Weight gain, cancer, infertility: Contraception myths examined

MANILA, Philippines — More Filipinos are turning to modern family planning methods, but concerns about weight gain, depression, infertility, sexual problems and cancer continue to shape how women decide whether to start or stop using hormonal contraception.

Data from the Philippine Statistics Authority’s 2025 National Demographic and Health Survey (NDHS), as cited by the Commission on Population and Development (CPD), show that 58.6% of married women use some form of family planning, while 33.8% of all women do so.

The use of modern methods has also steadily increased over the years, from 25% in 1993 to 45% in 2025, while use of traditional methods stood at 15% and 14%, respectively.

READ: PH fertility rate hits historic low as contraception gaps persist

Graphics by Ed Lustan/Inquirer.net

Yet even as use has grown, misinformation and concerns about side effects remain barriers to contraceptive uptake and continued use, said Dr. Bernabe Marinduque, vice president of the Philippine Society for Responsible Parenthood Inc. (PSRP).

He said social media has given misinformation and misconceptions about contraception a much wider reach.

“It used to be that the myths and misconceptions spread in the community were the mafia. Now we have the internet and social media, and they’re actually a very strong factor in spreading the myths and misconceptions,” Marinduque said during an event marking World Contraception Day on Sept. 24.

He cited a 2022 study that examined videos about contraception and recorded about 1.13 billion views, illustrating the scale at which information — including misconceptions — can circulate online.

Twenty babies are born every hour to adolescent Filipino mothers. (Photo courtesy of Marianne Bermudez/Philippine Daily Inquirer)

The concerns surrounding contraception, however, are not limited to misinformation. Marinduque said some fears may have a basis in evidence, underscoring the need for health providers to discuss possible side effects honestly rather than simply dismissing patients’ concerns.

“Myths and misconceptions and wrong information about contraception continue to be issues on contraceptive uptake and discontinuation,” he said.

So, what does the evidence actually say about these concerns? Marinduque breaks down some of the most common misconceptions about hormonal contraception, drawing on findings from scientific studies and reviews.

Myth 1: Hormonal contraception inevitably causes weight gain

Weight gain is one of the concerns that can discourage women from using contraception.

Marinduque acknowledged that weight gain has been documented in studies, particularly among users of injectable contraceptives, implants and hormonal IUDs.

But he said the evidence does not support the idea that all hormonal contraceptives necessarily cause significant weight gain.

“Weight gain has been documented in numerous studies, especially among users of DMPA, injectable, implant, hormonal IUD,” he said. “But there are also many studies showing that hormonal contraceptives cause little, if any, weight gain at all.”

He cited two large reviews of existing studies that reached different conclusions. One found an average weight gain of about 2 kilograms among users of progesterone-based contraceptives over six to 12 months, while the other found insufficient strong evidence to establish a link between combined hormonal contraceptives and weight gain.

“So where are we now? Well, there’s weight gain, admittedly,” Marinduque said, emphasizing that the issue should be part of family planning counseling.

The takeaway: Weight changes can occur with some contraceptive methods, but the evidence does not support treating weight gain as an inevitable effect of all hormonal contraception.

Myth 2: Hormonal contraception causes depression

Mental health and mood changes are another frequently reported concern.

Marinduque said hormonal contraceptive users commonly report mood changes, but the evidence linking hormonal contraception to depression remains conflicting.

He cited a 2019 systematic review by Worley et al. that found no association between progestogen use and depression in most of the stronger studies. He also cited a separate 2021 systematic review comparing different hormonal contraceptive methods with nonhormonal contraception, which found no association between hormonal contraceptive use and depression.

Contraceptives shown by an organization promoting family planning on Dec. 18, 2012, photo. (Photo courtesy of Joan Bondoc/Philippine Daily Inquirer)

Still, Marinduque cautioned that a possible effect may exist for a smaller group of women.

“So where are we now? Well, it might actually cause or aggravate depression in a certain group of women, a minority group of women, but we don’t know yet as of now,” he said.

The takeaway: The evidence does not establish a general link between hormonal contraception and depression, but mood changes should not be dismissed, particularly when a patient notices changes after starting a method.

Myth 3: Using hormonal contraception causes infertility

Some women also report fear of infertility or delayed fertility as a reason for avoiding contraception.

Marinduque explained that the concern is partly rooted in the fact that some methods can temporarily delay the return of fertility after discontinuation.

For injectable contraception, for example, he said fertility may be delayed, but that does not mean permanent infertility.

“Well, it’s true, it can actually delay fertility,” Marinduque said.

However, he clarified that ovulation occurred within a year after discontinuation among 95% of users in the evidence he cited.

Graphics by Ed Lustan/Inquirer.net

For implants, Marinduque said there is a rapid return to fertility, with about 80% of users becoming pregnant within a year after discontinuation. He likewise described a rapid return to fertility after discontinuing hormonal IUDs.

For progestin-only pills (POPs) and combined oral contraceptive pills (COCs), he said there were no changes in fertility after discontinuation.

“There are no changes in fertility after discontinuing progestin-only pills (POPs), and the same is true for combined oral contraceptive pills (COCs),” he said in Filipino.

The takeaway: Some methods, particularly injectables, can delay the return of fertility after stopping, but the evidence cited by Marinduque does not support the idea that hormonal contraception permanently causes infertility.

READ: CPD: 14.1% of Filipinos still use traditional family planning

Myth 4: Hormonal contraception ruins a woman’s sex life

Concerns about reduced libido, vaginal dryness and other forms of sexual dysfunction also appear among common contraceptive misconceptions.

Marinduque said the evidence is particularly difficult to interpret because sexual function is influenced by many factors.

A 2019 systematic review he cited found that hormonal contraception could have a worsened, neutral or improved effect on sexuality.

“But let me tell you, this is a very difficult evidence, there’s conflicting findings on this one,” Marinduque said, explaining that sexual dysfunction is multifactorial and can involve health, relationships, culture, mood and other factors.

At the same time, he noted that reducing the fear of an unintended pregnancy could itself have a positive effect on sexual well-being.

“But one thing is sure, mitigating fear of pregnancy and contraception may actually improve sexuality,” he said.

The takeaway: There is no simple one-way relationship between hormonal contraception and sexual function. Individual experiences may differ, and other factors can influence sexuality.

Graphics by Ed Lustan/Inquirer.net

Myth 5: Hormonal contraceptives cause cancer

According to Marinduque, one of the most persistent concerns is that hormonal contraceptives cause cancer.

He said this belief continues to worry women considering or currently using hormonal contraceptives. However, he stressed that the relationship between contraception and cancer varies depending on the type of cancer and that association should not automatically be interpreted as causation.

READ: DOH debunks pervasive myths that cause public to fear contraceptives

Breast cancer

For breast cancer, Marinduque said studies have observed an association with hormonal contraceptive use but described the risk as relatively small compared with established risk factors.

“There’s an association. I’m not talking about causation,” he said.

He explained that cancer development involves multiple factors rather than a single cause.

“There has to be several mutations before cancer develops,” Marinduque said.

He also pointed to other established breast cancer risk factors, including genetic factors, radiation exposure, hormone replacement therapy, obesity, age at first childbirth, age at menopause and early menarche.

Ovarian cancer

For ovarian cancer, Marinduque cited a 2018 prospective cohort study that found current and former hormonal contraceptive users had a lower risk of ovarian cancer compared with nonusers.

He said the study estimated that hormonal contraceptive use potentially averted 21% of ovarian cancer cases and found a dose-response relationship, with longer use associated with lower risk over time.

Endometrial cancer

For endometrial cancer, Marinduque cited a 2021 Nurses’ Health cohort study involving about 107,000 women that found a reduction in endometrial cancer among oral hormonal contraceptive users.

He said the protective effect can persist after discontinuation and noted that progestogens and hormonal IUDs are also used in treating endometrial hyperplasia, a precursor to endometrial cancer.

Cervical cancer

The picture, however, is different for cervical cancer.

Marinduque said combined oral contraceptives may increase the risk of progression from high-risk human papillomavirus (HPV) infection to cervical cancer, particularly with prolonged use.

But he emphasized the need to put this association in context because persistent HPV infection is the established primary cause of cervical cancer.

“You have the HPV, which is an established cause of cervical cancer that you get. Hormonal contraceptives, as only one of the other factors that applies to this cervical cancer development,” he said.

He added that the risk associated with prolonged combined oral contraceptive use gradually declines after discontinuation, returning to levels comparable to those of nonusers within 10 years.

He also noted that some studies examining the potential link between combined oral contraceptive use and cervical cancer did not account for HPV infection, an important factor in cervical cancer development.

The takeaway: The claim that hormonal contraception simply “causes cancer” is an oversimplification.

The evidence differs by cancer type: Breast cancer involves an observed association that Marinduque said should not be equated with causation; hormonal contraceptive use has also been associated with lower risks of ovarian and endometrial cancer; while prolonged combined oral contraceptive use may affect cervical cancer risk in the context of persistent HPV infection.

In this photo taken in 2019, an AIDS Society Philippines staffer talks to visitors about HIV AIDS and offers free testing at their booth set up at the public cemetery in Cainta, Rizal. (INQUIRER FILE PHOTO)

READ: Married Filipino women more likely to use contraceptives than single ones

Myth 6: Hormonal contraception increases the risk of HIV

Marinduque also discussed concerns about hormonal contraception and human immunodeficiency virus (HIV), a sexually transmitted infection (STI) that can progress to acquired immunodeficiency syndrome (AIDS) when left untreated.

He cited evidence following the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial in 2019 that found no evidence of increased HIV risk associated with DMPA, IUDs and hormonal implants.

He also cited a 2022 meta-analysis by Akter et al. that found a positive association between hormonal contraceptive use and congenital herpes, a rare but potentially life-threatening infection in newborns that can occur when herpes simplex virus (HSV) is transmitted from mother to baby during pregnancy, labor or delivery.

The same analysis, however, found a negative association between hormonal contraceptive use and trichomoniasis vaginalis, a common sexually transmitted infection, and bacterial vaginosis, a common vaginal condition caused by an imbalance in the vagina’s normal bacterial community.

But Marinduque stressed that such findings need to be interpreted in context, including other factors such as sexual partners.

READ: HIV surge in the Philippines amid poor sex education, policy gaps

The takeaway: The evidence cited by Marinduque did not show increased HIV risk from the contraceptive methods discussed, while other sexually transmitted infections and related outcomes require separate consideration.

‘Fears about side effects should be taken seriously’

For Marinduque, the response to contraceptive misinformation should not be to dismiss women’s concerns.

Rather, he said health providers need to give patients enough evidence-based information to understand the possible side effects and benefits of the methods available to them.

“Although hormonal contraceptives confer numerous benefits, including established non-contraceptive benefits, protection from cancer, for example, some of the fears women have about hormonal contraceptives could have some basis, and this information should be divulged to the patients,” he said.

He urged health providers to take those concerns seriously during family planning consultations.

“Health providers should make sure that the fears about side effects are taken seriously, and evidence-based information about this should be discussed during provision of family planning services,” he added.

For him, that conversation is increasingly important as women encounter more information and misinformation online.

“And there is too little being done to counter the pervasive misinformation on contraception on the internet and the social media,” he stressed.

Access remains part of the problem

While misinformation can influence contraceptive decisions, CPD said barriers also include access to preferred commodities and trained providers.

Among all women ages 15 to 49, pills remained the most commonly used modern method at 11.6%, followed by female sterilization at 4.6% and injectables at 3.4%.

Pills and condoms are also largely obtained through private sources, which can mean out-of-pocket expenses for users.

Graphics by Ed Lustan/Inquirer.net

For sexually active unmarried women, the 48% unmet need for family planning underscores the continuing gap between wanting to avoid or delay pregnancy and having access to a modern method.

Lisa Grace Bersales, undersecretary for population and development, said government efforts need to focus on people whose access to reproductive health services remains limited.

“While more and more women and men are recognizing the importance of family planning, the government needs to strengthen its initiatives to reach out to women and men who have low access to reproductive health services so they can fully exercise their reproductive rights. We need to reach those who are poor, marginalized, and those living in isolated and disadvantaged areas,” she said in a statement.

Lolito R. Tacardon, deputy executive director III of CPD, likewise described the latest NDHS figures as showing both progress and continuing gaps.

“The 2025 NDHS tells two stories. The first is progress: more Filipino couples are exercising their reproductive agency — the ability to freely decide whether, when, and how many children to have, and to have the information and services to act on those decisions,” he said.

“But the second is persistent inequality. Unmet need among married women rose slightly to 12.5% in 2025, while met need barely moved. Among sexually active unmarried women, unmet need is far higher, at 48%, a gap unaddressed for too long. Reproductive agency is not truly universal if it is enjoyed only by some,” he added.

Graphics by Ed Lustan/Inquirer.net

The need for accurate information was also emphasized by health and development partners.

“Every woman deserves a full range of choices about her own body, and that starts with making those choices reachable. That’s the vision behind World Contraception Day: a world where every pregnancy is wanted. Across every market we serve, Bayer holds to one belief: access to contraception isn’t a privilege, it’s a basic part of women’s health,” said Dr. Carmela Luisa Pagunsan, ASEAN head of medical affairs at Bayer Philippines Inc.

Dr. Ingrid Magnata, country program manager of Jhpiego Philippines, meanwhile, said expanding contraceptive choice requires more than simply making different methods available.

“Expanding contraceptive choice is not only about having different methods available. It requires strong health systems, equipped providers, reliable information, and services that enable people to make voluntary and informed decisions. Sustained collaboration with government and partners helps make these choices accessible where and when people need them.” /dm