While birth control may keep you pregnancy-free, it often causes changes to your body. While some can be positive (Lighter periods and clearer skin? Yes, please.), there are plenty that are more complicated. No method of birth control is perfect, so we asked M.D.’s to break down the most common potential birth control side effects. Evaluate the pros and cons with your doctor—then you can make an educated decision about what’s best for you.
1. Lighter Period
“Taking estrogen in any form will likely make your period lighter and your skin better,” says Nerys Benfield, M.D., M.P.H., an assistant professor in the department of obstetrics and gynecology and women’s health at the Montefiore Medical Center Albert Einstein College of Medicine. So that includes any form of hormonal birth control including the pill, the ring, hormonal IUDs, the patch, and the implant.
2. Breast Tenderness
Breast tenderness is a common symptom for those taking hormonal birth control, especially within the first few weeks of starting it. What’s not normal? Breast lumps or breast pain—if you’re experiencing either, talk to your doctor.
3. Breast Enlargement
When you first start taking estrogen and/or progestin, you’re likely to retain fluids during your first few menstrual cycles, which can cause your breasts to be temporarily larger. The effect will subside in time, or when you stop taking the hormonal birth control.
4. Clearer Skin
“Taking estrogen in any form will likely make your skin better,” says Benfield. Estrogen keeps acne-causing sebum at bay, giving you clearer, healthier skin.
Any fluctuation in hormones can cause headaches. During your period, your hormone levels are in constant flux. For that reason, your period may be causing headaches. When you add hormonal birth control to the mix, this can exacerbate the headaches or actually reduce their frequency and/or pain. It all depends on your individual body. If you’re currently not on birth control and are experiencing headaches during menstruation, talk to your doctor to find out if hormonal birth control could help prevent them. On the flip side, if you’re happily headache-free, know that going on birth control can change that.
6. Weight Gain
Weight gain is most often associated with progestin-only pills or the Depo-Provera shot. The Depo-Provera shot is administered every three months and has the highest dose of all the hormonal birth control options. Therefore, less desirable effects like weight gain are slightly more common. “Most women who use it will not gain weight, but if you are one of the women who does, you can find another method that’s better for you and your body,” says Benfield.
7. Missed Periods
Birth control can stop your period altogether, reduce its frequency, shorten its length, or lessen your flow. So don’t let a missed period freak you out. If your period disappears after getting an IUD for example, it’s likely normal. If you’re worried, talk to your doctor.
8. Less Cramps
Hormonal birth control including combination pills, NuvaRing, progestin implants, and the contraceptive patch can all help reduce painful menstrual cramps, given that they reduce your period’s frequency or halt it altogether.
Taking estrogen pills can lead to nausea (which Benfield says will normally ease up over time). The higher the dose of estrogen in your birth control, the more likely you’ll experience nausea. Nausea is more common when you first start taking the pill and should subside within a few days.
10. Skin Irritation
Skin irritation can be par for the course if you use the patch as your birth control method. The patch is another form of hormonal birth control that is worn on your stomach, butt, back, or upper arm. Since it sticks directly to the skin, it’s possible for the adhesive to irritate your skin. “We do recommend that each week, you put the patch in a different place,” said Benfield. If irritation persists, talk to your doctor about switching to another brand of the patch or switching methods altogether.
11. Blood Clots
The birth control patch also puts you at a higher risk of blood clots than with other forms of birth control, according Alyssa Dweck, M.D., an assistant clinical professor at the Mount Sinai School of Medicine. “It has a black-box warning [an FDA label that calls attention to serious or life-threatening risks], which can scare patients and practitioners alike, but it’s still a great form of birth control,” she says.
Blood clots are also a concern for smokers. Smokers are at a high risk for blood clots, and taking birth control with estrogen can increase that risk. If you smoke, talk to your doctor about other forms of birth control, like the progestin-only pill.
Cramping is the main birth control side effect for IUD users. There is discomfort and cramping upon first insertion by your doctor, but on the plus side, you get protection for three to five years (depending on the type you choose). With the hormonal IUD, you will also likely get a lighter, less crampy period. “Eventually you might not have a period at all,” says Benfield. The hormonal IUD could also cause some of the other hormonal birth control side effects on this list (like breast tenderness and headaches) but there’s a smaller chance you’ll notice them than there is with oral contraceptives.
13. Discomfort During Intercourse
If you’re thinking about getting an IUD, you should also consider what it’s like to have sex once it’s been implanted. There are small strings on the bottom of the device that your partner might feel. “At first the strings are a little stiff, but they soften over time,” says Benfield. And if the strings continue to be disruptive to your sex life, you can always get them trimmed, she says.
14. Heavier Periods
The experience of living with the copper IUD is the same as the hormonal one (insertion cramping, discomfort during intercourse, etc.), but the major difference is your period will get heavier for the first year. “After a year the period should be where it was before,” says Benfield. “But with those first couple of months, I always tell my patients to be prepared and have pads on hand.”
15. Red, Bumpy Rash and Irritation
Even condoms come with a side effect for those with latex allergies. “You’ll know within 20 to 30 minutes of using one if you have a latex allergy,” says Benfield. A red, bumpy rash will appear. And—get this—not only in the area where the condom has touched. “People would expect, ‘Oh, it’s going to be a rash where I put the condom,’ and that’s not necessarily the case. It can be anywhere on the body,” says Benfield. If an allergy presents itself, you can try polyurethane or natural condoms. The bells and whistles of some condoms on the market are also something to consider, says Dweck. She’s talking about vibrations, warming lubricant, spermicides—these things can cause irritations. “A plain condom with a separate water-soluble lubricant is always a safe choice,” she suggests.
16. Urinary Tract Infections
Urinary tract infections are a common side effect of diaphragms, especially for women who are already prone to UTIs. That being said, diaphragms are still a great female-controlled, nonhormonal barrier method when used properly. You’ll need to get fitted for one, and once you do, it’s inserted into the vagina just before intercourse.
17. Less Milk Production During Breastfeeding
If you’re nursing, it’s important to note that estrogen can dry up your milk supply. Dweck recommends considering progestin-only pills.
18. Hair Loss
Hair loss can occur when taking hormonal birth control, especially for people with a family history of baldness. Hair growth occurs in phases: an active phase (anagen), a transitional phase (catagen), and a resting phase (telogen). Hormonal birth control can cause the hair to enter or remain in the resting phase, which can cause hair loss.
19. Increased Vaginal Discharge
One of the side effects associated with the NuvaRing is increased vaginal discharge. The NuvaRing is a small plastic ring that you insert into the vagina each month; it releases the same combination of estrogen and progestin as the combo pill (but does it in a smaller dose and a bit more steadily). Of course, some people aren’t crazy about the idea of inserting something into their bodies. “There’s that group of women who just don’t feel comfortable with anything in the vagina,” says Dweck, “and it can also cause a little bit of vaginal drainage, so some people don’t love it for that reason.”
20. Soreness on Your Arm
The birth control implant is a progestin-only hormonal option comes in the form of a flexible plastic rod (the size of a matchstick) that’s implanted beneath the skin. In addition to the progestin-related birth control side effects, you may also have soreness, swelling, and bruising on your arm at the implantation site for up to two weeks.
This article was originally published on Glamour US.