It’s striking how something that once felt liberating now feels contested. For more than 50 years, hormonal contraception has been quietly woven into the fabric of modern life – prescribed in GP surgeries, slipped into handbags, taken without much ceremony. Now the tide of hormone hesitancy is rising as contraceptive users – citing hormonal side effects such as low mood, skin changes and weight gain – seek alternatives. As a sexual and reproductive health consultant, I’ve observed that patients are increasingly uneasy, often due to something they’ve seen online. Trust, once assumed, perhaps taken for granted, is now beginning to fray.
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To understand the moment, it helps to return to basics. Hormonal contraception works by delivering either a combination of oestrogen and progestogen, or progestogen alone, to prevent pregnancy. Combined hormonal contraceptive (CHC) – most commonly “the pill”, still chosen by about 30 per cent of UK contraceptive users – suppresses ovulation, thins the womb lining and thickens cervical mucus. Variations include the patch and vaginal ring, which deliver hormones through the skin or vaginal wall rather than via the digestive system.
The progestogen-only pill works primarily by thickening cervical mucus, which is why its effectiveness is more time-sensitive. Longer-acting methods, such as the injection (Depo- Provera) and the implant, go further, suppressing ovulation by acting on the pituitary gland, while also thinning the womb lining. The hormonal intrauterine device (IUD) works locally within the uterus; it prevents pregnancy largely through similar mechanisms, though it only stops ovulation in a minority of users.
All of which is to say: these are sophisticated, varied interventions, not a monolith. Yet they are frequently offered as a default solution, not only for preventing pregnancy but for managing a host of concerns, from acne to heavy or painful periods to polyendocrine metabolic ovarian syndrome, PMOS (previously called polycystic ovary syndrome, PCOS). The logic is understandable: these medications can be remarkably effective at controlling symptoms. But their ubiquity can come at a cost. Like any medication, hormonal contraception can bring side effects, which can vary considerably from person to person.
“Contraception can be amazing and empowering and freeing. It can open up one’s life to live it in a way one chooses,” says Dr Neha Pathak, a clinical academic consultant in sexual and reproductive health. “But if you are experiencing lots of side effects, then it can feel like you have to choose the least worst option.”
Common side effects include changes in bleeding pattern, breast tenderness, nausea, water retention, acne, headaches or vaginal dryness. Many experiencing these side effects do not realise that there are many varieties of CHC tablets that deliver different types and levels of oestrogen and progestogen. The combined patch and vaginal ring absorb through different routes and can have a different side-effect profile.
A levonorgestrel-releasing (a type of progestogen) IUD can be an excellent solution for those experiencing symptoms such as heavy or painful periods but there is still a lack of investigation for underlying causes, which might be due to conditions such as fibroids or endometriosis. The latter takes on average eight years to diagnosis and, in Black women, 10 years. “Often women are less likely to keep going back if they don’t feel heard,” says obstetric and gynaecology registrar Dr Remi Mogekwu. “Unfortunately, not all GPs have the same experience with periods and knowing when to prescribe a contraceptive or when to do an ultrasound scan and escalate.”
Dr Rebecca Mawson, a GP and clinical lecturer, says that women using contraception should be offered an annual review because “the current way we provide primary care with 10-minute appointments is not conducive to good care, especially for reproductive health, which needs longer to discuss complex issues”.
Some of these complexities loom large in public consciousness. The link between the combined pill and blood clots, for instance, has been widely reported – most recently following the 2025 death of 19-year-old Áine Rose Hurst, whose fatal brain clot was associated with her contraceptive use. Statistically, the risk of thrombosis is around three times higher in users of the combined pill compared to non-users, though still relatively low overall. For context, pregnancy itself carries a higher risk, increasing the likelihood of blood clots fivefold.
Understanding what “risk” actually means in medical terms – probability, relative versus absolute risk, individual factors and so on – is crucial, yet often poorly communicated. Before prescribing the combined pill, clinicians should assess factors such as weight, blood pressure and personal or family history. But again, time pressures can affect these conversations. “I worry that the short consultations can make people feel pressured into choosing a contraceptive method that might not be right for them,” says Pathak. “It is essential that we use all the tools at our disposal, including digital tools, to prepare people so they have knowledge in advance of their consultation.”
In the case of the contraceptive injection Depo-Provera, the fallout has been huge. Currently the subject of legal action, thousands of users are claiming a link between its use and the development of meningioma, a rare brain tumour. The College of Sexual & Reproductive Health states that “meningioma is an uncommon and predominantly benign tumour… the main risk factors are advanced age and being female”. More commonly, the injection is associated with weight gain and, in some cases, reduced bone mineral density. These effects, while not universal, contribute to the broader sense of unease that has begun to surround hormonal contraception.
Where the conversation becomes even more complex – and more political – is in the question of what is prescribed to whom, and why. Depo-Provera has historically been used disproportionately among Black women and those from lower socioeconomic backgrounds, raising concerns about inequitable exposure to potential side effects. As a longer-acting, provider-controlled method, its ease of administration has also contributed to a troubling history of coercive use, where reproductive autonomy was undermined rather than supported.
Reproductive coercion is not confined to history. It can take many forms, from partners sabotaging contraception to healthcare providers exerting undue influence or making assumptions about patients’ lifestyles. In its most extreme iterations, it includes refusing to remove contraceptive devices or carrying out procedures without informed consent – practices that disproportionately affect those whose pregnancies are deemed “high risk” or socially “undesirable”. This feeds into a broader erosion of trust. When patients feel unheard, uninformed or steered toward particular options, the result is not simply dissatisfaction but disengagement.
Some fears, however, persist without strong evidence. Concerns about long-term fertility, for instance, are widespread – particularly as the average age of first-time motherhood climbs to nearly 31 in the UK. The idea that hormonal contraception “shuts down” fertility – and conversations about it, particularly on social media – can be compelling, but research tells a more reassuring story. Studies have found no significant difference in pregnancy rates as compared with the non-hormonal IUD.
Dr Pathak stresses the steps patients can take to get the most out of their consultation: “Arm yourself with trusted knowledge in advance, go to reliable websites, such as the NHS or ContraceptionChoices.org, which are evidenced based. Everyone has a slightly different need and it’s about finding the right contraception for you. Lots of clinics are happy to have an initial chat: you can leave and think about it, then come back again.”
And while scepticism might have grown, thankfully so has innovation. New forms of contraception are on the horizon, including a male contraceptive gel that suppresses sperm production within 12 weeks and is fully reversible – a development that could redistribute the burden of contraception more equitably within heterosexual relationships. Advances in vaginal rings, such as progestogen- only options, might offer alternatives for those unable to take oestrogen, while early research into biodegradable implants hints at a future without removal procedures.
Still, progress is uneven. According to McKinsey, as of 2021 only about two per cent of global medical research funding (outside of cancer) is allocated to sexual and reproductive health research – a figure that underscores just how much remains unknown. In that context, the current moment of scrutiny feels less like a rejection of hormonal contraception than a demand for something better: more information, more time and more choice, all of which should centre the people who actually use contraception.