It can’t be overstated that reproductive control is essential to reproductive freedom for women. But decades of such freedom have also given us the luxury of a next-level set of worries: What is birth control really doing to my body, and what will happen if I stop taking it? The answer is: mostly good things; maybe bad things. And it depends.

What also can’t be overstated: For every fix we have in place for our health and autonomy, there is an anecdote supporting that it is great for you but will also surely be the cause of your death. The pill is no different. Over at Health.com, we learn that not only is the pill a widely studied contraceptive—”more studied than aspirin,” says Anne Foster-Rosales, MD, chief medical officer for Planned Parenthood Golden Gate—but that it is both wonderful and terrible for you.

The good stuff, Dr. Lee Shulman tells Health.com:

  • Help reduce menstrual bleeding for women at risk of anemia
  • Reduce painful periods
  • Cut back on the risk of uterine infection and ovarian cancer
  • Treat PMS mood swings
  • Help clear up mild to moderate acne

The bad stuff? Anything from sore boobs…

Most side effects of the Pill are minor, such as breast tenderness, headaches, or nausea, and they often subside after a few months. But rare, serious side effects include blood clots, heart attack, and stroke. Women who smoke or have any sort of heart problems should not use hormonal methods of birth control. (Its a good idea to ask to be screened for heart problems before starting one.) “Its critical that women realize that whether its a birth control pill or baby aspirin, when they put a pill in their mouth there’s a risk,” says Dr. Schulman.

There is also the rare but possible side effect of death.*

Point being: There’s a risk. There’s a risk. There’s a risk. There’s a risk. Everything is a risk: antibiotics, alcohol, smog. The pill is no different. You know this; you already intuitively knew this.

  • Red meat is a risk.
  • Water is a risk.
  • The sun is a risk.
  • Sunscreen is a risk.
  • Life is a risk.

Everything is a trade-off, and this is your life. There is no perfect birth control, and for some women, there is not even a good one. But let’s say you’ve been on hormonal birth control already for a good amount of time and are just not happy with it. Either you’ve had some side effects you’re not super jazzed about, like feeling bloated and/or batshit crazy, or perhaps you’ve just decided that you don’t want a bunch of artificial hormones juking your system. (Pretty sure it says that on the Yasmin warning label: May juke your system.)

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What happens now? Another set of maybe-somethings vs. maybe-nothings. According to the literature, any number of things are to be expected that amount to nothing worse than whatever you were experiencing before you started birth control in the first place—i.e., the return of all your oldest, coolest, awesomest period symptoms. More cramping, more bleeding, more acne.

Women’s Health rounds it up thusly:

  • Heavier periods/worsening cramps
  • Weight loss
  • Breasts may deflate
  • Body will produce more discharge
  • Sex drive may improve
  • PMS might get hella worse
  • You may feel or see yourself ovulating (discharge)

Most women put up with this stuff because it’s not so bad, and they are going off birth control to try to become pregnant. But over at Self, Annie Daly talks with three women who’ve opted to go off birth control after being on it for a decade or more for a variety of reasons not related to procreation: Women who just didn’t want all the hormones in their bodies, who braced themselves for the terrible side effects only to find nothing but blue skies.

Daly writes:

“The hormones in birth control pills can cause physical and mental fluctuations in your body over time, which is something not many people think about. The hormonal blend affects different people differently, so the symptoms can be different for everyone,” explains women’s health specialist Jennifer Wider, M.D.

One of the biggest long-term side effects is blood clotting, which can reveal itself in your body in the form of swollen legs or a pain in the calf. Research suggests the pill may also up your risk of cervical cancer, says Wider. Another side effect is that the pill can impact your libido over time—either increase it or decrease it—as well as your moods. “Basically, any change involving your hormones, like acne, sleep, body temperature, mood swings, can possibly be linked back to being on birth control for too long, no matter which pill you are on. So it’s really important to stay on top of any symptoms that seem out of the ordinary,” Wider continues.

Though admittedly not common, Daly found a couple women who opted out of birth control only because they were tired of weird side effects, or sick of no longer really being in tune with their bodies after eight or more years on hormones. They braced themselves for negative transition side effects that never came.

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Nadia, 29, took Ortho Cyclin, then Yaz, from age 16 to 28 for pregnancy prevention and irregular periods. No weight gain, no crazy feels. At 28, her gyno assured her that a decade of time on the pill was not harmful. But at 29, she began to experience thinning hair, hot flashes, extreme emotions. After reporting those effects, her doctor suggested she stopped taking it because of the risk of stroke. Though Nadia knew there were potential side effects, she felt like her doctor never framed it as that sort of risk until she was actually having them. She reports:

The difference has been so noticeable. My hot flashes stopped. My hair is getting thicker. And most importantly, I feel so much more even. As I said, I had been feeling emotionally out of control on a fairly regular basis. Now, I only feel that way when I am blatantly PMS-ing on the days before my period, and also when I am extremely stressed. My reactions are in line with what’s happening, instead of being really exaggerated. And it feels great to not have this weird thing in my body. I know that my emotions aren’t chemically induced: Every reaction I have, every feeling I have, is mine. And mine alone.

After 15 years of hormonal birth control (Yasmin, Yaz, Loestrin 24, and the NuvaRing), Bonnie, 34, was “ready to know [her] body without hormones.” The internet warned her she’d have terrible cramping, acne, mood swings, the works. She went cold turkey in December of 2014, and claims to feel amazing. “No weight gain, no skin issues, no mood swings. I did pass this weird, muscus-y bloody sack, but I consulted with a friend, who said that’s normal.” Bonus: She feels “happier and more balanced and more free.”

Lucia, 33, says that after nearly eight years on Ortho Lo, she started to tire of the drastic mood swings, hysterical sobbing at Law and Order, and general short-temperedness. She stopped taking it at 28 and has regained a sense of “awareness” and “control,” and just feels more “natural.”

Obviously, this is a highly individual thing and a highly personal choice. As someone who both prefers to not be pregnant in general but also feels crazy on the pill, I am a friend and ally to both sides here. I’ve written about my experience trying to find the right contraceptive for me before, and I will restate what I quoted then from a HuffPo piece:

All brands of the pill are equally effective at preventing pregnancy, but that doesn’t mean they’re all equally well-suited to you and your body. And for a lot of women, the onus is on them to figure out what is best.

There is a great website to help you weigh and compare these risks. Yes, ditching birth control can be great and all, but all these women are now back on condoms as their only method of prevention, which is neither infallible (nor fun). Trade-offs! Life! Your choice! Still, the point of Daly’s piece can’t be overstated enough: You’re in charge of your health. It’s totally on you to be attuned to your body, symptoms, needs, and advocate for those needs. Who else is going to do this work, if not you? Certainly not your hormones.

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*An earlier version of this piece mentioned inaccurate information that IUDs can spread infections from the vagina to the uterus. There is a small risk of spreading infection at the time of insertion only, which is eliminated with STI testing prior to insertion.

Image by Sam Woolley.


Contact the author at tracy.moore@jezebel.com.