Hormonal birth control is 99 percent effective if used perfectly. But if you miss a pill, then it only becomes 91 percent effective. There are other factors that could also interact with its efficacy, including certain vitamins and supplements that can have unwanted interactions.

“Oral contraceptives (OCs) are absorbed in the lining of the gastrointestinal (GI) tract. After absorption, the estrogen component of OCs is metabolized in the liver by a specific enzyme system called cytochrome P450,” Dr. Mary Jacobson, the Chief Medical Officer over at Alpha Medical, explains to SheKnows.

Birth control pills and certain supplements can have a conflicting interaction with the enzyme, which means when taken together, the birth control could become less effective resulting in side effects, including unplanned pregnancies. Below is a list of vitamins and supplements that could interfere with your birth control.

 St. John’s wort (Hypericum perforatum)

St. John’s Wort is a dietary supplement which people can buy over the counter in the U.S. and according to Jacobson the plant is used to treat depressive symptoms. “St. John’s Wort speeds up metabolization of OCs which decreases the amount of hormones in OCs which are absorbed. This can lead to higher rates of breakthrough bleeding and an undesired pregnancy.”

Activated charcoal

While activated charcoal is used as a detoxifier in treating patients in the emergency department for suspected poisoning, Jacobson notes that people, especially millennials take it in smaller doses “for unfounded claims of health benefits, including removing toxins from the body and skin.” However, if you take your OCs around the same time you eat charcoal, “the charcoal may bind to OC hormones in your gut and render them ineffective.”

Soy products

Soy products, such as tofu and tempeh, contain isoflavones which are a type of phytoestrogen.  Phytoestrogens are compounds found in plants and foods that act similar to estrogen in the body. “Phytoestrogens have been studied for potential benefits in menopausal symptoms like hot flushes and osteoporosis, lowered risks of cardiovascular disease, obesity, metabolic syndrome and type 2 diabetes, brain function disorders, breast cancer, prostate cancer, bowel cancer and other cancers,” Jacobson explains. “Phytoestrogens can theoretically impact the estrogen in birth control. However, more research is needed to determine the effects of phytoestrogens on birth control.”

Grapefruit

According to Jacobson, eating grapefruit or drinking grapefruit juice could impact the amount of many medications, including OCs that your body absorbs. “Grapefruit has been shown to slow the breakdown of estrogen from OCs in your body,” she says. “So, estrogen from your birth control may hang around in your system longer. More research is needed to determine the exact effect of grapefruit on hormone regulation. Occasionally eating grapefruit should not be a problem but eating a lot of grapefruit may impact metabolism of medications which you are taking.’

Are there alternatives to these vitamins and supplements?

If you’re on birth control, Jacobson advises discussing your goals of taking supplements, including vitamins and minerals with your provider. “If you are medicating depressive symptoms with St. John’s Wort and are having success, consider switching from an OC to a different form of hormonal contraceptive that does not interact with St. John’s Wort,” she says. “Hormones from an IUD, patch, ring, or implant are absorbed directly into the bloodstream and are unaffected by St. John’s Wort. Alternatively, if St. John’s Wort is ineffective for treating depressive symptoms, talk to your provider about alternatives like prescription anti-depressants and talk therapy.”

Before taking vitamins and supplements, what are some guidelines someone should take into consideration or talk with their doctor about?

When discussing birth control, Jacobson recommends your provider know about all medications, vitamins, minerals, herbs, and supplements which you are taking so they can discuss potential drug interactions as well as scientific evidence in support or refutation of supplements which you are taking. “Remember, more is not better. Additional nutrients provided by dietary supplements can help meet recommended nutrient targets but can also potentially lead to excess intakes and affect your kidney and liver function. Try to achieve your goals through dietary modifications first.”

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