I’ve Been on The Pill for 22 Years. Is That OK?

We cleanse our homes of negative energy. We eliminate toxic friends. We detox using house plants and dry brushes and vegan coconut soup and armpit masks (wait, what?). 

But lately, some serious questions have been raised in wellness circles online and among women we know, asking if the indefinite use of hormone-based oral contraceptives could be more harmful than we've realized.

Do we need to detox from the pill?

It’s a complicated conundrum that hits close to home. With the exception of my two pregnancies, I have been on the pill for 22 consecutive years. Like many women, I started taking it in my teens, to control painful menstrual cramps. But the more I read about the pill’s link to increased cancer risk, anxiety and depression, the more I wonder if it remains my healthiest option. 

Even raising this topic feels taboo—like walking into a political minefield. As New York magazine’s Anna Silman asks in her in-depth essay on the subject, “Is it anti-feminist to question the pill?” Given how hard past generations of women fought to access birth control, and what they had to endure without it, I worry about drawing attention to the pill’s possible downsides—which, by the way, science insists are minimal. In fact, the pill may even reduce your risk of certain cancers. And some studies show it may reduce depressive symptoms. Are you as confused as I am?

As I weigh the deeply personal pros and cons, here’s the section of Silman’s essay I can’t get out of my head. She interviews Dr. Sarah Hill, a professor of psychology at Texas Christian University and author of the book This Is Your Brain on Birth Control. Dr. Hill highlights a “lack of vibrancy” women on the pill may experience. This “general dullness,” she suggests, is a biochemical reaction to the pill’s tinkering with our hormone levels. “And these hormones are part of the signalizing machinery that make us feel like ‘us.’…Having lower levels of these hormones may make Pill-taking women’s brains less excitable and less able to absorb all of the depth of their experiences than non-Pill-taking brains. It may make life feel more flat.”

What is the medical community’s consensus on all of this? How do we know if prolonged use of the pill could hurt us, even in some gauzy, practically imperceptible way? Even if they are minimal, how do we decide if the risks are worth it? 

I asked Dr. Aviva Romm, M.D.—a Yale-and Tufts-trained family medicine and obstetrics physician—these and many other questions. Our edited and condensed conversation is below.  

A: Yes. It’s not a medication you have to taper off. You can stop the pill anytime. 

A: There’s no technical syndrome called Post Birth Control Syndrome. What we do know is there is a phenomenon of symptoms that women, when they go off the pill, frequently experience. But statistically, at least 80 percent of women who go off the pill will be cycling normally within three months. However, keep in mind that 50 percent of women go onto the pill for reasons other than contraception. For example, a lot of women have symptoms of Polycystic Ovary Syndrome (PCOS) and that gets them put on the pill, sometimes without a proper diagnosis. Perhaps they had irregular or heavy periods or they were skipping periods or they had acne, and their gynecologist said, "Well, you should take the pill." So when they go off the pill, they’re right back to where they were before. If they had irregular periods before, they may re-experience those symptoms. If they had acne before, it may come back. But I’ve also had patients who never had acne before, who were on the pill for sometimes a decade, who came off it and now they have acne. 

A: No. Most women who did not have gynecologic or hormonal imbalance symptoms prior to the pill will resume cycling without a problem and will not have problems. However, some women do have a new onset of menstrual irregularity, acne or other symptoms post-pill. This tends to be more significant, however, for women who went on the pill for reasons other than contraception, in which case you may have some work to do to get your hormones balanced. But you don’t have to detox after you go off the pill. Your body is going to go back to doing what it was doing normally. Your estrogen and progesterone levels will quickly level out if you have otherwise healthy normal liver detoxification functioning. But we all should be mindful to get the nutrients we need to keep our detoxification system healthy (like eating a good, Mediterranean-style diet, and taking a multi or prenatal vitamin) and minimize the environmental toxins that impact that system.

A: There are definite, very real side effects from the pill, and women should be informed of these by health professionals, who tend to minimize the risks. I don’t think women should be on it indefinitely. A major study just came out that says even just being on the pill for six months increases your risk of developing diabetes later in life. And some risks are well known—for example, increased risk of blood clots. While some will say that statistically, a pregnant woman’s risk of blood clots is way higher than the risk of blood clots with the pill, which is true, keep in mind that you’re only pregnant for ten months at a time, and you could be on the pill for ten years. If you have migraines with an aura, if you smoke and you're over 35 and you’re on the birth control pill, then you have a much higher risk for a clot or a stroke. It’s wise to be aware of what the symptoms of these side effects are so you know what to look out for. 

A: All medications, even Tylenol or ibuprofen, have some risks. The estrogen-containing pills seems to be the ones that cause the most risk. Most of the [downsides] that we associate with the pill are really estrogen-driven. Studies suggest there is an increased risk for Crohn’s disease associated with pills containing estrogen. It’s also typically the estrogen in the pill that’s going to cause mood swings and weight gain. That said, progestin-only pills can also cause mood changes, and may increase depression and anxiety. I always do prefer progestin-only pills for greater safety. But it doesn’t mean that it’s absolutely hazardous for every woman to be on the pill.

A: When we take hormonal birth control, we’re giving our bodies more of those hormones than we are physiologically supposed to get. So, we want to be mindful of that. But that doesn’t mean it creates a toxic environment, and it doesn’t mean that your body can’t handle it. It means you want to make sure you’re giving your body what it needs to compensate for the nutrients that are getting expended; the pill does deplete certain nutrients like antioxidants. 

If you’re on the pill for any of those other reasons that are not for contraception, it’s really important to look for the root causes of those conditions and treat those conditions, not just suppress or mask those symptoms with the pill.

In my medical practice, if I have a patient who is willing to try non-pharmaceutical approaches for gynecologic symptoms, I will always encourage such options first; for example, dietary strategies. For contraception, natural family planning and non-hormonal forms of contraception such as a hormone-free IUD, or diligent and proper use of condoms, are excellent options. 

A: No. There’s no evidence of that. And there have not been any birth defects related to emergency contraception. So even if you take the morning after pill, it doesn’t work, and you stay pregnant, that has not been shown to have harmful side effects.

A: It’s one side of the story. In fact, some women who take the pill feel an incredible freedom to pursue their careers, to have more relaxed sexual lives. And if women are struggling with chronic pain—let’s say they have endometriosis and the pill has helped relieve that a little bit—then they may feel more energy and more vibrant than if they were encumbered by awful symptoms. 

But, we do know that through our cycles, when we’re not on the pill, we have natural surges in energy. So, for example, mid-cycle with ovulation, women typically have a burst in creative energy, a burst in social drive, wanting to get out more, connect with other people, greater sexual desire, and interestingly, greater ability to read people’s facial expressions and recognize "stranger danger"—for example, if you’re out at a bar or on a date. The pill suppresses ovulation and, with it, can suppress these creative and social impulses.  

There are pros and cons to being on the pill. It’s a complicated issue. There’s not just one answer. It’s a very personal choice. What’s most important is that women have a choice over their reproduction. Birth control pills are part of giving women that choice. Women shouldn’t be made to feel guilty for going on the pill, or pressure to go off the pill if it’s working for them. Women do need to be knowledgeable about the alternatives for treating hormonal imbalances, options for contraception, and the risks of the pill, and aware of the risk factors that increase those risks. But we don’t have to throw out the pill with the bath water.