Are Hormonal Birth Control Methods Safe? Recent Study Reveals Potential Risks

For most of the past six decades, hormonal birth control has been treated as a largely settled question. The pill transformed reproductive freedom, earned a place on the World Health Organization's list of essential medicines, and became one of the most extensively studied drugs in pharmaceutical history. More than 150 million women worldwide use some form of hormonal contraception. It works. It is, by most clinical standards, safe.

And yet the conversation around hormonal contraception has never been more complicated than it is right now. A growing body of research — some of it quite recent — is raising questions that clinicians are increasingly reluctant to dismiss: about depression and mood changes, about blood clot risk, about a potential link to certain cancers, and about whether the risk-benefit calculus is being communicated honestly to patients. This article examines what the research actually shows, which risks are well-established versus speculative, and what women navigating these choices need to know.

What Hormonal Birth Control Actually Does in the Body

Hormonal contraceptives work by delivering synthetic versions of estrogen, progestin, or both into the body to prevent ovulation, thicken cervical mucus, and thin the uterine lining. They come in multiple forms: combined oral contraceptives (the "pill"), progestin-only pills (the "mini-pill"), contraceptive patches, vaginal rings, hormonal IUDs, the contraceptive implant, and injectable contraceptives like Depo-Provera.

These methods differ significantly in their hormonal composition and delivery mechanism, which matters enormously for their risk profiles. A low-dose combined pill and a high-dose progestin injection do not carry identical risks, and lumping them together as a single category obscures as much as it clarifies. Most of the concerns discussed below apply to some methods more than others — and the details matter for individual decision-making.

Blood Clots: The Clearest Established Risk

The association between combined hormonal contraceptives (those containing both estrogen and progestin) and venous thromboembolism — blood clots in the deep veins or lungs — is the most well-established risk in the literature and has been known for decades. Estrogen increases levels of clotting factors in the blood, which raises the risk of DVT and pulmonary embolism.

The absolute risk, however, remains low. Women not using hormonal contraceptives experience roughly 2 to 4 blood clots per 10,000 women per year. Combined pill users experience approximately 3 to 9 per 10,000, depending on the progestin type and estrogen dose. For context, pregnancy itself raises VTE risk to around 29 per 10,000 — considerably higher than any hormonal contraceptive.

Risk is not uniform across all users. Women with a personal or family history of blood clots, those with inherited thrombophilias (like Factor V Leiden), smokers over 35, women with migraines with aura, and those with certain cardiovascular conditions face substantially elevated risk. For these groups, progestin-only methods — which do not meaningfully raise VTE risk — are typically recommended instead. The key message is that the absolute risk for most healthy young women is low but not zero, and screening for individual risk factors before prescribing combined hormonal methods is clinically essential.

The Mental Health Question: What Recent Research Shows

The potential link between hormonal contraception and depression has been one of the more contentious areas of women's health research. Many women report mood changes, emotional blunting, or depressive symptoms after starting hormonal birth control. For years, these reports were frequently minimized or attributed to other factors. A series of large studies has changed that picture.

A landmark 2016 Danish cohort study — which followed over a million women for more than 13 years — found that women using combined oral contraceptives had a 23% higher rate of first-time antidepressant use than women not using hormonal contraception. The association was stronger for progestin-only pills (34% higher) and highest of all for progestin-only methods like the patch and vaginal ring. Adolescents showed the largest effects.

A 2023 follow-up study from the same research group extended these findings, examining brain imaging data and finding structural differences in regions associated with mood regulation in hormonal contraceptive users. The research does not establish causation with certainty, and important confounders remain difficult to fully control for. But the consistency of the signal across multiple large studies has made dismissal increasingly difficult to defend.

The practical upshot: depression and mood changes are real potential side effects that deserve to be taken seriously in clinical consultations. Women who experience significant mood changes on one formulation often find that switching to a different progestin or a non-hormonal method resolves the issue. The individualized response to synthetic hormones is genuine — some women experience no mood effects at all while others are significantly affected, and predicting who will fall into which category remains difficult with current tools. Paying attention to overall mental and physical wellbeing while using any hormonal method is worthwhile practice.

Cancer Risk: A Nuanced Picture

The relationship between hormonal contraception and cancer risk involves trade-offs that many women are never fully informed about. The associations run in multiple directions.

On the risk side, a large 2023 study published in PLOS Medicine — following 1.8 million Danish women over 11 years — found that all forms of hormonal contraception were associated with a modestly elevated risk of breast cancer compared to never-users. The elevated risk was around 20-30% relative increase for current or recent users, though the absolute increase in numbers is small for younger women (whose baseline breast cancer risk is already low). The risk appeared to persist for some years after stopping hormonal contraception, and higher-dose methods carried larger relative risks.

This finding is consistent with earlier research, including the 1996 Collaborative Group on Hormonal Factors in Breast Cancer analysis and a major 2017 New England Journal of Medicine study. The hormonal link to breast cancer is biologically plausible: both estrogen and progestin can stimulate the proliferation of breast cells, including hormone-receptor-positive cancer cells.

On the protective side, the evidence is equally robust: combined hormonal contraceptive use is associated with a significantly reduced risk of ovarian cancer (up to 50% reduction with long-term use) and endometrial cancer (up to 30% reduction). These protective effects persist for many years after stopping and are clinically meaningful. For women with a strong family history or genetic predisposition to ovarian cancer, the protective effect of oral contraceptives has been a legitimate consideration in clinical discussions for decades.

The net cancer effect depends heavily on individual risk profiles, which formulation is used, and how long it is used — underlining once again why generalized risk statements are limited in value without individual context.

Cardiovascular Effects

Combined hormonal contraceptives modestly raise blood pressure in some users and are associated with a small increase in arterial events (heart attacks and strokes) in women who have additional risk factors. For healthy non-smoking women under 35 with no cardiovascular risk factors, the absolute risk of a serious cardiovascular event is very small. For women who smoke, have hypertension, migraines with aura, or existing cardiovascular disease, the risk is meaningfully elevated and combined methods are generally contraindicated.

Progestin-only methods, including the hormonal IUD and the implant, have a much more favorable cardiovascular profile and are typically safe even in women who cannot use estrogen-containing methods. Understanding which type of contraception is actually being prescribed — and how it differs from others — is one of the most important things a patient can do when discussing options with a healthcare provider.

The Recent Study That Has Attracted Attention

The 2023 PLOS Medicine breast cancer study has received significant media coverage and rekindled public debate about hormonal contraception safety. Its large sample size, long follow-up period, and finding that risk applied to all hormonal methods — not just combined pills — generated concern among both patients and clinicians.

Several things are worth noting about interpreting this research. First, the absolute risk increase for younger women is small even if the relative risk is meaningful — a 20-30% relative increase in a very low absolute risk translates to a small number of additional cases per 100,000 users. Second, the study captures associations, not proven causation, and residual confounding (differences between hormonal contraceptive users and non-users in other health behaviors) cannot be fully eliminated. Third, the alternative — unintended pregnancy — carries its own health risks, and the contraceptive benefit of these methods is substantial and well-established.

None of this means the findings should be minimized. A meaningful association that replicates across multiple large studies over decades is not noise. But it should be contextualized rather than converted into panic.

Methods That Avoid These Risks

For women who are concerned about hormonal contraceptive risks, non-hormonal options exist with high effectiveness. The copper IUD is the most effective non-hormonal method available, with a failure rate under 1% — comparable to or better than most hormonal methods — and no systemic hormonal exposure. Its main downside is that it can cause heavier periods and more cramping, particularly in the first months after insertion.

Barrier methods (condoms, diaphragms, cervical caps) are effective when used consistently and correctly, though typical-use failure rates are higher than hormonal or intrauterine methods. Fertility awareness methods, when properly practiced and consistently applied, can be reasonably effective for women with regular cycles — though the learning curve is significant and typical-use failure rates are higher than method-use rates suggest.

The hormonal IUD — often discussed separately from systemic hormonal methods because it delivers progestin locally rather than systemically — has very low systemic hormone absorption. Its systemic effects are substantially smaller than those of combined oral contraceptives, and for many of the risks discussed above (VTE, cardiovascular effects, systemic mood effects), the hormonal IUD's profile is considerably more favorable. Discussing this distinction with a provider is worthwhile for women who want hormonal contraception with reduced systemic exposure.

The Communication Gap

Perhaps the most consistent finding across surveys of women's experiences with hormonal contraception is that many women feel they were not adequately informed about potential risks before starting. Awareness of the blood clot risk is reasonably common, but the depression association and the breast cancer data are frequently unknown to users. This represents a failure of informed consent that the medical community has begun to acknowledge more openly.

Good reproductive healthcare involves being offered an accurate, individualized picture of the benefits and risks of different methods — including those benefits that are not primarily contraceptive (menstrual regulation, endometriosis management, PCOS treatment, reduced ovarian cancer risk). It means having mood changes taken seriously as a potential medication side effect rather than attributed to unrelated causes. And it means being offered the opportunity to try different formulations if one is not well-tolerated, rather than being told that available methods are all the same.

For women interested in understanding how their overall lifestyle choices interact with hormonal health, blood sugar regulation, gut microbiome health, and dietary patterns all interact in complex ways with hormonal systems. Maintaining general health practices that support hormonal balance does not replace contraceptive decision-making but is a reasonable complement to it.

What to Ask Your Provider

If you are currently using hormonal contraception and want a more complete picture of your individual risk, several questions are worth raising with your healthcare provider: Does your personal and family history include any blood clotting disorders? Do you smoke? Do you have migraines with aura? Are you experiencing mood changes since starting your current method? Are there formulations with a more favorable risk profile for your specific situation?

If you are considering starting hormonal contraception, asking specifically about the VTE risk of the formulation being proposed, whether your risk factors change the calculation, and what non-hormonal options are available with comparable effectiveness will help ensure you receive a thorough consultation rather than a formulaic one.

The answer to "are hormonal birth control methods safe?" is not a simple yes or no. For most healthy women, the absolute risks are small and the contraceptive benefits are substantial. For some women, based on individual risk factors, certain methods carry meaningful concerns that warrant choosing alternatives. The goal should be that every woman making this decision does so with an accurate, individualized understanding of her own situation — not with outdated reassurances that dismiss legitimate questions or with exaggerated fears that ignore the very real risks of unintended pregnancy. What a balanced, evidence-based approach to health information looks like is the same here as everywhere else in medicine: honest, nuanced, and responsive to what the research actually shows.

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