Many women have been mistakenly told—or have come to believe—that they cannot take birth control pills due to certain medical conditions. However, for most women, oral contraceptives are safe and effective, even when managing chronic health issues. This article explores some of the common myths about birth control, the conditions that may contraindicate its use, and guidance from key research and medical organizations.
Can Women with Medical Conditions Safely Use Birth Control Pills?
The answer is often yes. For most women, the risks associated with oral contraception are low, even if they develop certain medical conditions while using the pill. According to guidelines from the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG), many women can safely continue using oral contraceptives as they age or manage chronic conditions, provided those conditions are well-controlled.
Key considerations include:
- Hypertension: Women with controlled high blood pressure can generally continue oral contraceptives with monitoring.
- Diabetes: Women with diabetes—without complications such as kidney or vascular disease—can also safely use hormonal contraception.
- Perimenopause and Early Menopause: Many women can use oral contraceptives until menopause or into their early 50s, depending on individual health status. The North American Menopause Society (NAMS) recommends contraception until menopause because fertility does not immediately end at a certain age.
Who Should Avoid Combination Oral Contraceptives?
Combination oral contraceptives (which contain both estrogen and progestin) are contraindicated in certain situations due to increased risks. These include:
- Active Cancer: Women with uterine or breast cancer should not use hormonal contraceptives, as they may exacerbate hormone-sensitive cancers.
- History of Blood Clots (DVT/PE): Estrogen-containing contraceptives increase the risk of blood clots and should not be used by women with active or past deep vein thrombosis (DVT) or pulmonary embolism (PE).
- Alternative Options: Progesterone-only contraceptives (such as the mini-pill, IUDs, or implants) are safe for women with a history of clots.
- Smoking and Age: Women over the age of 35 who smoke are at a significantly increased risk of cardiovascular events (e.g., heart attack, stroke) when using estrogen-containing contraceptives. Smoking cessation or transitioning to a non-estrogen method is advised.
- Other Contraindications: Severe liver disease and poorly controlled hypertension are also reasons to avoid combination pills.
For detailed guidelines, consult the CDC’s Medical Eligibility Criteria for Contraceptive Use.
Over-the-Counter Birth Control Pills: Is It Safe?
One ongoing debate is whether birth control pills should be available over the counter (OTC). Critics argue that easy access could lead to misuse by women who may not be aware of medical contraindications. However, research such as the CHOICE Project, which studied contraceptive use and accessibility, has shown that simplifying access to birth control increases consistent use without significantly increasing health risks. For most women, regular check-ins with a physician remain the best way to ensure safe and effective use.
Age, Fertility, and Contraceptive Use
Many women wonder when they can safely stop using birth control. While fertility declines with age, the exact timeline varies:
- The average age of menopause is 51, but some women remain fertile until their mid-50s. Both ACOG and NAMS recommend continuing contraception until menopause or until the age of 50–55 if menopause cannot be confirmed.
- Age alone is not a medical reason to stop birth control pills. However, women in their 40s and beyond should reassess their contraceptive method regularly with their gynecologist.
Does Birth Control Increase Breast Cancer Risk?
Studies on breast cancer and oral contraceptives have been mixed. While some research shows a slight increase in breast cancer risk for women over 40–45 who use oral contraceptives, the overall risk is low and declines after discontinuation. For younger women and those without significant risk factors, the benefits of birth control often outweigh potential risks.
Notably, oral contraceptives provide protective benefits against other cancers:
- Ovarian Cancer: Multiple studies have confirmed that oral contraceptives reduce the risk of ovarian cancer.
- Endometrial Cancer: Long-term use of the pill is associated with a lower risk of endometrial cancer.
- Colorectal Cancer: Both men and women benefit from aspirin as a protective agent against colon cancer, and oral contraceptives may further reduce colorectal cancer risk in women.
Choosing the Best Contraceptive for You
The most important factor in choosing a birth control method is finding what works best for your body and lifestyle. Options vary widely, from combination pills to progesterone-only methods, IUDs, and implants. Regular check-ins with your gynecologist are key to ensuring your method continues to meet your needs, especially as your health changes over time.
The Bottom Line
Birth control pills remain a safe and effective option for many women, even as they age or manage chronic conditions. While some medical conditions may contraindicate the use of combination oral contraceptives, alternative methods are available. Research continues to refine our understanding of the risks and benefits, empowering women to make informed decisions.
If you have questions about whether the pill is right for you—or want to explore alternatives—schedule an appointment at Women’s Health Practice. Our team specializes in personalized care for contraception, hormone management, and overall reproductive health.
Key References
- Centers for Disease Control and Prevention (CDC). Medical Eligibility Criteria for Contraceptive Use. Updated 2016. Link to guidelines
- North American Menopause Society (NAMS). Contraception for Women Over 40. 2021.
- American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin: Contraceptive Use. Updated 2020.
- Finer, L.B., & Zolna, M.R. (2016). The CHOICE Project: Increasing Access to Birth Control Improves Adherence. Obstetrics & Gynecology.
This version is concise, evidence-based, and professional, with clear sections for easy reading and links to reputable sources. Let me know if you’d like further adjustments!
