According to a recent eye-opening analysis from Penn State, girls born in 2019 will likely take medication for 60% of their life. What’s the primary driver behind this statistic? You guessed it: hormonal birth control (HBC) use. Given the widespread use of HBC, ubiquitously known as ‘the Pill’ (though it’s available in pill, patch, ring, or implant form), the average woman likely believes it to be relatively harmless, though its mental health effects are increasingly widely acknowledged. But even though “everyone’s [taking] it” and it’s widely available (progestin-only O-pill is available over the counter since March of 2024), HBC may interact with hundreds of medications. These interactions could decrease HBC’s effectiveness at preventing pregnancy or increase the risk of serious side effects like blood clots.
What is a medication interaction?
According to the National Institutes of Health (NIH), a medication interaction, also known as a drug interaction, “is a reaction between two (or more) drugs or between a drug and a food, beverage, or supplement.” The most common way other medicines interact with HBC is by decreasing its pregnancy prevention effectiveness. But there are also medication interactions that increase a person’s risk of experiencing serious side effects.
The most common way other medicines interact with HBC is by decreasing its pregnancy prevention effectiveness. But there are also medication interactions that increase a person’s risk of experiencing serious side effects.
While many medicines interact with HBC, the risk of serious side effects is so strong with some medications that their use is actually contraindicated, meaning that they should not be prescribed for someone who takes HBC.
Which medicines interfere with birth control?
Hundreds of medicines interact with HBC. Some are prescription drugs, but others are over-the-counter (more on this below!) or even herbal supplements, like St. John’s wort. Some antibiotics, many anti-seizure medicines, and some psychiatric medicines (like those prescribed for anxiety, depression, or bipolar disorder) are the most commonly prescribed medications likely to cause medication interactions with hormonal birth control. While antibiotics are only taken for a short time and a woman might be encouraged to use another form of birth control while she uses them, anti-seizure medicines and many psychiatric medications are taken every single day. HIV medications, also known as antiretrovirals, like Ritonavir, Darunavir, Ombitasvir, and Paritaprevir, are contraindicated with HBC, according to GoodRx.com.
Medication interactions may decrease birth control’s effectiveness at preventing pregnancy
How do medicines interact with birth control? Vomiting due to illness or nausea from other medications may cause poor absorption of birth control, and therefore less pregnancy prevention effectiveness. The same thing can happen from diarrhea, which is a common side effect of many medications (including HBC, especially when a woman first starts taking it). Regular laxative use or abuse may also lead to the same outcome. On the other hand, if a medicine interacts with HBC by speeding up its absorption, there will be less in your bloodstream. Less HBC in your bloodstream, whether from too fast metabolism (breakdown of the medicine, usually by your liver) or too little absorption, may mean that ovulation isn’t prevented.
Medication interactions may increase the risk of birth control side effects
While some sources like the University of Colorado insist “Women using hormone-based birth control methods are not at any increased risk of experiencing complications or side effects when taking other medications,” scientific research suggests otherwise. Melatonin, smoking, and NSAIDs (yes, over-the-counter, plain-Jane NSAIDs) like Ibuprofen, Motrin, and Aleve may all interact with hormonal birth control to cause potentially serious side effects. Melatonin, a common over-the-counter sleep aid, is unlikely to render HBC ineffective, but HBC may increase the effects of melatonin. This may lead to sedation, according to the Mayo Clinic.
Women who use HBC and smoke, especially (but not only) women who are also overweight, are at increased risk of cardiovascular problems. Keep in mind that ‘cardiovascular’ refers to both your heart and your blood vessels, which are located throughout your entire body. While the highest risk of cardiovascular problems like heart attack or coronary artery disease is in women who smoke more than 15 cigarettes a day, any amount of smoking (even occasional) increases your risk.
Perhaps the most surprising medication interaction with the potential to cause serious problems is between HBC and NSAIDs. Recent research suggests that women who took birth control and NSAIDs like Advil, Ibuprofen, Aleve, or Motrin for just one week were at 10x higher risk of developing a blood clot than women on HBC alone. Blood clots, as we’ve covered before, can be fatal.
How long will a medicine interfere with your birth control?
The answer is: it depends. The amount of time a particular medicine might interfere with your birth control could be just a few days. Anesthesia, as one example, could decrease birth control’s effectiveness for up to 7 days. A month is the potential length of time for decreased effectiveness if you take griseofulvin, a medicine for ringworm, athlete’s foot, and jock itch, or diabetes medicine Actos (pioglitazone).
How can you know what medicines your HBC interacts with?
Apple product users have the option to check medication interactions in their Health app. GoodRx.com’s ‘Drug Info’ tab for each medication brings up a list of medication interactions, though you have to scroll quite a ways to get to it. As an example, the GoodRx.com entry for Ortho Tri-Cyclen, a popular HBC pill, lists over 160 medications it may interact with. RxList.com also has a birth control pills page that includes the most common medication interactions.
What options do you have if your medicine interferes with your birth control?
If your medicine interferes with your birth control, whether short-term or long-term, the most common recommendations are either to use a condom or to switch to another form of birth control, like the IUD. As we’ve covered before, though, when you opt for a condom you’re using a less reliable form of contraception. IUDs may also be problematic for a host of other reasons.
The only form of pregnancy prevention that is guaranteed not to cause physical or emotional side effects is fertility awareness, also known as natural family planning (NFP). Modern, evidence-based fertility awareness methods (FAMs) have little in common with the Rhythm Method of yesteryear and boast typical-use pregnancy prevention rates comparable to (and in some cases, better than) hormonal birth control. FAM or NFP users may even experience positive “side effects” like improved communication and respect within relationships, and increased body literacy.
References:
Additional Reading:
FAM Basics: Your hormones during a natural cycle vs. your hormones on the Pill
