The Truth About the Birth Control Pill: Weight Gain, Migraines & Blood Clots

In this episode, I answer the most common (and most Googled) questions I get about the birth control pill — in plain, real‑world language.

We talk about how to actually take the pill correctly (including what time of day makes the most sense), whether it’s safe to skip your period, what the “mini pill” really means, and the truth about weight gain.

Spoiler: the pill does not cause weight gain. And yes, you can safely skip placebo pills if that’s right for you.

I also break down:

• ✅ The best time of day to take birth control
• ✅ How to safely skip periods using continuous pills
• ✅ What the “mini pill” actually is (progesterone-only vs ultra–low-dose combined pills)
• ✅ Birth control and migraines (especially migraines with aura)
• ✅ Breast cancer myths vs what major medical organizations actually say
• ✅ Blood clot risk — who’s at higher risk and when progesterone-only options may be safer

We get into the real medical data around blood clots, smoking, obesity, and family clotting disorders, because that’s the most important serious risk to understand.

If you’ve ever wondered:
- “Is it bad to skip my period?”
- “Will birth control make me gain weight?”
- “Can I take the pill if I get migraines?”
- “Does birth control increase cancer risk?”

This episode is for you.

My goal is always the same — give you evidence-based information so you can make informed decisions about your body.

You can write to us at Questions@GynoInfo.net

And follow us on Instagram @gynoinfo

Remember, any questions that I answer or information that I give you on this podcast are to be understood as information only, not treatment of your medical problems. While I'm a very knowledgeable gynecologist, I'm not your gynecologist who has talked to you and examined you personally and is therefore actually able to treat you.

So please consult your own healthcare professional with any medical questions or concerns.

Transcript

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Welcome to Gyno Info, Frank Talk with Dr. Burkey, the podcast dedicated to teaching everyday women what they need to know about their body and how it works to successfully deal with the healthcare system and communicate with their doctors. Each week, I'll provide you with new information and practical tips about gynecology and women's health care. I want to prepare you for your doctor's appointments by teaching you what to expect, what information your doctor will need to know from you, and what questions you will need and should ask her so you can be confident and make the most out of every visit. Gyno Info will give you the knowledge you need to take charge of your health and do this in a clear and frank way that you can understand without having a medical degree. One episode at a time. So now let's begin. Hello. Welcome back to Ghyno Info, the podcast about women's health in normal, everyday language that normal, everyday people can understand. No special medical words and no doctor speak. A special welcome to any new listeners, those who just discovered us for the first time. And please take a moment now to subscribe to GhynoInfo. It makes it much easier to find this same episode again in case you get interrupted and would like to finish the podcast later on. For today's episode, I decided to go over some tips and tricks and questions on birth control pills that come up in my office all the time. The first one is at what time a day should I take my birth control pill? That really depends a lot on your lifestyle. The most important thing is that you take it roughly at the same time a day, give or take an hour or two. I find that very young people, especially teenagers who have a biological clock that does not work before nine o'clock in the morning, are best uh served if they take the pill somewhere between 7 and 10 p.m. That is, before they go out on the weekend, because they might stay out till late and sleep till 4 p.m. in the afternoon. But if you have to have major chores that you have to do seven days a week that require you to get up at 7, then taking the pill at 7 in the morning might be a good time. You just need to check which fits best with your lifestyle and not just during the week, but also on the weekend. Then another question that comes up sometimes is women will say, some of my friends take their pills without a break and never have a period. Is that safe? That is definitely safe, and it always works for birth control, but it may not work for controlling your bleeding. Basically, the regular way of taking the pills is taking either 21 days of active pills or 24 days of active pills, and then either four or seven days of placebo pills, and during that time you will have a slight bleeding. Now, if that bleeding is super light, you might actually try to take 21 or 24 days of active pills in a row and skip the placebo pill, skip the sugar pills. And then that would be 42 pills or 48 pills in a row, and then you can take a four or five or six, but never more than seven-day break, and then start over. And if you don't have any breakthrough bleeding, any bleeding when you are on active pills, you can then extend it to taking 63 pills in a row or three times 24 pills in a row, three packages in a row, and then do a break. And if you do it like that, that you gradually expand the time that you take the pills continuously before you let your body have a break and have a light period over time, that bleeding will get so light and go away, then it's perfectly safe. But if you just start taking the pills without taking the sugar pills from the very beginning that you start the pills, you're highly likely to have some bleeding in between. If that doesn't bother you, uh, you can certainly do it. It's not gonna change how well they work for birth control. After you're able to take three or four packs in a row without having any breakthrough bleeding, you can just continuously take the pill. And should you ever have some breakthrough bleeding or some spotting, you can say, okay, uterus, you want to have a period, let's have one, stop for four, five, or six days, and then restart the pills. Now that only works with the kind of package that has all the active pills of the same color. If you have a package that has three or four different colors instead of just the active pills one color and the sugar pills, the placebo pills another color, then it will not work. It will completely confuse your body and your bleeding will get irregular. So it only works if you have the same type of active pills. Those you can take continuously. One last point about taking the pill continuously. There are some pill brands that come in 84 pill packages, where you take 84 pills in a row, and then you will have a break of seven days, and they're packaged that way. They tend to be a little bit more expensive. And as I said, you could do the same thing with any old pill package, be it a 21-day or a 28-day pill package, or even with a 24-pill package. But it's certainly convenient to have it all taken care of that you just take four pill packages in a row and use the same. Now, the next question that always comes up is what is a mini pill? That can be two different things depending on who you are talking with. One thing has to do just with the dosage of the regular combined pills. Those pills contain estrogen and progesterone. They're a combined pill with two different hormones. And in the olden days, the estrogen was very, very high. When my mom started taking the pills 60 years ago when the pill was first on the market, then that pill contained 150 micrograms of ethanol estradiol, the estrogen hormone that was used at the time. And when I started taking the pill, it's maybe 80. And now the pills that are now on the market are either 15, 20, or 30 micrograms of ethanol estrodiol, the estrogen components of the combined pill. So that is a lot lower than it used to be, which also means the risk of blood clots and fluid retention and all the estrogen side effects is a lot lower. Some people will call these ultra-low-dose combined estrogen pills mini pills because they're mini compared to the olden days. The other pill that is sometimes called the mini pill is the pills that have 28 days of pills in the same package, and you take them continuously. Those contain only one hormone, only the progestin component of the combined pill. And they are designed to shrink the lining of the uterus so much that you don't have any bleeding at all. They work in a similar way than the hormonal IUDs that also give off progesterone continuously and shrivel up the uterine lining. And so you don't have any bleeding, or you have some irregular breakthrough bleeding. Those so-called mini progesterone-only pills, some people also call them POP pills, the pop pills, only have one hormone and you take the pill every single day without a break. Those are also sometimes called mini pills. Then a very weighty question that always comes up, and that is, will I gain weight with a pill? I'm so scared of gaining weight. All my friends say I'm gonna gain weight with a pill. Well, all your friends are wrong. You do not gain weight with a pill. If you do studies and you put 1,000 women on the pill and the other thousand women not on the pill or on a fake pill, both groups will gain the same amount of weight, whether they were on a real pill or on a fake pill. And these studies have actually been done. The women who gained weight with the pill will 100% blame the pill. The women who did not take the pill and gained weight, they will say, Well, I went on a cruise, I changed work, now in my new job, I don't have to walk up the stairs anymore every day. They have all the normal explanation for gaining weight. So it's not the pill, it's really the lifestyle. The other thing to consider is also that often young women start on the pill when they start having sex. And that may be about the same time that they're done with puberty. They stop growing, they're no longer running around on the playground during recess, but they sit around and stand around and chat with their friends, they're no longer burning as much calories than when they were in elementary school. But they keep eating like they used to, like they were when they were little kids, and of course they will gain weight. And then they're the women who actually lose weight on birth control pills. Those are the women who have polycystic ovary syndrome and they have insulin resistance, and because of that, they gain weight when they're not taking the pill. You can hear about polycystic syndrome in three different podcasts that I've done in February of this year. You can just look them up. But basically, women with polycystic ovaries, they will then take the pill, which stops their insulin resistance and makes their body more able to process carbohydrates and sugars instead of turning them straight into fat. And those women will actually lose weight with the pill. So this whole rumor of gaining weight with a pill is just dead wrong. But it probably comes also from the very olden days when people had these megadoses of estrogen, which then made them retain a lot of fluid. But that was not fat, it was just fluid water weight. And as soon as they stopped the pill for the seven days, they would shed it out again. But anyways, you can blame the pill, but it's not the pill that makes you gain weight. But then another question that sometimes comes up is about migraines. There are all those warnings about migraines in the package inserts, but many women, if they don't take the pill, their migraines will get a lot worse. And so they will ask about migraines. The key to that is reading the package inserts correctly. There's actually two types of migraines. There are migraines with aura. Migraines with aura are particular migraines that start with kind of light flashes or numbness in one side of your body, or they have some nerve symptoms. They're not just a headache. Those are the kind of migraines that by themselves increase your risk for strokes. And if you combine them with a pill, then you will have a higher risk of strokes on top of just the one you have with migraines. So the two, the migraines and the pills together make your risk for strokes higher. So that's an absolute contraindication. That's an absolute reason that you cannot take the pill. But then there are the other type of migraines. Those migraines are called paramenial migraines. They tie themselves to the menstrual cycle. They happen as part of PMS just before your period starts. And those migraines get actually stopped by birth control pills because you get a fixed dose of hormones every day in your pill, the brain does not tell the ovaries to make additional hormones that then can trigger those migraines. So the regular old migraines without aura, without neurological symptoms, are very often getting a lot better with birth control pills. One big question that always comes up is do the pills increase the risk for breast cancer? And the answer is definitely not. All the major gynecological organizations in the world say that breast cancer risk is not increased with birth control pills. If you do have a breast cancer that you got for some other reason and you take any type of estrogen-containing medication, be that birth control pills or be that hormone replacement therapy that you take from menopause, of course, if that cancer is one breast cancer type that likes to eat estrogen, it will grow faster. But it is not the birth control pill that caused it in the first place. Now, this is the official opinion of all the gynecological specialty societies in the whole world, and it is what science says. It is not necessarily what is in the package insert. It's not necessarily what the US government says, but it is what the facts are. And so you can ignore information you hear on the internet that is not always correct. You need to always make sure you have it from the right source. So again, science says breast cancer risk is not increased by taking birth control pills. And another risk factor that people like to talk about and should be talking about is what about blood clots? And that is probably the only serious side effects, unwanted effect of birth control pills that is worth talking about. If in your family there are a lot of people who have blood clots either in pregnancy or after they had their baby, or with birth control pills, or with flying, or other reasons that can increase your risk of blood clots, then you may have a so-called familiar blood clotting disorder, a condition that you're born with that increases your risk for blood clots. And in that case, you should absolutely not take birth control pills, but you should also be especially careful and maybe take blood thinners when you're pregnant, because the risk of blood clots is about 20 to 40 times higher with pregnancy than with birth control pills. That's the most dangerous condition that will increase your risk for blood clots is pregnancy, because you make way more hormones and estrogen when you are pregnant than when you take a low-dose birth control pill. But nevertheless, if you have a clotting disorder in your family, if you have a tendency in your family to get blood clots that you're born with, you should definitely not take birth control pills. But most women don't have that. Most young women that are not smoking, that are not massively overweight, that don't have a family history of blood clots, they are completely safe taking the pill. The risk is extremely, extremely small. But if they smoke, for instance, they have a risk of blood clots that's 60 times higher. But 60 times higher of hardly anything is still not that high. So if you're smoking and you're not overweight and you're under 30, you can probably take the pill, but you should try to decrease your smoking massively, and ideally you should stop smoking. It's expensive, it stinks, and it's bad for you. So there's no reason to smoke. People who have familial tendency to get blood clots can take those special mini pills that I talked about. Those are the pills that don't contain estrogen, that only contain progesterone. Those are the pills you take 28 days straight, same package, and start the next one the very next day without ever stopping. Those are pills for women who have a bleeding problem. Or they can use a copper IUD or they can use a hormonal IUD, but what they should not take is birth control pills that contain estrogen. The same goes also for women who have migraines with aura that I talked about. Those are the migraines with neurological with nerve symptoms. Those are also an absolute contraindication for estrogen containing birth control pills, but they can take the mini pills, the progesterone-only pills, just like the people with an increased risk of blood clots. And as always, I hope you found this podcast gave you some more new insights and information this time about birth control pills, and that you found it useful and will share it with as many other women as you can. And remember that if you have any further questions about the pill or any other topic having to do with women's health, please don't hesitate to send them to me at questions at gynoinfo.net. And please also make sure that you click the subscribe button wherever you listen to or watch GynoInfo so you can get back to it easily whenever and wherever you want. And also, the more people subscribe, the easier it will be for others to find us. Thank you. Until next time. Thank you for listening. And remember that you and your health are super important and deserve your full attention. Don't ever put off contacting your doctor because you're scared or embarrassed when something feels wrong about your body. Doctors are here to help you, not to judge you. And also, regular well-woman visits are always a good idea that you should make time for. You deserve it and you owe it to yourself, and you owe it to your body and your health. This podcast is part of Pridehouse Media, hosted by me, Dr. Burke, produced and edited by Josh Rosenzweig. Original music composed by Nell Balaban. If you enjoyed this episode, please subscribe wherever you listen to podcasts. And while you're there, leave us a rating and a review. It really helps others discover the show. Stay connected and join the conversation by following me on Instagram and Facebook at GyNoInfo and on LinkedIn at GynoInfoPodcast.