Birth Control and Chronic Conditions

Can birth control affect chronic conditions?

Yes — hormonal birth control methods can influence chronic health conditions in several ways.

Most hormonal contraceptives deliver synthetic versions of estrogen, progestin (a form of progesterone), or both into the body. These hormones don’t just prevent pregnancy; they also interact with systems involved in inflammation, blood clotting, metabolism, mood, and menstruation.

The types of contraception people may use include:

• combined hormonal contraceptives, which contain both estrogen and progestin
• progestin‑only methods, such as the “mini pill“, hormonal intrauterine devices (IUDs), implants, and injections
• non‑hormonal methods, such as copper IUDs and condoms

Hormonal birth control can have a range of effects on the body. For many, these effects are mild or even beneficial.

In other cases, the benefits outweigh the potential risks or side effects, particularly when contraception helps manage symptoms of an existing condition.

Potential benefits for chronic conditions

Hormonal birth control is often prescribed because it can improve symptoms of certain chronic or cyclical conditions. It may help with:

• Regulating menstrual cycles: Combined and progestin‑only methods can make periods more predictable, which can help if you have irregular cycles.
• Painful or heavy periods: Hormonal contraceptives may help reduce cramps and heavy bleeding for some people.
• Premenstrual syndrome (PMS): Birth control may help reduce certain PMS symptoms for some people.
• Acne: Combined hormonal contraception can reduce androgen activity and oil production in the skin, often helping with hormonal acne.
• Polycystic ovary syndrome (PCOS): Similarly, combined hormonal contraceptives can reduce androgen levels in people with PCOS.
• Endometriosis: Hormonal birth control is one of the treatment options for managing endometriosis symptoms.
• Hormonal migraine: For some people with menstrual‑linked migraine without aura, stable hormone delivery via certain contraceptives may reduce episodes. However, people who have migraine with aura may need to avoid certain types of hormonal birth control.

In these cases, the hormonal effects of birth control also treat symptoms and can improve quality of life, alongside providing contraception.

Potential interactions with chronic conditions

How birth control interacts with chronic conditions depends on the method and the condition. Some important interactions include:

High blood pressure and cardiovascular risk

Estrogen‑containing methods can modestly raise blood pressure and slightly elevate the risk of blood clots, stroke, or heart attack, especially in people with uncontrolled hypertension or other risk factors like smoking.

However, the American College of Cardiology points out that the risk of stroke related to combined birth control is lower than the risk of pregnancy-related stroke.

For people with high blood pressure or cardiovascular disease, progestin‑only methods or nonhormonal options may be safer choices.

Diabetes and metabolic conditions

Hormonal birth control may affect blood sugar regulation because estrogen and progestin can raise glucose levels or contribute to weight gain, which can complicate diabetes management.

Additionally, certain vaginal rings are not suitable for people with complications from diabetes, such as kidney or eye disease.

Epilepsy

Some anti‑seizure medications can interfere with the effectiveness of hormonal contraceptives. Likewise, the estrogen in hormonal birth control can decrease the effectiveness of lamotrigine and valproate, which doctors use to treat epilepsy and bipolar disorder.

If you’re taking epilepsy medication, it may be a better idea to use the levonorgestrel IUD, the copper IUD, or Depo‑Provera shots. Discuss this with your clinician.

Thrombosis or clotting disorders

Doctors typically advise people with a history of deep vein thrombosis (DVT) or clotting mutations to avoid estrogen‑containing methods due to increased clot risk. A doctor may advise progestin‑only or nonhormonal options instead.

Mental health conditions

Hormonal birth control might or might not affect your mental health — so far, the research is mixed.

A 2023 study found that pill users may face up to a 130% increased risk of depression, especially during the first 2 years of use.

However, a 2019 bulletin from the American College of Obstetricians and Gynecologists (ACOG) says that those with existing depression can use any form of birth control, as no forms appear to worsen existing symptoms.

Autoimmune diseases

Hormones can interact with the immune system, which may have implications for those with autoimmune conditions.

Research from 2019 shows that hormonal contraception might worsen the symptoms of systemic lupus erythematosus (SLE) and anti-phospholipid syndrome. It may have minor adverse effects in people with inflammatory bowel diseases.

Other research shows that there are mixed effects on people with HIV or with multiple sclerosis (MS). Further research is necessary.

Drug interactions

Some medications used to treat chronic conditions can interact with hormonal birth control in the following ways:

• Anti-seizure drugs: Some drugs for epilepsy may reduce the effectiveness of some hormonal contraceptives.
• Certain antibiotics: Antibiotics like ifampicin and rifabutin may reduce the effectiveness of hormonal contraception.
• St. John’s wort: This herbal supplement can interact with contraceptives, reducing their effectiveness and potentially causing breakthrough bleeding.

Talk with your clinician about all medications, supplements, and herbal remedies you’re taking to ensure safe and effective contraception.

Things to consider when choosing birth control

When choosing a method, you’ll want to consider:

• your chronic conditions
• the medications you take
• the effectiveness of the birth control method
• its ease of use
• the potential side effects
• the costs

It may be a good idea to ask your clinician the following questions:

• “How might this method interact with my chronic condition?”
• “Are there preferred contraception options, given my medications?”
• “What are the risks and benefits specific to my health profile?”
• “Would a nonhormonal option be safer or effective for me?”

If you think your contraceptive is worsening your symptoms, it’s a good idea to make an appointment to speak with a healthcare professional about your alternatives.

Alternatives to hormonal birth control

Not all birth control methods rely on hormones. Nonhormonal birth control options include:

• Copper IUD: Highly effective and hormone‑free, suitable for many people with chronic conditions where hormones are risky.
• Barrier methods: Condoms, diaphragms, and cervical caps physically block sperm from entering the uterus, with varying degrees of effectiveness.
• Fertility awareness methods: This involves consistently tracking your natural cycles of fertility and ovulation. Its effectiveness depends on many factors, including the regularity of your menstrual cycle.

Be aware that, of all contraception types, only condoms can effectively protect against sexually transmitted infections.

Summary

Birth control and chronic conditions intersect in many nuanced ways. Hormonal contraceptives can both benefit and complicate chronic health issues, depending on the method and condition.

Understanding how different types interact with specific conditions can help you make informed choices in collaboration with your clinician. If hormonal contraception isn’t ideal for you, there are a few nonhormonal alternatives to consider.

Ultimately, personalized care and open discussion with your healthcare professional help ensure you choose a contraceptive that fits your health needs and lifestyle.