Almost half of pregnancies in the United States are unintended, despite the availability of highly effective forms of birth control. Women often cite side effects as a reason for stopping hormonal birth control, and most research on the topic comes from a medical perspective. In this study, I analyze hormonal contraceptive side effects from a social perspective that highlights the link between cultural messages about gender and women’s contraceptive behavior. Drawing on data from interviews with 88 women, I argue that the gendered emphasis on women’s appearance and emotionality shapes women’s perceptions about the seriousness of hormonal contraceptive side effects, like weight gain and emotional volatility, and their propensity to stop use as a result. Contrary to understandings of side effects as a purely medical aspect of use, the gender analysis elucidates the ways that particular side effects are imbued with social meaning that can undermine women’s goals to prevent pregnancy.