This article was updated May 21st, 2026.

Written by Mariam Kamel, DO and Lori A. Atkinson, MD

Many patients seeking contraception have concerns regarding prescribed birth control methods. Some of the most common concerns are surrounding future fertility and safety, often stemming from social media sources, particularly related to intrauterine device (IUD) and oral contraceptive pill (OCP) use.¹ 

Patients should be counseled that contraceptive effects are typically short-lived after discontinuation and that duration of contraceptive use does not affect long-term fertility.² Depot medroxyprogesterone acetate (DMPA) results in the longest time to return to fertility, with a median of 10 months after cessation. Patients discontinuing long-acting reversible contraceptives (LARCs) return to fertility after 1 cycle, whereas those discontinuing OCPs, hormonal rings, or patches return after 2-4 cycles.³ One popular social media concern is that levonorgestrel IUD might cause infertility due to its long-term use, however evidence shows most people conceive within a year of removing a hormonal IUD regardless of parity, age, or length of use.⁴

Despite the reassuring amount of evidence, if hormonal contraception remains a concern for patients, they can be advised that non-hormonal methods (condoms, diaphragms, spermicides, copper IUD, Phexxi, or fertility awareness) have no effect on fertility. Fertility awareness, in particular, may be useful for patients with regular periods who are able to track the changes in their bodies. The FDA cleared The Clue birth control smartphone application to aid with fertility awareness, noting a 6.5% failure rate over one year with typical use, comparable to failure rates of condoms and withdrawal.^5,6 However, it is difficult to peer review those apps, and the evidence base remains low quality.⁶  

Patients may also express concerns regarding the general safety of contraception, including the risk of cancer or venous thromboembolism (VTE). Generally, progestin-only and non-hormonal methods have the lowest risk of VTE, but even the estrogen-mediated increase in VTE risk remains low when used by those at average thrombotic risk.³ Evidence suggests a slightly increased risk of VTE with the use of DMPA.^7,8

Patients should be counseled that estrogen and progestin may raise the risk of developing breast cancer.^9-11 It should also be noted that the increased risk was noted in patients with BRCA 1 and BRCA 2 mutations and not in the general public. In addition, patients should be informed that the risk of breast cancer returns to baseline 10 years after the cessation of OCPs.^3,10 On the other hand, OCPs have shown reductions in the overall risk for ovarian and endometrial cancers.³ For more disease-specific safety concerns, the Medical Eligibility Criteria for Initiating Contraception is an excellent evidence-based resource from the US Centers for Disease Control (CDC) and World Health Organization (WHO) to guide patient discussions.¹¹ Ultimately, the decision to start a particular contraceptive method should always involve shared decision-making with the patient.

RHAP Resources:

Your Birth Control Choices Fact Sheet

Medical Eligibility Criteria for Initiating Contraception

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Sources:

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