ACHES (Birth Control Adverse Effects)

Nursing Knowledge

ACHES (Birth Control Adverse Effects)

Birth control methods, including combined oral contraceptives (COCs) and progestin-only pills (POPs), can lead to a range of adverse effects such as menstrual irregularities, nausea, breast tenderness, and mood changes. While some of them are mild and often improve within a few months of use, there are rare but severe adverse effects that nurses and clients must be aware of and monitor for. The ACHES mnemonic helps recall their warning signs.
Last updated: February 21, 2024

Table of contents

The ACHES acronym for birth control side effects

ACHES is a mnemonic used to remember the warning signs for serious adverse effects of hormonal contraceptives. 

A – Abdomen: severe pain may indicate liver tumor or ectopic pregnancy

C – Chest: severe pain and SOB may indicate MI or PE

H – Head: sudden severe headache may indicate stroke

E – Eye: blurriness or loss of vision may indicate blood clot in eye

S – Sudden pain or swelling in leg: may indicate VTE

Side effects of combined hormonal contraceptives (COCs)

COCs contain estrogen and progestin, for example:

  • Contraceptive pill
  • Hormonal patch
  • Hormonal ring 

Adverse effects may vary based on the type and dose of each component. Clients should be taught the ACHES warning signs and report concerning symptoms. Reporting of benign adverse effects should also be encouraged though, as a change of formulation may improve symptoms. 

Common, benign adverse effects

  • Breakthrough bleeding
  • Nausea
  • Headaches
  • Abdominal cramping
  • Breast tenderness
  • Vaginal dryness
  • Decreased libido
  • Mood changes

Serious adverse effects

  • Hypertension
  • Blood clots (VTE, stroke)
  • Cardiovascular events
  • Liver disorders
  • Glucose dysregulation with history of diabetes


  • Uncontrolled hypertension
  • Migraine with aura
  • Ischemic heart disease
  • History of blood clots or coagulation disorders
  • Known liver disease
  • Smokers > 35 years old
  • Endometrial or breast cancer

Side effects of progestin-only contraceptives

Progestin-only contraceptives like implants, IUDs, injections or the mini pill do not contain estrogen. For this reason, they have fewer adverse effects than COCs and

may be safe for individuals who are unable to take estrogen. 

Benign, common adverse effects include irregular bleeding and increased acne. Contraindications are a known or suspected pregnancy, unexplained vaginal bleeding, and breast cancer. 

Clients should be informed that irregular bleeding often improves after the first 6 months of use, but should be encouraged to report it if persistent and/or bothersome. 

Tip: COCs and the mini pill have many drug–drug interactions. Take a thorough medication history to identify interactions that may decrease contraceptive efficacy.

Side effects of taking Plan B while on birth control pill 

Plan B is a morning-after emergency contraception pill. Potential adverse effects of taking Plan B while taking hormonal contraceptive pills can include: 

  • Nausea/vomiting
  • Dizziness
  • Fatigue
  • Headache
  • Breast tenderness
  • Irregular or heavier bleeding 
  • Lower abdominal pain or cramps

How soon do birth control side effects start? 

Adverse effects can start immediately or within a few months of starting contraceptive use. A lot of adverse effects may improve within a few months, so giving it a little time before changing to another option may be suggested if symptoms are acceptable to clients. 

Potential side effects of getting off birth control

Some clients can experience adverse effects when stopping the use of hormonal birth control options. For combined oral contraceptives, these include: 

  • Menstrual irregularities, especially if cycle used to be irregular before use of hormonal birth control
  • Mood changes
  • Acne
  • Weight fluctuations


ACHES (Birth Control Adverse Effects)

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Nursing Cheat Sheet

Overview of side effects and patient education for combined and progestin-only hormonal contraceptive methods.

Master the topic with a unique study combination of a concise summary paired with video lectures. 

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