Women take birth control for a wide range of reasons, and preventing pregnancy is only part of the picture. More than half of pill users rely on hormonal contraceptives at least partly for purposes beyond contraception, including managing painful periods, treating acne, regulating irregular cycles, and controlling conditions like endometriosis and PCOS. About 1.5 million women in the U.S. use the pill exclusively for these noncontraceptive purposes.
Preventing Pregnancy
The most straightforward reason, cited by 86% of pill users, is pregnancy prevention. How well birth control works depends heavily on the method and how consistently you use it. The pill has a failure rate of about 9% with typical use, meaning roughly 9 out of 100 women will become pregnant in the first year. With perfect use, that drops to 0.3%. Long-acting methods perform better because they remove the daily routine from the equation: hormonal IUDs have a typical-use failure rate of just 0.2%, and the implant sits at 0.05%, making it the most effective reversible option available.
The most popular contraceptive methods among U.S. women ages 15 to 49, based on 2022-2023 federal data, are female sterilization (11.5%), the pill (11.4%), long-acting reversible contraceptives like IUDs and implants (10.5%), and condoms (7.1%).
Reducing Period Pain and Cramps
About 31% of pill users take it specifically to reduce cramps and menstrual pain. Hormonal contraceptives thin the uterine lining, which means there’s less tissue to shed each month and fewer of the inflammatory compounds that trigger cramping. For women with endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, this effect is especially valuable. The pill causes those misplaced tissue patches to shrink by slowing cell growth and promoting cell breakdown. Clinical trials show meaningful reductions in menstrual pain, pain during sex, and even pain during bowel movements for women with endometriosis who take the pill compared to a placebo.
Managing Heavy Bleeding
Some women lose enough blood during their periods to develop iron deficiency or anemia, a condition called menorrhagia. Hormonal IUDs are particularly effective here. A study of the hormonal IUD found that it reduced menstrual blood loss by more than 90% within three cycles, with a median reduction of about 97.6% by cycle six. For women with bleeding disorders like von Willebrand disease, hormonal birth control can be a critical tool for preventing dangerous blood loss each month.
Regulating Irregular Cycles
Around 28% of pill users take it to regulate their menstrual cycles. Some women have periods that arrive unpredictably, sometimes weeks apart, sometimes skipping months entirely. Hormonal birth control overrides the body’s natural hormonal fluctuations by supplying steady levels of estrogen and progestin, which produces a predictable cycle. For some women, this regularity also helps prevent menstrual migraines that are triggered by the natural hormone drop before a period.
Skipping periods entirely is also an option. Continuous use of the pill, where you skip the placebo week, safely suppresses menstruation for as long as you continue. A 2014 Cochrane Review confirmed this approach works just as well for contraception as the standard 28-day cycle and can be maintained indefinitely. The monthly bleed that happens during the placebo week isn’t a true period. It’s a withdrawal bleed, and it isn’t medically necessary.
Treating PCOS
Polycystic ovary syndrome affects how the ovaries function and causes the body to produce excess androgens, sometimes called “male hormones.” This can lead to acne, unwanted facial or body hair, thinning scalp hair, and irregular or absent periods. Combined hormonal contraceptives (those containing both estrogen and progestin) are a first-line treatment. They work on two fronts: the progestin suppresses the ovaries’ hormone production by signaling the brain to dial back the hormones that stimulate them, while the estrogen component increases a protein called sex hormone-binding globulin that soaks up free testosterone in the blood. The net result is lower androgen activity and improvement in the skin and hair symptoms that many women with PCOS find most distressing.
Clearing Acne
About 14% of pill users cite acne treatment as a reason for use. Androgens drive oil production in the skin, and excess oil clogs pores. Combined birth control pills lower the amount of active androgen circulating in the body, which reduces oil output. Three specific pill formulations carry FDA approval for acne treatment, though other combined pills work through the same mechanism. This approach tends to work best for hormonal acne, the kind that flares along the jawline and chin and worsens around your period.
Easing PMDD Symptoms
Premenstrual dysphoric disorder goes well beyond typical PMS. It involves severe depression, intense anxiety, pronounced mood swings, and a sharp drop in interest in daily activities during the two weeks before a period. These symptoms can be debilitating enough to interfere with work and relationships. A specific type of progestin called drospirenone has shown particular promise for PMDD. Unlike most synthetic progestins, drospirenone blocks a hormone called aldosterone that causes the body to retain salt and water. This counteracts the bloating, breast tenderness, and swelling that estrogen promotes. In a survey of nearly 11,000 women across 15 European countries, pills containing drospirenone improved depressed mood, irritability, breast pain, bloating, and skin problems. A separate study found significant reductions in both bloating and breast tenderness along with measurable improvements in psychological well-being.
Teens and Women Who Aren’t Sexually Active
Among teens aged 15 to 19 who use the pill, 82% do so at least partly for noncontraceptive reasons, and a third use it solely for those purposes. Roughly 762,000 women who have never had sex use the pill, and 99% of them do so exclusively for medical reasons like cycle regulation, pain management, or acne. The idea that birth control is only about preventing pregnancy doesn’t reflect how it’s actually prescribed or used, especially for younger women whose most pressing concern may be debilitating cramps or severe acne rather than contraception.
Long-Term Cancer Risk Reduction
One benefit that rarely drives the initial decision but accumulates over time is a reduced risk of certain cancers. For every five years of oral contraceptive use, the risk of endometrial cancer drops by about 24%. Among women who never took the pill, roughly 2.3 out of 100 will be diagnosed with endometrial cancer before age 75. For women who used it for 10 years, that number falls to about 1.3 out of 100. The protective effect is strongest against the most common type, carcinomas of the endometrial tissue, where the risk reduction reaches 31%. Oral contraceptives are also associated with lower rates of ovarian cancer, with the protective effect lasting for decades after discontinuation.