Hormonal contraceptives are a mainstay for many women, but their side effects have been well-documented. These range from a potential increase in blood pressure to the development of migraines, nausea, and even cardiovascular disease. The medical consensus on contraceptives is that there’s a need to balance the risks with the benefits. While some research suggests that they come with a lowered risk of uterine cancer, the latest study on hormonal contraceptives found that they are associated with an increased risk of breast cancer.

The latest study on hormonal contraceptives found that they are associated with a slightly increased risk of breast cancer. A team of researchers at Oxford Population Health’s Cancer Epidemiology Unit analyzed data from 9,498 women who developed invasive breast cancer between the ages of 20 and 49, against 18,171 women without breast cancer. Published in the journal PLOS One, the study suggested an increase in the risk of breast cancer associated with hormonal contraceptive use — irrespective of whether the contraceptive was a progestogen-only oral preparation, injected progestogen, or a progestogen-releasing intrauterine device. A combined estrogen and progestogen oral preparation was associated with a 23% increased risk of breast cancer.

The researchers further estimated the “absolute excess risk” of women developing breast cancer due to the use of hormonal contraceptives over a period of 15 years. For women between the ages of 16 and 20, the likelihood ranged from eight in 100,000 women; for those between the ages of 35 and 39, it went up to 265 in 100,000.

“Given that a person’s underlying risk of developing breast cancer increases with advancing age, the absolute excess risk of breast cancer associated with either type of oral contraceptive will be smaller in women who use it at younger ages,” said Kirstin Pirie, one of the lead authors who is a statistical programmer at Oxford Population Health. Since most women who are prescribed hormonal contraceptives are below the age of 50, experts believe the risk shouldn’t be an absolute deterrent against taking them. “These excess risks must, however, be viewed in the context of the well-established benefits of contraceptive use in women’s reproductive years,” Pirie added.

Related on The Swaddle:

How the Morning‑After Pill Became the Most‑Used Birth Control for Young Indian Women

“For anyone looking to lower their cancer risk, not smoking, eating a healthy balanced diet, drinking less alcohol, and keeping a healthy weight will have the most impact,” Claire Knight of Cancer Research UK, told The Guardian.

The risk did appear to decline steadily after the women stopped the use of the contraceptives. It didn’t go away completely, though. Women who were last prescribed contraceptives more than five years ago still lived with a 15% risk of developing breast cancer; for those whose last prescription was between one and four years ago, the average risk was 17%. Women who had contraceptives prescribed to them within the last year still had a 33% risk.

On the flipside, however, previous research found that hormonal contraceptives are associated with a lower risk of ovarian and endometrial cancer, too. Specifically, there is a 30% decreased risk of endometrial cancer among women; with longer usage associated with an even lower risk, a study in JAMA Oncology found. Moreover, this protective effect stops when women stop using the pills. There’s a 30% to 50% lower risk of developing ovarian cancer among people who take oral contraceptives, too, according to a study in the Journal of Clinical Oncology.

The conversation around contraceptives is complicated culturally too. What is frequently overlooked in debates surrounding their side effects is their impact on women’s mental health. In 2021, a 28-year-old woman told The Swaddle, “I expected birth control only. But I got depression because of it. I cried every day, and everything made me feel sad.” She had started taking birth control pills upon her gynecologist’s recommendation; it seemed like a convenient and cost-effective option to her, at the time. But the mood swings made her feel awful the whole time she was on the pill. “It made me feel moody, and I really didn’t enjoy sex,” she recalls. Like many other women, it made her gain weight too. In fact, the experience left such a bitter taste in her mouth that she “wouldn’t recommend it to anyone.”

Related on The Swaddle:

All You Need To Know About Birth Control Pills

But contraceptives can also be empowering. They bestow women with choice, often acting as a powerful tool preventing them from being doomed to roles they may not want. A 27-year-old woman had told The Swaddle that while her birth control pills did bring her irregular periods, spotty skin, breast tenderness, and mood swings, they also allowed her to have “lots of anxiety-free sex.”

One solution that would allow cis women in heterosexual relationships to continue having “anxiety-free sex,” without having to weigh the risks against the pros of contraceptives is a male contraceptive. In recent times, there have been promising developments: in 2018, a clinical trial of a male contraceptive gel kicked off in the US; in 2019, researchers at the Indian Medical Research Council completed clinical trials for the world’s first injectable male contraceptive, claiming it is 97.3% effective and has zero long-term side effects.

The concern, so far, has also been this: are men willing to bear the responsibility of birth control? Turns out, many of them are. A recent survey of 19,000 men from eight different countries, including India, found that more than 78% of men are indeed willing to take male contraceptives. An earlier survey by The Swaddle, too, had presented similar results: 46.6% of men surveyed by the team were open to the idea of the injectable male contraceptive.

And, as one of the respondents had said, “Women are going through more than enough shit as it is. So, [with] a combination of the [male] condom and this injection, women can stop worrying too much. It will be really nice to see them not worry so much. It’s high time we, as the laziest gender, take a more active role in preventing unwanted pregnancies.”