Birth Control Pills (Part 2): Additional Risks

November 9, 2020 | Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

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 Birth Control Pills (Part 2): Additional Risks
Birth control pills are fraught with serious health concerns in addition to numerous drug-nutrient depletions. (Go to: Birth Control Pills: Drug-Nutrient Depletions) Women of all ages take oral contraceptives for years, even decades, often unaware of the risks. Sometimes the first sign of a problem from taking this medication is life altering. It may be a sudden blood clot or may be more insidious, like chronic diarrhea, gallbladder irritation, or thyroid dysfunction. Regardless, you need to be aware of the risks that come with birth control pill use.

Blood Clots, Stroke and Heart Attacks


One of the most disconcerting challenges with oral contraceptive use is the risk for blood clots. Medication type (estrogen or estrogen-progesterone combinations), length of use, and dosage directly impact risk, but blood clots can occur at any age with small prescription doses or higher doses and years of use. These medications affect clotting factors and coagulation processes, making it more likely for blood clots to occur.

There is a 3-8 times higher risk and incidence of venous thrombosis (clot in the leg), or other clot related concerns, like stroke and heart attacks, for oral contraceptive users.

Meta-analysis shows the greatest risk occurred with > 50 mcg estrogen dosage. However, a case report study showed that even one month of very low dose oral contraceptives in a young woman, non-smoker, caused a heart attack.

Obesity with a BMI >25, smoking, diabetes, and high blood pressure further worsen risks. Iron deficiency with estrogen oral contraceptive use is also connected to ischemic strokes regardless of the other factors.

Increased Risk of Blood Clots


This adverse blood clot risk increases if you have an underlying blood coagulation disorder. Hidden risks occur with hereditary thrombophilias, i.e. antithrombin deficiency, protein C deficiency, protein S deficiency, factor V Leiden and prothrombin-G20210A mutation, and other pro-coagulation factors like fibrinogen, factor VII, factor VIII, and factor X.

The only way to truly know if you have blood clotting risks is to measure these coagulation factors. Has your medical provider evaluated your coagulation pathways before writing out the prescription for oral contraceptives that you expect to be on for years? While family history is helpful to know, it does not fully reflect your own personal risks.

Changes in Homocysteine Metabolism


Elevated homocysteine levels and oral contraceptives are a risk factor for cardiovascular disease. Homocysteine build-up irritates the inner lining of blood vessels and is linked with impaired methylation. Consequences of elevated homocysteine has been linked with stroke and ischemic stroke, microbleeds in the brain, heart disease, diabetes, several cancers, kidney dysfunction and vitiligo – changes in skin pigmentation. (See Birth Control Pills: Drug-Nutrient Depletions for nutrients that affect homocysteine and methylation.). Optimal homocysteine level is 7 and lower.

There is also an increased risk of hypertension with long-term use of birth control pills. One meta-analysis study showed a 13 percent increase risk for every 5 years of oral contraception use. The hypertension effects may persist into later life, even after discontinuation.

Inflammatory Bowel



Other disorders like ulcerative colitis, a type of inflammatory bowel disease, may occur with oral contraceptive use. Research shows it does not matter if the oral contraceptive is estrogen or estrogen-progesterone combinations. Greatest risk occurs with long-term birth control use and smoking.

Liver and Gallbladder


Oral contraception use, especially with higher estrogen content, has been linked with a variety of liver concerns. It affects bile acid function within the liver and increases the risk of gallstones. Liver cancer, blood clots in the liver, and various manifestations of liver inflammation has occurred with oral contraceptive use.

Your liver is the largest organ of the body and is constantly working to manage many vital life functions. After food and other compounds have been broken down in the digestive tract, they enter the blood stream and travel to the liver. From there, the liver works on detoxification to remove unwanted and unhealthy compounds. Bile acid production and excretion occur together with cholesterol management, hormone and drug detoxification. The liver breaks down protein, fats, and carbohydrates that are either metabolized for energy or stored for later use. It synthesizes clotting factors and activates thyroid hormone.

Toxins and chemicals overload liver detoxification systems in our modern world. Sedentary lifestyles also stress the liver leading to NAFLD – non-alcoholic fatty liver disease. Add in the use of social drinking or significant alcohol intake, years of oral contraceptive use and other medications like Tylenol. It is a recipe for liver-distress or health disaster.

Copper Excess


Oral contraceptives may even cause copper excess in your body. Too much copper causes oxidative stress on tissues. Copper levels may also build-up in the eye or seriously affect the liver, which may reflect Wilson’s disease. High copper levels from oral contraceptives also contributes to significant cardiovascular disease risk and increased mortality.

Thyroid and Endocrine Disruption


Oral contraceptives affect thyroid metabolism. Human studies show that oral contraceptive use may cause elevated thyroxine binding globulin (TBG) and TSH.

Oral contraceptives have been found in the water supply as the metabolites are excreted in human waste or the medications may be disposed of in the toilet. Aquatic studies show that zebra fish experienced lowered T3 and T4 thyroid hormone levels along with disruption to several genes related to the hypothalamus-pituitary-thyroid (HPT) axis due to the presence of NET in the aquatic supply. NET is synthetic progestin norethindrone that is used in oral contraceptives, hormonal therapy, and livestock farming. While this example focuses on fish in the water supply, all sorts of drug residues are found in the consumer water supply. Check with EWG.org or local municipal for reports on your water supply.

Eye Changes


Oral contraceptives may cause other eye changes in addition to those caused by copper build-up. Increased central corneal thickness was found to be significantly higher in women who used oral contraceptives compared to those who did not. The average age of the women in the study was 32 years old. This can impact how your eye doctor evaluates your eye pressure and glaucoma risk.

Exercise Performance


Some research also suggests that women athletes on oral contraception may experience a slight decline in their exercise performance compared to non-users.

The Next Generation


Limited early studies show oral contraceptive use affects the health of the next generation. A small meta-analysis study identified a higher incidence of asthma and respiratory allergies in children who had exposure from their mother before and during pregnancy.

As with any of these concerns, risks vary from person to person due to type of medication (estrogen and progesterone or estrogen only) and amounts, diet, lifestyle, nutrient status, alcohol use, gut health, blood sugar management, obesity, genetics, presence of coagulation factors, and more. My goal here is to get you to think, ask questions, and take charge of your health. There are ways to approach birth control and natural family planning without the use of chemicals and hormone alterations.

Other concerns that are managed with the hormones in oral contraceptives, like insulin resistance that underlies PCOS, difficult menses, migraines, and acne can often be healthfully managed with diet, lifestyle, and nutrients. Removal of sugar, processed foods, gluten, and caffeine can help turn around the struggle with hormone regulation. Today’s health management is about reducing risk and optimizing for the best. Are you informed of the concerns and making proactive healthy choices?

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