When I first tried Nexplanon, a progestin-only birth control implant, I spot-bled almost every day… for a year straight.

While the break-through bleeding was both inconvenient and expensive (liners aren’t cheap), birth control health effects like this at least prove the progestin was doing its job: thinning my uterine lining to prevent sperm from reaching eggs. 

To address the bleeding, my doctor prescribed me a combination birth control pill to take for 3 months– on top of the Nexplanon still implanted in my arm. According to plan, my cycle normalized. The estrogen in the pill helped re-thicken my uterine lining, and ‘stabilize’ my hormones (The catch: I ate like a bottomless-pit and gained weight faster than I ever had before). 

After learning about the links between sex hormones like estrogen and progesterone to metabolism, mental health, and circulation, I couldn’t help but wonder how altering a carefully regulated feedback system with synthetic hormones could not cause any long term effects. 

Most of all, I wondered how birth control ultimately impacts female longevity. So I started searching all over the web for studies that investigated if, and how long-term birth control health effects may impact how long I live. 

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The science behind birth control health effects

Globally, the intrauterine device, aka the IUD (159 million users, 17%), and female sterilization (219 million users, 24%) are the most common forms of contraception used. 

And while the birth control pill is the third-most commonly used contraceptive method (151 million users, 16%), I will be focusing on the pill because it utilizes the highest dosages of the sex hormones, estrogen and progesterone. 

Previous studies have linked both hormones to physiological changes that may impact human lifespan. Some IUDs contain the hormone progestin (synthetic progesterone), but there are no IUDs made with both estrogen and progestin.

Combined oral contraceptive (COC) pills work by combining the synthetic versions of estrogen and progesterone to trick the body into believing ovulation is constantly occurring, and/or to physically prevent sperm from reaching eggs.

Estrogen and progesterone are crucial hormones that regulate the menstrual cycle. 

During each phase of the cycle, estrogen and progesterone levels fluctuate to prepare the uterine environment for implantation and pregnancy. If pregnancy doesn’t occur, hormonal signals cause your uterus to contract and shed its lining (your period). 

So how do birth control pills use the two hormones most important for creating the perfect pregnancy environment … to prevent pregnancy? 

There are two main kinds of birth control pills: combination and progestin-only. Combination pills contain estrogen and progestin in varying proportions, depending on the hormone dosage you feel comfortable taking, and how often you want a period. 

Combination birth control pills start working immediately if you start them within 5 days of your period start date. At any other time, they take about a week to be effective at preventing pregnancy. 

The combination of estrogen and progestin in oral contraceptive pills works to prevent pregnancy by stopping the ovaries from releasing eggs (ovulation), thickening the cervical mucus to block sperm from reaching eggs, and thinning the uterine lining to make it less likely for a fertilized egg to implant. 

Progestin-only pills, called “minipills,” contain a lower hormone dose than combination pills, and may be a better option if you are breastfeeding, shouldn’t take estrogen, or have a history of blood clot or stroke. 

Progestin-only pills are slightly less effective at preventing ovulation, making them slightly less effective at preventing pregnancy than combination pills. However, if used correctly, progestin pills are still ~99% effective! They prevent pregnancy by thickening cervical mucus and thinning the uterine lining. 

While pills with estrogen are more likely to cause breast tenderness, nausea, dizziness, and headaches, progestin-only methods (like the minipill or implant) increase your chances of prolonged spotting and breakthrough bleeding as a result of a thin uterine lining. 

All of these annoying, uncomfortable birth control health effects occur because the medication introduces your body to higher levels of hormones than it is used to. 

However, the side effects are not always negative, or long lasting. Studies have also shown birth control can help acne, menstrual cramping, and premenstrual symptoms!

The list of noticeable side effects—especially in the early days of taking the pill—goes on and on. 

But what about long-term birth control health effects? 

Can prolonged hormonal alterations ultimately impact how long you live?

The short answer: No study has yet shown a significant difference in lifespan between birth control users and non-users. But, many of those studies have been observational population studies (which, due to the many potential confounding variables, can show correlation but not causation). Overall, this research has demonstrated both potential health risks and birth control pill benefits when it comes to longevity.

Birth control longevity risks

Most studies on the relationship between combined oral contraception (COC) pill use and lifespan are long-term observational studies. 

This makes sense— the best way to evaluate how birth control impacts women is to study the experiences of real people on the pill, both during and after use. 

However, observational studies are inherently limited for many reasons, including a higher likelihood of researcher bias, the difficulty of accounting for every possible confounding variable, and the fact that many rely on possibly inaccurate methods of data collection like self-reporting and surveys. This is why we always tell readers to take their results with a grain of salt, and to seek out randomized controlled trials (RCTs) wherever possible.

But where RCTs are not possible (i.e. a true human longevity RCT would likely require locking up people in a research environment for their entire lives in order to control every possible variable; an ethical minefield, to say the least) observational and population studies are the next best thing and may, at least, point us in the right direction.

Does birth control cause cancer?

Since many women take the pill for years, and certain cancers are influenced by hormones, I came across lots of research on the link between contraception and cancer risks. 

From 1976 to 2012, the Nurses’ Health Study evaluated the association between oral contraceptives and all-cause and cause-specific mortality in 121,577 female nurses. Longer duration of birth control use was associated with higher rates of death from violent or accidental causes, and with breast cancer. Although note that the hormonal dosage of the OC pills taken in this study were much higher than those typically prescribed today.

While the study observed a slight increase in breast cancer risk during use, and reduced risk of ovarian and endometrial cancer, the researchers reported:

“There was no overall trend in risk with increasing duration of past use of oral contraceptives for total mortality or mortality related to cardiovascular disease or cancer.”

Another cohort study by the Royal College of General Practitioners (RCGP) reported an increased risk of breast (~1.48 times more likely) and cervical cancer (~2.32 times more likely) in current oral contraceptive users and those who had taken the medication within the past 5 years. 

The elevated risk seemed to disappear within five years after use ended. They did not observe an increase in mortality from cervical cancer, nor an increased risk of new malignancies later in life. 

A more recent 2022 review of the literature on COCs and cancer suggested that while COC users may have an elevated risk of “malignancy of the liver, cervix, and breast in comparison with non-users,” these elevated risks “deteriorate subsequently after cessation of COCs, restoring within about 10 years to that of non-users.”

In addition, the meta-analysis emphasized that despite an increase in risk of certain malignancies during COC use,

“To this day, in no study has cancer been shown as an enhanced mortality factor among [combined oral contraceptive] users.”

Overall, these analyses suggest that risk of cervical, breast, and/or liver cancer may be elevated during combination pill use, but this risk diminishes overtime after stoppage. Past usage is unlikely to increase chances of cancer late in life. 

Since potential elevated risks tend to go away after usage stops, I personally won’t be basing any future decisions on whether or not to use birth control again on concerns regarding cancer. 

But if I had a personal history of breast cancer, I wouldn’t use hormonal contraception to avoid pregnancy. Instead, I may opt for a non-hormonal method, like a non-hormonal IUD, or condoms and cycle tracking. 

In terms of breast cancer specifically, the 2024 U.S. Medical Eligibility Criteria (MECThe CDC wrote these criteria to provide “evidence-based clinical practice guidance for health care providers.”) does not recommend COC use for women with personal history of breast cancer. The criteria note that since “breast cancer is a hormonally sensitive tumor,” the prognosis for recent or current breast cancer “might worsen with [combined hormonal contraceptive] use.”

However, based on the evidence to date, both the MEC guidelines and the 2022 review I mentioned above state that COC use does not further raise the risk of breast cancer for women with family history of breast cancer, or susceptibility genes for it.

Oral contraceptives and cardiovascular disease

Apart from cancer studies, I also compiled some research on long-term birth control health effects related to cardiovascular disease (CVD) and events. 

According to the MEC, limited evidence suggests that women with hypertension may have a small increased risk for cardiovascular events when using progestin-only pills or injectables. 

I found the observational evidence on combination pill use and cardiovascular (CV) risk to be a bit conflicting.

A 2023 meta-analysis of 3,245 participants, conducted by Frontiers in Cardiovascular Medicine, observed that “the use of [second and third generation] OCs suggests a significant increase in the prevalence of traditional cardiovascular risk variables” such as increased systolic and diastolic blood pressure, total cholesterol, and high-density lipoproteins. However, in contrast to this relatively small analysis, other previous studies have reported no significant impact of birth control on these same CV risk variables. 

CV disease risk already rises with age, but it “may [further] increase with combined hormonal contraceptive use,” according to the MEC. In general, providers recommend women over 35 exercising caution with combination pill use, as risk of venous thromboembolism (blood clots) at this age may increase by 2.5- to 10- fold, compared to users under 35. 

The criteria also reported an elevated risk of cardiovascular diseases when taking birth control for smokers, or individuals with CVD risk factors like obesity, hypertension, history of high blood pressure during pregnancy, family history of thrombosis, and/or dyslipidemia. 

The MEC strongly advised individuals with multiple risk factors to exercise caution before using birth control, as it may “substantially” raise risk of cardiovascular disease or other CV conditions. 

ESC Heart Failure’s 2022 study similarly reported that women who are obese and use COCs have a “greater risk (between 12 and 24 times) to develop venous thromboembolism than non-obese non-COC users.” For individuals who are overweight or obese, the study recommended progestin-only contraceptives.

Another meta-analysis I found from 2000 suggested the same association between combined oral contraceptive users with higher BMIs and “risk of venous thrombosis.”

Finally, data from the large-scale (161,017 participants) observational study, the UK Biobank Study, ultimately reported no association between oral contraceptive use and increased CVD events or all-cause mortality. 

Overall, if you smoke, have multiple pre-existing cardiovascular disease risk factors, are over the age of 35, or are obese, your doctor may advise progestin-only birth control. Otherwise, there doesn’t seem to be a ton of evidence that suggests healthy, younger individuals should avoid COCs due to heart health concerns.

Other potential birth control risks I found

I also came across some insightful studies on combined oral contraceptive (COC) use and mental health. 

A 2024 systematic review suggested an increase in depression risk and antidepressant use among certain contraceptive users. However, the study reported this risk for mostly hormonal IUD and patch/ring method users. 

Another 2024 meta-analysis in Frontiers in Endocrinology reported that most studies showed no significant relationship between mental symptoms and oral contraceptive (OC) use. 

Although, for adolescent OC-users, the meta-analysis did suggest a potentially higher risk of “depressive symptoms.”

Besides my brief look into contraceptive use and mental health, I found an interesting tidbit about contraceptives’ effect on telomere length in that UK Biobank Study I previously mentioned. 

Telomeres are DNA structures that rest at the end of chromosomes, and maintain stability and structural integrity (kind of like the caps at the end of shoelaces that keep them from fraying). Telomere length is often considered a marker of cell aging because with each cell division, telomeres shorten. It’s been suggested as a potential measure of our biological age.

The UK Biobank data showed an association between oral contraceptive use and shorter telomeres. While this was the only study I found on this specific relationship (and telomere length may not actually have the best correlation with biological age), I am interested to see what future studies find!

Birth control benefits for longevity 

Despite the doom-and-gloom above, there is hope! Birth control may also offer substantial, long-lasting benefits that I will discuss below.

While the birth control health effects I experienced when I was seventeen weren’t fun, I’ll admit that its protective effects against certain cancers are a key benefit not to be ignored (and backed by lots of observational evidence!).

Contraception and cancer: birth control’s protective effects

One of the most frequently observed longevity benefits of birth control pills is a protective effect against certain cancers.

Published in 2010, the Oxford-Family Planning Association contraceptive study demonstrated a protective effect of combination birth control pill use against mortality from endometrial and ovarian cancer. This protection seemed to remain for 20+ years after last use. 

Similarly, after observing 46,022 women for up to 44 years, the Royal College of General Practitioners study I previously mentioned found that contraceptives use was associated with reduced colorectal, endometrial, ovarian, lymphatic, and hematopoietic cancer. These protective birth control health effects remained for years after use ended. 

More recently, the previously mentioned 2022 meta-analysis on COCs and cancer came to a similar conclusion:

“COCs have a strong and long-lasting suppressive effect on endometrial, ovarian and colorectal cancers.”

These protective effects may persist for up to 30 years after stopping COC use. Due to this potential for long term prevention (especially later in life, when cancer becomes more common), the authors pointed out that this benefit may outweigh any temporary elevated cancer risks during COC use.

Combined oral contraceptives may also protect against ovarian cancer. Interestingly, the meta-analysis reported an up to 50% risk decrease with longer periods of contraceptive use. 

A large pooled analysisA type of meta-analysis that only includes studies with the same design and statistical models, and a homogenous population. by Beral et. al. even predicted that by 2008:

 “Oral hormonal contraceptive pill use already has prevented 200,000 incidents of ovarian malignancy and 100,000 deaths from this cancer worldwide.”

Finally, the CDC’s 2024 U.S. Medical Eligibility Criteria echoed previous meta-analyses’ findings that COC use reduces the risk for both endometrial and ovarian cancer.

As you can see, these protective effects are very promising. Even so, this does not mean each individual will experience the same positive effects for the same duration, as observational studies can only show correlation, not causation. 

A few more positive birth control health effects 

Here’s a list of more longevity benefits that I think are worth mentioning!

• -Birth control was demonstrated to prevent future ovarian cyst formation by reducing overall ovarian activity. (Not recommended as a treatment for existing ovarian cysts) 

• -For women with heavy menstrual bleeding disorders: reducing bleeding and decreasing the risk of iron deficiency anemia. 

• -Potential protective effect against the progression of rheumatoid arthritis. 

• -For women with pre-existing mental disorders, hormonal birth control use seemed to decrease depressive symptoms. 

Limitations of some long-term birth control studies

To fully understand the long-term impacts of birth control pill use on mortality, the 20+ year cohort studies I mentioned are crucial. Long-term studies essential to evaluate the pill’s chronic risks and side effects, both during and after use. 

However, the majority of these long-term studies began over 20 years ago, when oral birth control pills were formulated with much higher hormone doses than today.

Most combination pills today contain between 10 and 30 micrograms of estrogen. The pills available from the 1950s to the 80s contained up to 150 micrograms of estrogen. The type of progestins used in newer and older pills also differs (I explain how in the next section!)

Due to these differences between older and newer generation pills, some results from long-term observational studies I mention in this article cannot be directly extrapolated to apply to today’s contraceptives’ effects. 

While most of the meta-analyses I included in this post were published within the past five years, many of them reference evidence from studies that included women who took first or second-generation pills (contain more estrogen, and older-generation progestins). 

I found it important to mention this limitation because nearly every meta-analysis I read included a similar disclaimer. However, most of these meta-analyses demonstrated comparable results between women who took first and second gen vs third and fourth-generation pills, with some exceptions that I will explain below. 

How best to get the longevity benefits of birth control pills

When I first started my research, I assumed that newer pills (3rd and 4th generation) were generally safer than older (1st and 2nd generation) pills, as they were intended to be. I soon learned that the use of less estrogen and stronger, structurally different progestins reduces some side effects, but may increase risk of others. 

The image below provides a great rundown of the evolution of progestin compounds overtime! 

Each progestin type varies slightly in chemical composition (addition of a methyl group, acetate group, etc), which impacts what receptors it can bind. 

Receptors and the molecules that bind to them work like locks and keys. In this case, the progestins are the keys, and altering their chemical structure reduces the amount of locks (receptors) they fit into. 

(Like when you get a copy of your house key but one groove is slightly off, and now you’re locked out.) 

If the key can’t fit into the lock (i.e. the third generation progestin can no longer fit into an androgen receptor), then that biochemical pathway won’t activate. Hence the reduced amount of androgen-associated side effects from these newer progestins.

In comparison to second generation pills that use levonorgestrel, the lower androgenic activity of third generation progestins has been demonstrated to more effectively reduce potential birth control health effects like acne, weight gain, and hirsutismThe androgen-driven growth of excessive male-pattern hair in women after puberty..

However, I found a 2012 meta-analysis that demonstrated up to twice the risk of blood clots in users of oral contraceptives with desogestrel, gestodene, or drospirenone, compared to levonorgestrel. Compared to nonusers, third generation pills were associated with a 4.8- to 9.4-fold increased risk of this clotting.

In fact, this observation even prompted:

“Some regulatory agencies and professional groups to recommend restricting the prescription of third-generation oral contraceptives, but others contended that the data was not convincing enough to limit their use.”

While slightly concerning, the meta analysis made the important point that higher rate of venous thromboembolism (VT) does not necessarily cause increased mortality (the fatality rate of VT is ~1-2%). 

The study emphasized that the rate of fatality from a heart attack in young women has been estimated to be ~50%, and studies have not indicated a significant difference in heart attack rates between second and third generation pill users. 

The increased VT risk was not seen in newer progestin-only methods or IUDs. The researchers indicated that the elevated risk of thromboembolism was caused by the combination of newer, anti-androgenic progestins with estrogen. 

My general take from this is that if you are already at risk of blood clots, combination pills with levonorgestrel or progestin-only methods may be best.

In terms of cancer risk reduction, it is difficult to decide whether a longer period of use is significantly more or less beneficial in terms of longevity. 

• -Cervical cancer: A 2003 systematic review “found a 10% increased risk for less than 5 years of use, a 60% increased risk with 5–9 years of use, and a doubling of the risk with 10 or more years of use.” However, this risk diminished after being off of birth control for ~8 years. 
• -Breast cancer: A 2017 cohort study of 1.8 million healthy women in Denmark for about 10.9 years suggested that risk mostly increases within the first year of use, and then slightly increases overtime if use continues. 
• -Endometrial cancer: Contraception was shown to reduce risk by ~30%; risk reduction increased with longer durations of use (at least 1 year, but up to 10+ years). The most pronounced risk reductions were seen in users who smoked or were obese.
• -Ovarian cancer: 2013 systematic review and meta-analysis demonstrated a “significant duration-response relationship” between protective effects of contraception and longer duration of use. Use for just a few months is beneficial, but the longer you take BC, the more risk reduction possible!

Most of the large meta-analyses of long-term birth control health effects did not distinguish between the types of pills participants were taking. Due to the observational nature of these studies, researchers seemed to prioritize large sample groups of women who took birth control pills in general. Even when benefits or risks slightly differed between older and newer pill users, research did not indicate exactly what pill contents or specific variables were responsible. 

In addition, the studies I reviewed did not provide enough specifics to suggest exactly what dose of certain pills to take for longevity purposes. However, the evidence I described above does suggest that the magnitude of certain benefits and risks you may experience can be impacted by how long you use the pill. 

Overall, I think the main takeaway from this evidence is the importance of paying attention to the type of progestin in the birth control you choose. 

Personally, I wouldn’t lose sleep over the amount of estrogen in my pill because most birth control pills offered today are considered “low dose” (10-30 micrograms of estrogen), anyway. You can opt for a pill on the lower end of the estrogen scale (or progestin-only) if you want fewer side effects, but the main distinction you’d be making with your doctor is the type of progestin in your pill. 

As a reminder, progestin-only or combination pills with levonorgestrel may be safer if you:

• -Smoke
• -Are obese 
• -Are over 35 years old
• -Have a history of blood clots
• -Have multiple cardiovascular risk factors 

Non-Hormonal Birth Control Alternatives

After freeing my arm of the Nexplanon implant about six months ago, the primary mode of birth control I currently prefer is turning down dates, and instead spending Friday nights researching birth control.

Just kidding… I use cycle tracking + condoms. 

While I was on hormonal birth control, I often felt out of touch with my body. For five years, I experienced numerous physical and mental symptoms that I couldn’t categorize as consequences of unnatural hormone levels, or just a normal part of growing up.

Uncomfortable side effects aside, I felt like I sacrificed a deeper understanding of my own body in exchange for peace of mind about pregnancy.

That said, here are non-hormonal options that I believe are worth mentioning!

Cycle Tracking 

If you, too, feel that avoiding hormones altogether is best for your personal longevity goals, or you have pre-existing conditions that make birth control more risky, cycle tracking may be a great option for you!

So how does it work? (aka the “rhythm method of birth control”)

First it is critical I remind you that the rhythm method alone is not a reliable form of contraception (~75% effective). On more fertile days, make sure to use condoms or spermicide, or abstain from sex altogether. 

Tracking analyzes your past menstrual cycles to gauge when your fertile days (the few days a month that you can get pregnant) will be. You are usually most fertile in the days just before ovulation, on the day of ovulation, and within 24 hours of it. 

I prefer using a period tracker app, which calculates my cycle length and approximately when I’ll be ovulating, based on my period dates. Rachel’s article on the best free period tracker provides a detailed overview of the free apps you can try. 

This method is only efficient if you are basing your decisions about intercourse on the calendar date every time. On most hormonal birth controls, you don’t really have to worry about what day it is when making decisions about sex. If you are using tracking, it is crucial you are checking the calendar and using protection and/or self restraint when it comes to sex on fertile days. 

Moreover, in order to determine your cycle, it is crucial you allow the app a few months to track your period dates before you start relying on it to predict your fertile days. (Your cycle may not be exactly a month long!)

Since my period is very regular, this method has been working for me so far. However, if my period was irregular, or I found myself forgetting to track, I may consider a non-hormonal IUD if I didn’t want to use hormonal birth control.

The non-hormonal IUD may also be a better option for your peace of mind, if you want to avoid pregnancy without worrying about tracking, and hormonal side effects.

Non-hormonal IUD 

Also known as the copper or Paragard intrauterine device (IUD), this contraceptive method is a small piece of flexible plastic with copper wrapped around it. It is shaped like a T, and sits inside your uterus. The IUD’s copper slowly releases into the uterus, creating a toxic environment for sperm that prevents them from reaching eggs for up to 10 years. According to the Cleveland Clinic, this method is more than 99% effective. 

You may also be wondering what the common copper IUD side effects include:

This method may cause heavier or longer periods, more painful periods (cramping), spotting, or irregular periods. In terms of long-term health effects, the IUD is considered safe and copper toxicity is extremely rare. 

My longevity-focused birth control plan

Despite my previous qualms with Nexplanon, my research on birth control and longevity has left me with a surprising sense of relief regarding the medication’s long-term effects. 

While the research suggests you may be at a temporary elevated risk of certain cancers during COC use, these risks seem to disappear after use ends. However, protective birth control health effects against certain cancers appear to last for years after use (as many as 20!). The research on COCs and cardiovascular (CV) risk still varies, but most meta-analyses only warn against COC use if you have pre-existing CV risk factors, are over 35, or have a risk of blood clots. 

Based on this evidence, my overall interpretation (as a 22-year-old female, who is not diagnosed with hypertension, obesity, or other major CV risk factors, and has no personal history of breast cancer or blood clots) is that birth control is unlikely to play a major role in shortening, or extending my life. 

Overall, I would make any future decisions about birth control use based on how its side effects impact the quality of my daily life. 

Personally, I am unlikely to use hormonal birth control again because of the undesirable effects I’ve experienced. However, everyone’s body reacts to the pill differently– hormones could end up actually improving the quality of your life! 

If you feel that birth control is right for you, the current research does not seem to suggest that taking the pill will noticeably alter your lifespan one way or another. 

I hope this article helped you understand that subtle differences in hormonal contents of birth controls may be important to consider. In addition, previously observed long term health risks do not necessarily last forever, or outweigh potential benefits. A certain type of progestin, or estrogen dosage in one type of birth control method may better suit your longevity goals than another! 

Birth control health effects FAQ 

What are the long-term effects of birth control?

Observational studies have associated birth control use with protective effects against ovarian and endometrial cancers that may last for over 20 years after stoppage. During use, risk of breast and cervical cancers has been shown to be elevated in some women, but this higher risk drops off in the years after stopping hormonal contraception. 

Does birth control shorten your life?

No previous research has shown a significant difference in lifespan between birth control users and non-users. While birth control can both increase and decrease risk of certain cancers and cardiovascular events, previous observational studies including tens of thousands of women have failed to show that women who take birth control (even for many years) are on average living shorter lives than never-users.

Does birth control cause breast cancer? 

Birth control may slightly increase your risk of breast cancer during use, but this risk has been shown to diminish overtime after stoppage. The medication has not been shown to cause cancer. If you have a personal history of breast cancer, the CDC advises against hormonal contraception use, since the hormones may advance tumor growth. 

Does birth control cause ovarian cancer?

Birth control has not been shown to cause ovarian cancer. In fact, previous observational studies suggest long-lasting, protective birth control health effects against ovarian cancer!