Understanding birth control symptoms: What's “normal” and what's not

An estimated 65% of people with the capacity to get pregnant and between the ages of 15 and 49 are using birth control—which means that the vast majority of people who can get pregnant will use birth control at some point in their lives, whether that’s to prevent pregnancy, manage their periods, manage other health conditions, or all of the above.

When considering your options for birth control, there’s no such thing as “best.” And when thinking about birth control side effects, what’s “normal” is different for everyone. Just like all bodies are different, everyone’s experiences of and preferences for birth control are unique. None of this is one-size-fits-all.

Still, the primary way health care providers can prepare new birth control users for side effects is by sharing what the research shows is most likely. But if research doesn’t show a certain side effect as common, that doesn’t mean it can’t happen for the individual. This is why communicating what you’re going through to your health care provider is so important.

Hey Jane’s expert clinical care team can help you choose between 100+ options for birth control, including:

• Combination (estrogen and progestin) and progestin-only pills
• The patch (estrogen and progestin)
• The ring (estrogen and progestin)
• The shot (progestin)
• Varying doses and combinations of hormones
• Non-hormonal options

And if you find that one method isn’t working for you, they’ll continue supporting you until you find one that does.

What are the most common birth control side effects?

The following birth control side effects are common and expected for at least the first few months after starting a new method. Most of the time, your body adjusts to the hormones in about 2-3 months.

Birth control and spotting between periods

Breakthrough bleeding is unexpected vaginal bleeding while on hormonal birth control. It’s common, and often caused by lower doses of estrogen in birth control. Without the higher doses of estrogen, progestin triggers the breakdown of the uterine lining between expected bleeding times. Bleeding is expected during withdrawal periods from the hormones in birth control (during pill, patch, or ring “off-weeks”).

When using hormonal birth control, any vaginal bleeding during hormonal off-weeks is withdrawal bleeding rather than a “true” period. That’s because most hormonal birth control works by preventing ovulation (so no egg releases) and keeping the lining of the uterus thin (which means it’s not a great environment for a pregnancy to implant). Because ovulation doesn’t occur and that lining is so thin, it doesn’t build up and need to shed monthly. Having someone take estrogen—in the form of some birth control pills—and then stop during the off week (when you take the placebo pills) causes the uterus to bleed from that withdrawal. This is one of the reasons why it is safe to skip your period while on certain forms of birth control.

Breakthrough bleeding can happen more often in the first few months of using hormonal birth control. It can also be more common for people who don’t use birth control consistently, take pills late,  skip hormonal off-weeks altogether, take emergency contraceptive pills.

Other reasons for irregular bleeding can be smoking cigarettes, certain sexually transmitted infections (STIs), pregnancy or benign growths like uterine fibroids.

So, is spotting on birth control normal? Yes—and it is common. Breakthrough bleeding is expected and not usually a sign of an issue. If breakthrough bleeding bothers you, the following things can help:

• Taking birth control at the same time every day and not missing days
• Scheduling an off-week every few months of continuous combination birth control (e.g., the pill, patch, or ring) use
• Talking to your health care provider

But just because a side effect is common and expected doesn’t mean that you’re okay with it; if you have irregular bleeding on a certain method and don’t want to wait it out a few months, you can always try another method. Let your health care provider know any time you feel like side effects are a problem for you. They can help you figure out whether or not the breakthrough bleeding is caused by birth control—and find an option that’s more doable for you. For example, using birth control with a higher dose of estrogen or adjusting the number of pill-free days may reduce breakthrough bleeding.

Birth control and amenorrhea (absence of menstruation)

There are several types of hormonal birth control that may stop vaginal bleeding entirely. Amenorrhea is defined as no period for three or more months after periods have begun. As a reminder, any vaginal bleeding on hormonal birth control isn’t a true period because it doesn’t happen after ovulation; instead, it’s known as “withdrawal bleeding.”

People who use the following kinds birth control may have little to no bleeding:

• The birth control shot (this is common, often after the third shot)
• Continuous use of combined hormonal birth control (like a pill patch or ring) where off-weeks are skipped.
• Extended use of combination birth control pills (longer periods between off-weeks)
• Hormonal intrauterine devices (IUDs)

Some people, whether they’re using one of the above methods or not, may not have withdrawal bleeding from time to time. That’s normal and usually not indicative of any issues. Hormonal birth control prevents the thickening of the uterine lining, so there isn’t always tissue to pass. In fact, off-weeks and scheduled bleeding only came out of a religion-fueled desire to make birth control seem more “natural.”

If you’re ever nervous about pregnancy because you don’t have withdrawal bleeding, take a pregnancy test just to be safe. And if you don’t like the pattern of bleeding you have on birth control, talk to your health care provider about other options.

Birth control and nausea

Nausea is a common side effect of hormonal birth control. It’s one of several side effects that are primarily caused by higher levels of estrogen, although some people may have nausea while taking progestin-only birth control.

If you start taking hormonal birth control and have severe or disruptive nausea, first take a pregnancy test to confirm you’re not pregnant. Once that’s ruled out, you can try these tips for birth control nausea relief:

• If you’re using birth control pills, take them with food
• If you’re using birth control pills, take them at bedtime
• Take an anti-nausea medication
• Switch to a birth control option with a lower dose of estrogen
• Switch to a birth control option with only progestin
• Switch to a different brand of pill—like all medications, different formulations can have different additives and ingredients, some of which you may be sensitive to

If you’re using birth control pills and vomit within three hours of taking them, you should continue like you missed a pill entirely.

Nausea often levels out after a few months of taking a birth control pill; however, if you are having an unpleasant reaction that might impact how regularly you take your birth control pill, speak with a health care provider who can help you find a more comfortable option for you.

Birth control and headaches or migraines

Headache is a common side effect of hormonal birth control. It’s one of several side effects that are primarily caused by changes in levels of estrogen. (This is why headaches are also a common menstrual symptom.) Some people, however, find that hormonal birth control helps with headaches. Again, everyone’s different.

If you start taking hormonal birth control and have severe or disruptive headaches, you can try:

• Taking an over-the-counter pain medication during off-days
• Switching to a birth control option with fewer off-days
• Switching to a birth control option with a lower dose of estrogen
• Skipping off-weeks entirely
• Using a lower dose of estrogen during off-weeks
• Switching to a birth control option with only progestin

If you start getting headaches with visual changes or migraines with aura reach out to your provider as some methods of birth control are not safe for those conditions. 

Birth control and breast/chest tenderness

Breast/chest tenderness is a common side effect of hormonal birth control. It’s one of several side effects that are caused by hormonal changes. (That’s why it’s also a common premenstrual symptom.) 

If you start taking hormonal birth control and breast/chest tenderness bothers you, you can try:

• Taking over-the-counter pain medication
• Using a warm or cold compress
• Switching to a birth control option with fewer off-days
• Skipping off-weeks entirely
• If you’re using the patch, switching to combination birth control pills

If you continue to have an issue with breast/chest tenderness after a few months of taking your birth control, talk to your health care provider. It’s also important to reach out if you notice any significant changes, like breast/chest lumps, discoloration, itching, swelling, scaling, dimpling, or nipple discharge.

Birth control and acne

Some people on hormonal birth control, especially those taking progestin-only options (such as Opill), may experience acne flare-ups. But many forms of birth control are actually very effective in treating acne. That’s because acne can be triggered by hormonal changes. 

A 2009 Cochrane review evaluated the use of hormonal birth control for acne. The researchers identified 25 relevant clinical trials and found that all combination birth control pills helped treat inflammatory and non-inflammatory acne. 

There are four combination birth control pills the Food and Drug Administration has approved for acne treatment:

• Beyaz (steady stream of drospirenone, ethinyl estradiol, and levomefolate)
• Estrostep FE (steady stream of norethindrone acetate and ethinyl estradiol)
• Yaz (steady stream of drospirenone and ethinyl estradiol)
• Ortho Tri-Cyclen (menstrual cycle-like changes in ethinyl estradiol and norgestimate)

Less common birth control side effects

The following birth control side effects are ones that some people report, but that large bodies of research as of yet don’t demonstrate as commonly experienced.

Birth control and mental health

We know that hormones have an impact on mood and mental health. But do the hormones in hormonal birth control lead to worse mental health outcomes for users? 

Here’s what the research has demonstrated thus far (from most recent to oldest):

• A 2024 cross-sectional study evaluated National Health and Nutrition Examination Survey results from 6,239 women and found no statistically significant difference in clinically relevant depression between people who were current users of birth control pills and those who had never used them. However, the researchers noted that people who had severe mental health symptoms likely would’ve stopped using birth control pills.
• A 2021 systematic review and meta-analysis of randomized clinical trials (the “gold standard” in clinical research) reviewed 26 trials including 5,833 participants. The researchers found that hormonal birth control didn’t cause worse depressive symptoms than placebo.
• A 2021 cohort study of 739,585 women without prior psychiatric diagnoses or antidepressant use found that those who used combination birth control pills or progestin-only pills experienced no changes in risk of depression. Among adolescents, those who used progestin-only pills, the patch, the ring, the implant, and the hormonal IUD had a higher risk of depression. However, because of the study design, the researchers couldn’t prove birth control caused the increased risks.
• A 2019 cohort study looked at 1,010 adolescent users of birth control pills exclusively to identify a possible link with depressive symptoms. 16-year-olds who used birth control pills had more depressive symptoms than their peers who didn’t use birth control pills. However, because of the study design, the researchers couldn’t prove the pills caused higher rates of depression. They also noted that these findings shouldn’t encourage limiting use of birth control pills—they suggested the need to monitor young users.
• A 2018 systematic review of 26 studies including randomized controlled trials, cohort studies, and cross-sectional studies found a minimal link between progestin-only birth control and depression. However, the researchers noted that the best-quality evidence they had didn’t support an association.
• A 2016 prospective cohort study analyzed data from 1,061,997 women without prior diagnosis of depression, redeemed antidepressant prescriptions, or other psychiatric diagnoses. The researchers found that using hormonal birth control was associated with later use of antidepressants and diagnoses of depression. The association was especially strong among adolescents. The researchers acknowledged that adolescents are more sensitive to hormonal changes and more vulnerable to depression. They also acknowledged that not everyone who feels depressive symptoms gets treatment, meaning some participants may have already been at higher risk of depression.

While the literature doesn’t show a clear link or causal relationship between hormonal birth control and mental health, that doesn’t invalidate personal experiences. Your unique reaction to birth control is important. A good health care provider will hear your concerns, share what the research demonstrates, and work with you to find the best option for you. If a provider says what you’re experiencing isn’t real, find someone else. You deserve to feel heard.

Birth control and weight gain

Weight gain is a common part of life. Most people experience changes from year to year. But how much of those changes have to do with hormonal birth control?

A 2014 Cochrane review (one of the best-designed types of studies in clinical research) identified 49 clinical trials related to weight change and combination birth control. While the evidence wasn’t sufficient enough to conclusively evaluate the association between weight changes and combination birth control, the researchers found no significant changes. They recommended additional research that uses placebo or non-hormonal groups as controls.

What about progestin-only (non-combination) birth control? A 2016 Cochrane review of 22 eligible studies found some evidence of weight increase associated with progestin-only birth control. There was the most evidence supporting a link between the birth control shot and weight gain, but the researchers still considered the evidence low.

As it stands, the birth control shot is the only birth control option that has known effects on weight gain.

Birth control and decreased libido

The research on hormonal birth control and libido is mixed. But we do know that some people have reported an impact.

A 2013 systematic review evaluated the role of combination birth control pills in sexual desire. They reviewed 36 relevant studies including a total of 13,673 women. 85% of participants reported a higher sex drive or no change in sex drive after using birth control pills, while the remainder reported a lower sex drive. The only pills associated with decreased sex drive were those with lower doses of estrogen (15 mcg).

One of the ways hormonal birth control could affect sex drive is by decreasing levels of testosterone. In most of the studies included in the 2013 review, the researchers observed lower levels of free testosterone.

Sex is something that can be affected by many different things, including relationship satisfaction, mental health, and past experiences. Hormones and medication aren’t the only factors. That said, if you start hormonal birth control and notice a change in sex drive that you don’t feel comfortable with, talk to your health care provider. You can work together to find a better option.

Understanding and recognizing what’s “normal” and not with hormonal birth control can help you better prepare for the experience. And if it turns out that a non-hormonal method might be better for you, that’s important to know.

No matter how big or small the issue is, if you’re having one with your birth control, talk to your health care provider about it. Many side effects will decrease after a few months of using birth control. But your provider can explain how to manage birth control side effects and help you switch medications if another one might be less bothersome.

You deserve a form of birth control you can rely on—and one that makes you feel good and comfortable in your body. Hey Jane’s expert clinical care team can help you navigate the options and determine what’s best for you.