Which birth control has the most side effects?

October 7, 2025 •

4 min read

A 2022 survey found that almost one-third (31%) of contraceptive users experience side effects from their current method [1.7.1]. While experiences are highly individual, the question of which birth control has the most side effects often points toward specific hormonal methods like the injectable contraceptive, Depo-Provera [1.2.1, 1.2.2].

Quick Summary

Identifying the birth control with the most side effects depends on individual responses, but some methods are linked to more frequent or severe adverse effects. This overview compares hormonal and non-hormonal options.

Key Points

Depo-Provera: The injectable contraceptive is reported by doctors and patients to have the most side effects, including significant weight gain and bone density loss [1.2.1, 1.2.3, 1.6.2].
Hormonal vs. Non-Hormonal: Hormonal methods (shot, pills, patch, ring, implant) have systemic side effects like mood changes and headaches, while the non-hormonal copper IUD's effects are typically localized to the uterus (heavier periods, cramping) [1.2.5, 1.5.4].
Serious Risks: Methods containing estrogen (combination pills, patch, ring) carry a small but serious risk of blood clots, heart attack, and stroke, particularly in users with other risk factors [1.6.2, 1.8.2].
IUDs Generally Well-Tolerated: IUDs are often cited as having the fewest side effects, making them a popular long-acting choice, though they are not without their own potential issues like cramping and bleeding changes [1.2.1, 1.2.2].
Individual Experience Varies: The "worst" birth control for side effects is highly subjective and what works well for one person may not for another, often requiring a trial-and-error period [1.2.1, 1.2.4].
Return to Fertility: Most methods allow for a quick return to fertility after stopping, but the Depo-Provera shot can cause delays averaging 10 months [1.8.3].
Side Effect Duration: Many common side effects of hormonal birth control, like nausea and breakthrough bleeding, are temporary and often resolve within the first few months of use [1.3.2, 1.3.5].

Determining which birth control method has the most side effects is complex, as each person's body responds differently to hormonal and non-hormonal contraception [1.2.2]. However, based on patient reporting and clinical observation, some methods are more frequently associated with a higher incidence and severity of adverse effects [1.2.1].

The Method with the Most Reported Side Effects: Depo-Provera

The birth control shot, Depo-Provera (DMPA), is consistently cited by doctors and patients as the method with the most side effects [1.2.1, 1.2.2]. It is a progestin-only injectable given every three months [1.8.3]. The high dose of progestin can lead to a wide range of issues that cause many users to discontinue it [1.2.1].

Common and Serious Side Effects of Depo-Provera:

Weight Gain: Unlike most other hormonal contraceptives, the Depo-Provera shot is consistently associated with weight gain. One study found users gained an average of 11.2 lbs over 36 months [1.2.3, 1.3.2]. Another source notes an average gain of about 5 pounds in the first year [1.4.4].
Bone Density Loss: The FDA has issued its strongest "black-box" warning for Depo-Provera because it can cause a significant loss of bone mineral density, which may not be completely reversible and increases the risk of osteoporosis and fractures later in life [1.4.3, 1.6.2, 1.8.3].
Menstrual Changes: The most common side effect is a change in the menstrual cycle, including irregular or unpredictable bleeding or spotting. After a year, many users stop having periods altogether [1.4.4, 1.8.3].
Delayed Return to Fertility: It can take an average of 10 months, and sometimes up to a year or more, for fertility to return to normal after stopping the injections [1.4.1, 1.8.3].
Other Reported Effects: Other common side effects include headaches, mood changes, depression, decreased libido, hair loss, acne, and joint pain [1.2.1, 1.2.2].

Comparing Other Contraceptive Methods

While Depo-Provera often tops the list, other methods have distinct side effect profiles. The experience is highly dependent on whether the method is hormonal and the type and dosage of hormones used [1.2.5].

Hormonal Contraceptives (Pills, Patch, Ring)

Combined oral contraceptives (the pill), the patch, and the vaginal ring contain both estrogen and progestin [1.8.2]. They are often cited as having the second-highest number of side effects after Depo-Provera [1.2.2].

Common Side Effects: These are often temporary and may resolve after a few months. They include nausea, headaches, breast tenderness, bloating, and breakthrough bleeding or spotting [1.3.1, 1.3.5, 1.8.2].
Mood Changes: Studies show varied effects on mood. Between 4% and 10% of users report negative mood changes, while a majority report no change or a positive effect [1.3.3]. However, some research has linked hormonal contraceptive use to a higher risk of depression and anxiety [1.7.5].
Serious Risks: Though rare, methods containing estrogen increase the risk of blood clots (venous thromboembolism or VTE), heart attack, and stroke [1.6.2, 1.6.3]. The risk is higher for those over 35 who smoke, are obese, or have a history of migraines with aura [1.6.2, 1.6.5]. Some pills containing the progestin drospirenone may carry a slightly higher risk of blood clots compared to other pills [1.9.5].

Intrauterine Devices (IUDs)

IUDs are often reported to have the fewest side effects, which makes them a popular long-term option [1.2.1]. There are two main types: hormonal and non-hormonal (copper).

Hormonal IUDs (Mirena, Kyleena, etc.): These release a small amount of progestin locally in the uterus. Side effects can include irregular bleeding for the first 3-6 months, which often leads to lighter or absent periods [1.5.1]. Some users may experience acne, headaches, breast tenderness, mood changes, or ovarian cysts [1.3.1, 1.3.3].
Copper IUD (Paragard): This IUD is hormone-free [1.5.4]. Its most common side effects are heavier, longer, and more painful periods, especially in the first few months after insertion [1.5.2, 1.5.3]. It does not carry the hormonal side effects of other methods.

Comparison of Common Side Effects


Method	Common Side Effects	Unique/Serious Risks
Depo-Provera Shot	Weight gain, menstrual irregularity, headaches, mood changes, decreased libido [1.2.1, 1.4.4].	Significant bone density loss, delayed return to fertility [1.6.2, 1.8.3].
Combination Pills, Patch, Ring	Nausea, breast tenderness, headaches, breakthrough bleeding, mood changes [1.3.5, 1.8.2].	Increased risk of blood clots, heart attack, and stroke, especially with risk factors [1.6.2].
Progestin-Only Pills ('Minipill')	Irregular bleeding is the most common side effect; also headaches, breast tenderness, acne [1.3.1, 1.8.3].	Lower risk profile than combination methods; no increased risk of blood clots [1.9.3].
Hormonal IUD	Irregular bleeding/spotting initially, lighter or no periods long-term, cramps, ovarian cysts [1.3.1, 1.5.1].	Rare risk of uterine perforation or expulsion [1.5.1].
Copper IUD	Heavier, longer, and more painful periods, cramping, spotting [1.5.2, 1.5.3].	Does not have hormonal side effects. Rare risk of perforation or expulsion [1.5.1, 1.5.4].
Implant (Nexplanon)	Irregular bleeding patterns, headaches, weight gain, acne, mood swings [1.9.2].	Rare risks include blood clots and complications with insertion/removal [1.9.2].

Conclusion

While the experience of side effects is subjective, the Depo-Provera injection is widely reported to have the most significant and frequent adverse effects, including weight gain and a serious risk of bone density loss [1.2.1, 1.6.2]. Combination hormonal methods like the pill, patch, and ring also have a notable list of potential side effects, with the most serious being a rare but dangerous risk of blood clots [1.6.2]. In contrast, IUDs are generally associated with fewer systemic side effects, though the copper IUD can worsen menstrual bleeding and pain, and hormonal IUDs can cause irregular bleeding initially [1.2.1, 1.5.1, 1.5.3]. Choosing a birth control method involves balancing effectiveness, convenience, and an individual's tolerance for potential side effects in consultation with a healthcare provider.

For more comprehensive information on contraceptive methods, you can visit the FDA's Birth Control Information page [1.9.2].

Frequently Asked Questions

The Depo-Provera (birth control shot) is the only hormonal contraceptive consistently associated with significant weight gain [1.2.3, 1.3.2]. Studies have shown an average gain of 5 to 11 pounds over 1 to 3 years of use [1.2.3, 1.4.4].

The most common side effects include breakthrough bleeding or spotting between periods, nausea, breast tenderness, and headaches [1.3.5, 1.3.6]. These often improve after the first few months of use [1.3.2].

Yes. Hormonal IUDs can cause irregular bleeding, spotting, and eventually lighter or no periods, as well as acne or mood changes [1.3.1]. The non-hormonal copper IUD commonly causes heavier, longer, and more painful periods [1.5.3].

For methods containing estrogen (combination pills, patch, ring), the most serious risks, though rare, are blood clots, heart attack, and stroke [1.6.2]. The Depo-Provera shot carries a serious risk of significant bone density loss [1.6.2, 1.8.3].

Intrauterine devices (IUDs) and the NuvaRing are often reported to have the least number of side effects compared to methods like the shot and oral pills [1.2.1, 1.2.2]. However, experiences are highly individual.

Some studies have found a link between hormonal birth control use and increased rates of depression and anxiety [1.7.5]. However, the majority of users report either no change or a positive effect on their mood. If you have a history of depression, you should discuss this with your doctor [1.3.3, 1.3.6].

The patch has similar side effects to the pill, such as breast tenderness and headaches, but may also cause skin irritation at the application site [1.8.2, 1.9.2]. Some evidence suggests the patch may expose users to higher levels of estrogen than most pills, potentially increasing the risk of blood clots [1.6.1].