As misinformation about women's health spreads faster than ever, doctors say new research into the risks of hormonal contraceptives highlights the challenges of communicating with nuance in the age of social media.
The extensive study, conducted in Sweden, followed more than 2 million teenagers and women under 50 years of age over more than a decade. The results show that hormonal contraceptives are generally safe. However, small differences in breast cancer risk were also found depending on the types of hormones used in the formulation. Additionally, a small short-term increase in breast cancer diagnoses was observed among those who were already using or had used birth control for a short time.
These results are consistent with previous studies such as Danish analysis published in 2017 And Meta-analysis 2023 (Meta-analysis in medicine is a statistical method that combines the results of several independent studies to produce more accurate and reliable conclusions about a particular topic.)
The study was published online Oct. 30 at JAMA Oncology.
Doctors say the findings will not change current recommendations and that women should not stop using birth control.
However, actual warnings circulating on TikTok falsely claim that birth control causes cancer and is as dangerous as smoking. Reproductive health advocates warn that such research can easily taken out of context V social media and add up to an alarming figure.
Example: studying reported that women who used hormonal contraceptives had an approximately 24% higher risk of breast cancer than those who never used them. But because breast cancer in young women remains rare, this percentage represents an increase from about 54 to 67 cases per 100,000 women per year: that is, about 13 additional cases per 100,000 women, or one additional case per 7,800 hormonal contraceptive users per year.
Study authors Åsa Johansson and Fatemeh Hadizadeh, epidemiologists Uppsala Universityexplained that the increase is small and temporary, with a higher risk during use that decreases five to ten years after discontinuation.
Rachel Fey, interim co-CEO of Power to Decide, an organization whose mission is to provide accurate information about sexual health and contraception, said such nuances often get lost on social media.
“It makes me really angry because it's designed to scare people like me away from birth control, which has improved my life in so many ways,” she said. “It's very upsetting… especially when it's presented without context. And in the age of social media, this content can go viral without anyone in the know putting it into perspective.”
The study also found that the risk was slightly higher with some progestins, such as desogestrel, which is found in combined oral contraceptives such as Cyred EQ, Reclipsen, Azurette and Pimtrea, but was not increased with others, such as medroxyprogesterone acetate injections sold under the brand name Depo Provera.
How to interpret the results
Some experts caution that the results should be analyzed with caution because the study included both cases of invasive breast cancer and early, noninvasive lesions known as tumors in situ, growths that may not be life-threatening. Including these precancerous cases may make the overall risk of clinically significant disease higher than it actually is.
“A significant proportion of the ‘cases’ would never develop into invasive breast cancer,” explained Lina S. Mørch, principal investigator and team leader at the Danish Cancer Institute, who was not involved in the Swedish study. He added that it would be prudent to wait for more data to distinguish between early and late stages of cancer before making new recommendations on specific hormones.
Conversation between doctor and patient
While scientists debate how to interpret some details of the study, doctors stress that for most patients, the study confirms what they already often discuss in consultations: that hormonal contraceptives are generally safe and that decisions should be based on each woman's needs and values.
Katherine White, chief of obstetrics and gynecology at Boston Medical Center, said the study will not change the way she counsels her patients.
“When I counsel my patients about contraceptive options, I focus on their previous experiences, medical history, and what is important to them regarding the contraceptive method and pregnancy planning (if applicable),” she wrote in an email. “Side effects and risks are already a key part of the information I provide about hormonal and non-hormonal methods.”
Other doctors also noted that hormone-free options exist.
Eleanor Bimla Schwartz, chief of internal medicine at Zuckerberg San Francisco General Hospital, said that “for those who prefer non-hormonal birth control, the copper IUD has been a safe, convenient and highly effective option for more than a decade and can be easily removed if pregnancy is desired,” referring to a type of long-acting intrauterine device.
Mary Rosser, director of comprehensive women's health at Columbia University Irving Medical Center, said this was a large, high-quality study that looked at many types of hormones over several years. But he also said that medical recommendations should not change yet.
Johansson and Hadizadeh stressed that the results should inform shared decision-making rather than cause alarm. “Based on our data, it may be reasonable to consider formulations associated with lower risk,” they noted.
They noted that products containing medroxyprogesterone acetate, drospirenone, or levonorgestrel are associated with less risk, although it may be best to avoid long-term use of contraceptives containing desogestrel only if other suitable options are available.
Put risk into perspective
Hormonal contraceptives provide many health benefits beyond preventing pregnancy. They can reduce heavy menstrual bleeding, relieve pain caused by endometriosis, and reduce the risk of ovarian and uterine cancer, even years after it has stopped. Mørch said even small risks should be discussed, but decisions should be based on each woman's “values and preferences.”
White emphasized the importance of seeing the big picture. “The risk of unplanned pregnancy is 85% for those not using any contraceptive method, so any risk associated with contraception must be weighed against the risk of unexpected pregnancy,” he wrote.
