Oral Contraceptives: Benefits, Hidden Risks, and the Clitoris Finding

Full analysis

Dr. Sara Gottfried gives a detailed risk-benefit accounting of oral contraceptives (OCs). On the benefit side, taking OCs for about five years reduces ovarian cancer risk by roughly 50% — meaningful because ovarian cancer is rarely caught early, and symptoms like bloating are easily missed. On the risk side, she raises several concerns: OCs deplete magnesium and B vitamins, may disrupt the microbiome, raise a marker of systemic inflammation called high-sensitivity CRP by roughly 2–3 times, and make the stress-hormone (cortisol) system less flexible. Most significantly, OCs raise sex hormone binding globulin (SHBG) — a protein that binds and inactivates free testosterone — which can cause vaginal dryness, reduced libido, and loss of confidence and agency in women who are sensitive to testosterone decline. Research also indicates that OCs can shrink the clitoris by up to 20%. Gottfried adds that SHBG remained elevated in at least one study even a year after stopping the pill, raising questions about reversibility.