According to posts on TikTok, hormonal birth control can cause a nearly unlimited list of ailments: Depression, irreversible infertility, acne, destruction of the gut biome, weight gain, balding, and decreased libido to name a few.
At the same time, a growing number of influencers advocate tracking fertility cycles naturally – or with apps – to prevent pregnancy, while avoiding birth control altogether.
How did the pill get such a bad reputation and is there anything to worry about? Is cycle tracking a valid alternative? We asked researchers and doctors.
The claim
Hormonal birth control is dangerous. You can effectively prevent pregnancy with natural methods.
The evidence
Decades of use and research have shown that hormonal birth control, such as oral contraceptives, IUDs, patches, injections and implants, is safe and effective at avoiding pregnancy.
While there are some potential side effects, people on social media exaggerate or misrepresent the risks. A study of TikTok videos about contraception concluded they "showed poor reliability and quality." Only 10% were created by medical professionals.
Some of the more common side effects include headaches, mood changes, and breast tenderness. These can be unpleasant enough to lead some women to quit them, according to research.
More serious – but rare – complications of some types of birth control include blood clots or risk of uterine perforation from an intrauterine device. Evidence suggests oral contraceptives may raise risk of some kinds of cancers slightly, but provide protective benefits against others.
While they are safe for most people, clinicians stress that it is critical to evaluate risk on an individual basis, in conversation with your doctor. People who smoke, for example, can be at higher risks of blood clots if they take oral contraceptives.
" Google or social media will never have the answer because you are your own unique being," says Dr. Jennifer Conti, an obstetrician who works at Stanford University. "Even A.I. that's pooling tons and tons of different people's experiences – it's not your own," she cautions.
Keep in mind, social media can skew accuracy of risk-benefit calculations when it comes to making decisions about birth control, says Emily Pfender, a researcher at University of Pennsylvania who has studied the way contraception is represented on social media.
" This is a case of – the minority screams the loudest," she says. Her research shows testimonials about rarely occurring side effects from birth control and contraception are rewarded on social media.
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The alternatives
Instead of effective hormonal treatments, online influencers push "natural" methods to prevent pregnancy including cycle tracking apps or fertility awareness, which involves taking your temperature daily. Some even recommend unproven herbal supplements instead.
Experts warn cycle tracking can lead to a false sense of security when it comes to preventing pregnancy, as it's difficult to predict fertility accurately. One study showed an 8% to 9% failure rate among users of one app to avoid pregnancy. (Hormonal birth control methods have a failure rate of less than 1%, when used correctly.)
" The old joke we used to say is that those that use natural family planning have naturally large families," says Dr. Jeffrey Jensen, vice chair for research in obstetrics and gynecology at Oregon Health and Science University.
"For individuals that have highly regular cycles and are willing to have periods of voluntary abstinence, that will work," he says. "But many of my patients have busy lives and this may not be the thing they want to focus on."
Conti says one person's experience with these apps should not be predictive for others. " [Cycle tracking] does work for some people," says Conti. "But telling you that this is the only way to do it is a very privileged approach because you're only considering your exact situation and scenario."
The nuance
Complaints about birth control get conflated with another, real issue – that women often feel overlooked in medical settings, says Pfender. Posts that underscore "disenfranchised medical experiences that involve being silenced or ignored as a woman," get a lot of attention, she says.
For instance, a woman named Lizzy Morris recently talked about her experience with a hormonal IUD on TikTok. "I did not know the risks," says Morris in the video, as she points to a picture of an X-ray where, she says, her IUD became embedded in her uterus. She had to have it surgically removed.
Morris, a mom of three young children who lives in Georgia, said in an interview that her intention was not to scare people off birth control, but to bring awareness to the risks that she believes doctors don't often make clear enough to patients.
One survey showed that 29% of women felt their doctor had dismissed their health concerns in the previous two years.
Morris says she has often felt rushed or overlooked by doctors. Even when the risks of a type of birth control are low, she says, she would rather know about them – and she thinks doctors should discuss them. " People deserve that informed choice," she says.
Many in the medical community agree that lack of conversation about side effects is a problem.
But Jensen says that in the short time clinicians often have with their patients, focusing on uncommon side effects may mean less time to focus on those that are more likely.
With an IUD, for example, Jensen says, complications that require surgery are rare – one study suggested that for every 1,000 IUDs, between one and two result in "intrauterine migration," which can require surgery to remove, and this is often a minimally invasive procedure.
Common side effects like irregular bleeding are more worthy of discussion, he says: "That's something that actually clinicians should do a much better job at focusing on."
The bigger picture
Clinicians stress the importance of weighing potential side effects of hormonal birth control against the risks of unplanned pregnancy.
Aside from the choice to have a child or not, pregnancy itself can be dangerous, points out Jensen. Abortion restrictions compound that risk.
"It's not that long ago that the most likely way you would die as a woman would be in an obstetrically related event during labor," says Jensen. "Social media often gives no context around what exposure to pregnancy means to women."
Maternal mortality rates have improved in the last century, but there are still significant health risks, says Jensen, as well as considerations of equality. "The ability to avoid pregnancy means women's ability to be equal players in all aspects of modern life," he says.
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