The decision to stop taking the birth control pill after a diagnosis of Human Papillomavirus (HPV) is a common and medically complex concern. HPV is an extremely widespread sexually transmitted infection, and most sexually active people will contract it at some point. While the majority of HPV infections clear on their own, certain high-risk types can persist and cause changes to cervical cells. The concern arises because combined oral contraceptives (COCs), commonly known as “the pill,” introduce synthetic hormones into the body. This article explores the scientific evidence linking these hormones to HPV progression and provides context for the medical decision-making process. Navigating this issue requires balancing contraception needs and a potential, albeit small, increase in long-term health risk.
Understanding High-Risk HPV and Cervical Changes
The Human Papillomavirus is a group of over 200 related viruses, some of which are categorized as high-risk because of their potential to cause cancer. High-risk types, particularly HPV 16 and HPV 18, are responsible for nearly all cases of cervical cancer. A high-risk HPV infection becomes concerning if the body’s immune system does not clear the virus within a couple of years, leading to a persistent infection.
This persistence allows the virus to integrate its DNA into the host cell, which can lead to the uncontrolled growth and division of cervical cells. This process is called dysplasia, resulting in pre-cancerous lesions known as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesions (SIL). These lesions are graded as low-grade (LSIL) or high-grade (HSIL), with high-grade changes carrying a much greater risk of progressing to invasive cancer over time.
Regular cervical cancer screening, which often includes primary HPV testing or co-testing with a Pap smear, is designed to detect these high-risk infections and pre-cancerous changes early. If an HPV infection is detected, follow-up procedures like colposcopy—a magnified examination of the cervix—may be performed to confirm the presence and severity of any abnormal cells. Early detection and treatment of high-grade lesions are highly effective in preventing cancer development.
The Research on Hormonal Contraception and HPV Progression
Scientific evidence has established a link between the long-term use of combined oral contraceptives (COCs) and an increased risk of developing cervical cancer or high-grade lesions in individuals with persistent high-risk HPV. Major meta-analyses and cohort studies consistently show that this risk is directly related to the duration of COC use. The increased risk is typically not observed in women who have used the pill for less than five years.
The risk begins to rise significantly after extended use. For women who use COCs for five to nine years, the relative risk of developing cervical cancer is estimated to increase by about 60% compared to non-users. This risk can more than double for those who continue use for ten years or longer. Importantly, this risk only applies to women who have a persistent infection with a high-risk HPV type.
The proposed biological mechanism involves the synthetic estrogen and progestin hormones in the pill altering the cervical environment. These hormones may make the cervical cells more susceptible to the viral oncogenes, specifically the E6 and E7 proteins produced by the HPV virus. Research suggests that these hormones do not increase the risk of acquiring an HPV infection, but rather impair the immune system’s ability to clear a high-risk infection, leading to increased viral persistence. The elevated risk associated with COCs is not permanent; studies indicate that the risk returns to the level of never-users within about ten years after discontinuing the pill.
Balancing Contraception Needs Against Potential Risk
When considering whether to stop the pill, it is important to place the scientific risk into a practical context. The increased relative risk associated with COCs must be weighed against the very low absolute risk of cervical cancer in screened populations. Because cervical cancer is a relatively rare disease, even a doubling of risk still means the overall chance of developing cancer remains small for most women who adhere to regular screening guidelines.
The most immediate and tangible risk of stopping the pill without an alternative is unintended pregnancy. Unintended pregnancies carry their own set of health risks that may outweigh the long-term, slightly elevated risk of cervical cancer. A patient and their provider must carefully consider several personal factors in this decision.
Key factors include the total duration of COC use, the current status of the HPV infection—whether it is transient or persistent—and the severity of any existing cervical cell changes. For individuals with high-grade lesions or very long-term use (over five years), the argument for switching to a non-hormonal method becomes stronger. Conversely, for those who have only used the pill for a short time or whose HPV infection is likely to clear, the benefits of highly effective contraception may outweigh the theoretical risk.
Discussing Your Options and Alternative Methods
The decision to stop using combined oral contraceptives should always be made in consultation with a gynecologist or primary care provider. They can help assess your individual risk profile and ensure a smooth transition to an alternative method of contraception. The most important step is to avoid any gap in effective contraception if you are not planning a pregnancy.
Several highly effective non-hormonal or lower-systemic-risk hormonal methods are available.
Non-Hormonal Methods
The copper intrauterine device (IUD), such as ParaGard, is a completely hormone-free, long-acting reversible contraceptive that works by creating an environment toxic to sperm. Barrier methods, such as external or internal condoms and diaphragms, offer effective non-hormonal protection and provide some protection against sexually transmitted infections.
Lower-Systemic-Risk Hormonal Methods
Levonorgestrel IUDs release a progestin hormone directly into the uterus, resulting in much lower systemic hormone levels compared to the pill. This localized delivery is thought to pose a lower theoretical risk to cervical cells.
Regardless of the choice of contraception, continuous adherence to the recommended cervical cancer screening schedule remains the most effective defense against the progression of an HPV infection.