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http://www.womenshealthmag.com/health/how-worried-should-you-be-about-birth-control-risks

If you've ever leafed through the packet of prescribing information that comes with your , you were probably thoroughly terrified. It's about as scary as those television commercials that ask if anyone you know has died while taking a certain form of contraception.

It's true that some health risks have been associated with birth control, but it's also a fact that is a safe and effective way to prevent , as well as help with a host of other health issues—like alleviating PCOS and endometriosis, calming PMS and acne, and even lowering your risk of ovarian cancer.

So to find out how worried you should really be about these scary health risks, we reached out to three experts: Mary Jane Minkin, M.D., clinical professor of obstestrics and gynecology at Yale School of Medicine; practicing ob-gyn Alyssa Dweck, M.D., coauthor of V is for ; and renowned cancer researcher Marisa Weiss, M.D., founder and president of BreastCancer.org. Here's what they had to say. (Note: In some instances, their answers have been edited for length and clarity.)

WH: One of the first health risks most women associate with birth control is a blood clot. Is it true that your risk of these goes way up on birth control?

Dr. Minkin: There's no getting around it. All contraceptives have a slight increased risk of blood clots. However, it's not huge, and it's certainly less than the blood clot risk associated with pregnancy. Pregnancy is far and away the riskiest thing for developing a blood clot. The higher the dose of , the higher the risk of blood clots. For example, with the low dose pills we use today there's a very slight increased risk of blood clots. I'm not a big believer in the slight differential between other forms and pills. It's a very minimal difference in risk between them.

Dr. Dweck: The Pill, particularly the estrogen-containing pills, do afford a higher risk of blood clots, but I think what women need to know most is that your risk of having a blood clot while pregnant is a whole lot more than that. Third generation progestin- containing pills may have a slightly higher risk of blood clot than some of the older ones, but again, it's all about perspective. You may not want to put an obese, over 35-year-old smoker on one of those pills, because their risk of having a blood clot is already higher.

WH: So what should you do to reduce your risk of a blood clot? Dr. Minkin: No one can say 'I'll never get a blood clot,' because anyone can get one. The safest methods of birth control to keep you from getting a blood clot may be or a diaphragm or the copper IUD, which does not come with an increased risk. Then, get lots of , stay as close to your ideal body weight as you can, and of course, don't smoke cigarettes.

WH: What about the increased risk of stroke and heart attack on the Pill? Is this something most women should be worried about? Dr. Minkin: If you're over 40—some say over 35—and a smoker, there is an increased risk of heart attack and stroke. For nonsmokers, there's really no significant increased risk as long as you have normal blood pressure. The other exception is people who get migraines with aura. If you start seeing spots and dots dancing in front of your eyes before you a get a migraine, those are people who are not supposed to take birth control pills because of an increased stroke risk.

WH: We've seen a lot of research on the birth control-breast cancer link. How worried should women be about this? Dr. Dweck: Some of the really high-dose birth control pills that contain 50 micrograms of estrogen—some of the older pills—might have a higher breast cancer risk, especially if you've been on them for a long period of time. But again, you have to keep in mind that another risk factor of breast cancer is never getting pregnant, so there may be confounding variables. The short answer is yes, if you're on a really high-dose birth control pill, which we really don't use anymore, you have an increased risk. But after 10 years of being off the Pill, your risk of breast cancer is basically the same as someone who has not been on the Pill. And this also goes for people who have a family history of breast cancer.

Dr. Weiss: We know that the data on the old birth control pills did show a small increased risk in people taking it over time. In current and recent users who have been taking it for a long stretch of time, we see the risk tends to wear off after you've stopped it. It's also true that taking birth control pills for about five years—either continuously or in combination—lowers the risk of ovarian cancer.

When women are young and their breast cancer risk is low, taking birth control pills, which may increase the risk a little bit, doesn't add up to a lot. But as you extend your use over decades and you're now older and your natural risk of breast cancer is higher, then increasing a moderate risk a little bit can start to add up. Those women should ask their doctor about a non- hormonal method of birth control, like the Paraguard IUD.

WH: What about weight gain on birth control? Should I expect to go up a size? Dr. Dweck: The implant definitely seems to have a higher risk of weight gain, and the shot has a higher risk of weight gain. But the jury is still out. It's always been a controversial thing about weight gain on the birth control pill. I think the general science is that about a third of women gain on the Pill, a third of women lose on the Pill, and a third stay the same.

Dr. Minkin: It's minimal. What I can tell you is basically anything with estrogen in it can increase fluid retention to some degree. However, the drospirenone pills like Yaz actually act like a diuretic.

WH: Some studies have linked and birth control usage. Is this something women should be worried about? Dr. Minkin: There is a fair amount of older data on this. One of the issues is that birth control contains estrogen—which is a mood upper—but they also contain progestins, which can give mood fluctuations. There are certain people who are susceptible to mood issues on certain progestins. The key thing is not to be afraid of taking birth control pills, but have your antennae heightened. If you start noticing your mood going down, let your doctor know, because you may be able to change to a different pill. WH: What about ? Will my libido tank while I'm on the Pill? Dr. Minkin: Most women have a surge of around , so birth control suppressing ovulation will suppress that testosterone boost. So if you like that mid-cycle surge, you're not going to get that. That's primarily the issue.

Dr. Dweck: There are two sides to this coin. From a science standpoint, yes, because it prevents ovulation which can alter libido by lowering it, and some women notice a decline in their potential on the estrogen-containing pill. However, some women find they're so relieved that they have adequate birth control and they're not afraid of getting pregnant that their libido may be enhanced because they're not having that psychological block. It may also decrease your vaginal secretions and lead to vaginal dryness or painful sex for some people.

If someone comes into my office complaining of low libido and vaginal dryness and they're on the Pill, I'll consider taking them off the estrogen-containing pill. -only options, particularly the IUD, may be better. They don't necessarily prevent ovulation and therefore the hormonal fluctuations may not be as bad.