Navigating long-term contraceptive pill use: is there such a thing as too long?

The contraceptive pill, commonly known as 'the pill', has been a trusted choice for decades when it comes to birth control and managing fertility. It’s a simple birth control method and it’s easy to get, but the contradictory information about its long-term use can make it difficult to know whether it’s in your best interest to keep taking it or if it’s a good idea to take a break.
“If you’ve been on the pill for a while, it’s useful to fully understand its benefits and potential health concerns so you can make an informed choice when it comes to family planning and menstrual cycle management,” says nib Medical Advisor, Dr Hamish Black. "The pill is often the first thing that comes to people's minds when they think about contraception, but it's important to understand that it might not always be the right option for you."
How the pill works
Considered to be 99.5% effective if used correctly, the pill has been available in Australia since 1961, giving millions of women and people who menstruate the freedom to manage their reproductive health. Each pack mimics the typical 28-day cycle, so for those who remember to take their pill each day, the chances of falling pregnant are extremely low. There are two main types.
Combination pills include both oestrogen and progestogen, which work together to prevent your ovaries from releasing an egg. These pills also help stop sperm from entering your uterus by making its lining thicker.
Progestogen-only pills, sometimes referred to as the mini pill, are designed for those who cannot or prefer not to take oestrogen. This pill thickens the fluid near the cervix to help stop sperm from entering and fertilising an egg.
Benefits beyond birth control
Aside from preventing pregnancy, the pill can offer other advantages, like helping to regulate menstrual cycles, reduce period pain and improve acne. Doctors can also recommend the pill as a way to manage conditions such as endometriosis and Polycystic Ovary Syndrome (PCOS). PCOS affects about 10% of women, and is a complex condition associated with irregular menstrual cycles, weight gain, fertility problems and elevated diabetes risk. Taking the pill can provide some welcome relief.
Looking into long-term pill use
You may have heard pros and cons about staying on the pill long term, but it can be difficult to know what to believe. ‘Long’term’ generally refers to taking it for five years or more.
While many people think it can be wise to take a break from the pill every couple of years, according to La Trobe University research, whether or not a particular pill is problematic for a woman does not change with the duration of use. If taking the pill is causing unwanted side effects, taking a break won’t help – the same side effects will reappear when you start taking it again, according to the research.
Side effects can include bloating, headaches, mood changes, nausea and changes to your skin, among others.
As with any medication, people have different responses to taking the pill. Talk to your doctor if you’re worried about the way your body is responding to the pill.
When it comes to staying on the pill, it’s all about what works best for you and your health. Everyone’s situation is different, so it’s worth chatting with your doctor to explore what’s right for you. Staying informed on contraception options is great, but having an open conversation with your GP ensures you’re making choices that feel informed and tailored to your needs. Other forms of contraception may be more suitable if you’re experiencing side effects or are getting ready to start trying to conceive.
“What’s important is to weigh up your own health and circumstances and draw on informed sources when deciding what’s right for you,” says Dr Hamish.
Risk management and the pill
A common worry is that long-term use of the pill may harm your chances of falling pregnant in the future. But studies conclusively show that most people’s fertility returns to normal within a few months of stopping the pill.
You may have also heard there’s a connection between the pill and some cancers. While the pill can lower your risk for some cancers, like ovarian cancer, there’s some evidence it might slightly increase the risk for others, such as cervical cancer. But overall, current research suggests the benefits outweigh the risks for most people.
Also, for some people the pill can affect blood pressure and clotting, which is why it's essential to go for regular check-ups to make sure you’re managing this risk if it applies to you.
When to re-evaluate your contraceptive choices
There’s no one-size-fits-all approach to contraception. Life stages, health changes or personal preferences may mean the pill is no longer for you. For instance, it may not be the right choice if you have difficulty remembering to take medication or have medical conditions like migraines, obesity, a family history of deep vein thrombosis, take interfering medications, have had breast cancer or are immobile for extended periods. If you’re thinking about a change from the pill, there are lots of different birth control methods to explore. These include intrauterine devices (IUDs), implants, injections and barrier methods like condoms and dams. Each has its own set of benefits and considerations so talk it through with your GP if you’re unsure which way to go, to find one that’s right for you.
Looking for professional support?
If you’re exploring contraception options or have questions about what’s right for you, booking a telehealth consultation with a GP can provide personalised advice and support. Here are some additional resources that might be helpful:
For those already taking the pill, services like nib’s partner, hub.health, offer the convenience of renewing prescriptions and delivering them to your door.
The information on this page is general information and should not be used to diagnose or treat a health problem or disease. Do not use the information found on this page as a substitute for professional health care advice. Any information you find on this page or on external sites which are linked to on this page should be verified with your professional healthcare provider.