Human Papillomavirus (HPV) is an extremely common sexually transmitted infection, with most sexually active people contracting it at some point. The vast majority of HPV infections are transient, clearing naturally within one to two years without causing health problems. Combined oral contraceptives (OCs), commonly referred to as “the pill,” contain synthetic versions of estrogen and progesterone to prevent pregnancy. For a person with an HPV diagnosis, the central question is whether the hormones in the pill influence the virus’s behavior, specifically its persistence and potential progression to cervical cancer.
Evaluating the Scientific Connection
The scientific community has investigated the relationship between combined OCs and cervical cancer for decades. Research consistently finds that the pill does not cause HPV infection, but focuses on whether long-term OC use promotes the progression of an existing high-risk HPV infection. Large-scale studies suggest that OC use is associated with a small, measurable increase in the risk of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer. This risk is predominantly linked to cumulative exposure over extended periods.
The International Agency for Research on Cancer (IARC) classifies combined OCs as a carcinogen due to this association. However, the risk is not immediate or substantial for short-term users. Studies indicate that the elevated risk becomes noticeable only after a person has used the pill for five or more years. For instance, the risk moderately increases for those using OCs for five to nine years, and can double for those using the pill for ten or more years compared to never-users.
Researchers propose that the hormones in combined OCs may alter the cervical environment, increasing the susceptibility of cervical cells to chronic infection. The synthetic hormones might promote the expression of viral oncogenes or suppress the immune response needed to clear the virus. This small, increased risk is not permanent for current long-term users. The risk level gradually decreases after stopping the pill, returning to the baseline risk of never-users approximately ten years after discontinuation.
Factors That Influence Risk
The theoretical risk associated with long-term OC use interacts with several variables to determine the overall risk profile. The type of HPV infection is the primary factor, as only persistent infection with high-risk strains (such as types 16 and 18) can lead to cervical cancer. An infection with a low-risk strain carries virtually no threat of progression to malignancy, regardless of contraceptive choice.
Smoking status is another major independent risk factor that dramatically increases the risk of cervical disease. The toxins in tobacco smoke appear to concentrate in the cervical mucus, damaging cervical cell DNA and impairing the immune system’s ability to clear the virus. The combination of smoking, high-risk HPV, and long-term OC use creates a much higher risk scenario than any single factor alone.
The most powerful mitigating action against HPV progression is adherence to regular cervical cancer screening, which includes Pap tests and HPV testing. Screening is designed to detect precancerous cell changes (CIN) years before they can develop into invasive cancer. Because cervical cancer develops slowly, consistent screening effectively neutralizes the small, theoretical risk associated with OC use. For example, high-risk HPV testing every five years is a recommended, highly effective screening strategy for women aged 30 to 65.
Contraceptive Alternatives and Decision Making
The decision to stop taking the pill should always be made in consultation with a healthcare provider who can evaluate a person’s complete medical history and risk factors. For most people with HPV, the substantial benefits of combined OCs often outweigh the small, theoretical increase in cervical cancer risk, especially with consistent screening. These benefits include highly effective pregnancy prevention and reduced risks of ovarian and endometrial cancers. Stopping a reliable method without a comparable replacement can expose a person to an unintended pregnancy, which carries its own health risks.
If a person remains concerned about systemic hormonal exposure, effective alternatives are available that do not carry the same theoretical risk profile. Non-hormonal methods, such as the copper intrauterine device (IUD) and barrier methods, eliminate the concern. The copper IUD is a highly effective, long-acting method that has not been associated with an increased risk of HPV persistence or progression.
Localized hormonal methods, such as the progestin-only pill or the levonorgestrel-releasing IUD (hormonal IUD), are also options. While the hormonal IUD releases progestin directly into the uterus, minimizing systemic exposure, it is generally considered a safer option than combined OCs. Ultimately, the best course of action is to discuss the duration of OC use, the specific HPV strain, and screening history with a clinician. This ensures choosing the method that best balances contraceptive efficacy with personal risk.