More than 100 million women use oral contraceptives (birth control pills) globally. These pills come with its conveniences and benefits in providing an effective form of birth control, but they also come with their side effects (headache, irregular bleeding, bloating). Some side effects however, can be dangerous such as venous and arterial thrombophlebitis (blood clots), heart attack and stroke. With so many birth control pills on the market, including generics, it is important to look at which pills are safest to avoid these concerning side effects.

In an observational study of 5 million French women (ages 15-49), researchers examined women taking birth control pills with 30-40 ug ethinyl estradiol (EE) compared to those taking a 20 ug EE pill between 2010-2012. Those containing the lowest amount of estrogen (20-ug EE plus levonorgestrel) had the lowest risk for pulmonary embolism, stroke and heart attack. Common names of these pills include Alesse, Lutera, Lessina, Levlite and Sronyx. Those taking the higher 30-40 ug EE plus Desogestrel pill ( Desogen, Ortho-cept) had the highest risk for blood clots of the lungs (pulmonary embolism).

So if choosing a birth control pill, the lower dose estrogen pill is a safer start. Cigarette smoking negates that risk reduction so please don’t smoke.

Also, we have to remember that pregnancy is associated with a much higher risk for venous thromboembolism then any available estrogen-progestin contraceptive. If remembering to take a pill every day is difficult, then consider a long-acting reversible contraceptive, like the IUD or a progestin implant.

Reference: Weill A et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: Cohort study. BMJ 2016 may 10;353:i2002.