast cancer The risk of blood clots is higher in women who smoke, are over 35, or have certain medical conditions.
Management of Side Effects
If side effects are bothersome, switching to a different formulation with lower estrogen content or different progestin may help, and patients should contact their healthcare provider immediately if they experience severe abdominal pain, chest pain, severe headaches, vision changes, or swelling and pain in the legs, as these could indicate serious complications, as recommended by recent studies 1.
Special Considerations
Specific COCPs like those containing drospirenone (such as Yaz or Yasmin) may increase potassium levels and should be used cautiously in women with kidney or adrenal disorders.
Monitoring and Follow-up
A routine follow-up visit 1 to 3 months after initiating COCs is useful for addressing persistent adverse effects or adherence issues, and patients should be counseled on the importance of correct use and timing to avoid unscheduled spotting or bleeding, as emphasized in recent guidelines 1.
From the FDA Drug Label
ADVERSE REACTIONS An increased risk of the following serious adverse reactions has been associated with the use of oral contraceptives (see WARNINGS section): Thrombophlebitis and venous thrombosis with or without embolism Arterial thromboembolism Pulmonary embolism Myocardial infarction Cerebral hemorrhage Cerebral thrombosis Hypertension Gallbladder disease Hepatic adenomas or benign liver tumors The following adverse reactions have been reported in users of oral contraceptives and the association has been neither confirmed nor refuted: Pre-menstrual syndrome Cataracts Changes in appetite Cystitis-like syndrome Headache Nervousness Dizziness Hirsutism Loss of scalp hair Erythema multiforme Erythema nodosum Hemorrhagic eruption Vaginitis Porphyria Impaired renal function Hemolytic uremic syndrome Acne Changes in libido Colitis Budd-Chiari syndrome
The common side effects of Combined Oral Contraceptives (COCs) include:
- Thrombophlebitis and venous thrombosis
- Arterial thromboembolism
- Pulmonary embolism
- Myocardial infarction
- Cerebral hemorrhage
- Cerebral thrombosis
- Hypertension
- Gallbladder disease
- Hepatic adenomas or benign liver tumors Other possible side effects are:
- Pre-menstrual syndrome
- Cataracts
- Changes in appetite
- Cystitis-like syndrome
- Headache
- Nervousness
- Dizziness
- Hirsutism
- Loss of scalp hair
- Erythema multiforme
- Erythema nodosum
- Hemorrhagic eruption
- Vaginitis
- Porphyria
- Impaired renal function
- Hemolytic uremic syndrome
- Acne
- Changes in libido
- Colitis
- Budd-Chiari syndrome 2
From the Research
COCP Side Effects
- The combined oral contraceptive pill (COCP) is known to have various side effects, including an increased risk of venous thromboembolism 3, 4.
- Hormonal contraceptives, such as COCPs, can also have non-contraceptive benefits, including improved medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder 5, 4.
- The risk of side effects can be minimized by prescribing a pill with the lowest effective dose of oestrogen and progestogen, such as pills containing levonorgestrel or norethisterone in combination with ethinyloestradiol 35 microgram or less 3.
- Extended-cycle oral contraceptives, which involve taking the pill for 84 days or more without a break, can also have a similar efficacy and adverse effect profile compared to traditional cyclic regimens 6, 7.
- However, the incidence of hormone-related side effects or adverse events may not be lower with extended-cycle regimens, despite the potential benefit of lower daily doses of hormonal exposure 7.
- Common side effects of COCPs include bloating, menstrual pain, and changes in menstrual bleeding patterns, which can be reduced with continuous administration regimens 6.