Access to 50 years of data has led to the discovery of pulsar emission and rotation variability on timescales of months and years. Most of this long-term variability has been seen in long-period pulsars, with relatively little focus on recycled millisecond pulsars. We have analyzed a 38-pulsar subset of the 45 millisecond pulsars in the NANOGrav 11-year data set, in order to review their pulse profile stability. The most variability, on any timescale, is seen in PSRs J1713+0747, B1937+21, and J2145−0750. The strongest evidence for long-timescale pulse profile changes is seen in PSRs B1937+21 and J1643−1224. We have focused our analyses on these four pulsars in an attempt to elucidate the causes of their profile variability. Effects of scintillation seem to be responsible for the profile modifications of PSR J2145−0750. We see evidence that imperfect polarization calibration contributes to the profile variability of PSRs J1713+0747 and B1937+21, along with radio frequency interference around 2 GHz, but find that propagation effects also have an influence. The changes seen in PSR J1643−1224 have been reported previously, yet elude explanation beyond their astrophysical nature. Regardless of cause, unmodeled pulse profile changes are detrimental to the accuracy of pulsar timing and must be incorporated into the timing models where possible.