9 Things to Know About Birth Control Interactions With Dietary Supplements and Herbal Remedies

Interactions between birth control and dietary supplements may be more common than many people think. Almost two-thirds of U.S women ages 15 to 49 use some form of birth control. And about the same percentage of women age 20 and older report taking a dietary supplement.

Overlap between supplements and birth control is bound to happen. But which supplements and herbs should you watch out for, and which are OK?

What types of birth control can interact with supplements?

When it comes to birth control, some methods are more likely to have interactions than others. Oral contraceptives (birth control pills) tend to have more interactions with supplements than other forms of birth control. Although still possible, interactions with supplements are less likely with nonoral forms of birth control, such as the patch or vaginal ring.

Why do birth control pills interact with supplements?

Birth control pills contain hormones to prevent pregnancy. Some pills contain estrogen combined with a progestin (lab-made progesterone), while others contain a progestin only.

The hormones in birth control pills need to be metabolized (broken down) by the body to work properly. This process depends mainly on our digestive tract and liver enzymes. Some supplements can affect this process and disrupt how pills are absorbed or metabolized. Other herbs or supplements may affect the levels of the hormones themselves.

Which herbs and supplements affect birth control?

Here’s an overview of common supplements and herbal remedies and how they affect birth control pills. Some should be avoided, while others are likely safe at standard doses. And some may even be beneficial to combine with birth control pills, though there’s limited data on this.

*Melatonin doesn’t affect birth control’s effectiveness. But birth control may raise your risk of melatonin side effects.

Below, we’ll review 12 common supplements and their effects on birth control. Be sure to talk to a healthcare professional before starting any new supplement, including the ones listed here as safe or beneficial. A healthcare professional can screen your medication list to check for interactions with other medications and health conditions.

1. Ashwagandha and birth control are likely safe

It’s likely safe to combine ashwagandha and birth control pills. Information is limited, but studies haven’t found ashwagandha to interfere with the metabolism of birth control pills. Short-term use of the supplement (up to 3 months) is likely safe for most people. Safety data on the long-term use of ashwagandha is lacking.

EXPERT PICKS: WHAT TO READ NEXT

• Other birth control interactions: Pharmacists review medications that interact with birth control, from antibiotics to HIV treatments.

• What to expect: Read about the potential side effects of birth control and how to manage them.

• Hormone-free birth control: Not all birth control methods contain hormones. Physicians review nonhormonal birth control options and their effectiveness.

Keep in mind that ashwagandha can cause uncomfortable side effects, such as vomiting and diarrhea. There are also a few case reports of mild and reversible liver injury with people taking the supplement. If severe, these side effects could affect the absorption or metabolism of birth control pills.

2. Melatonin and birth control are likely safe

Combining melatonin and birth control pills isn’t likely to affect the efficacy of your birth control. In fact, in the 1990s a few studies unsuccessfully looked at whether melatonin could be used as an active ingredient in birth control.

But there’s still a potential interaction between melatonin and birth control. Some research suggests that birth control pills may enhance melatonin’s effects. If you’re taking birth control, be sure to start with a lower melatonin dose until you know how it affects you.

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3. Avoid combining grapefruit and birth control

Grapefruit and birth control pills can be a problematic combination. Studies show that grapefruit products increase the amount of estrogen and progestin you absorb from birth control pills. This interaction doesn’t change the pill’s effectiveness. But it may raise your risk of side effects, such as nausea or tender breasts.

Grapefruit blocks the liver enzymes responsible for breaking down many medications, including birth control. Some other citrus fruits — including Seville oranges, pomelos, and tangelos — may also have this effect.

If you love grapefruit, ask a pharmacist or prescriber how much is OK to consume. They may give you the green light to have a small amount from time to time.

4. Avoid combining St. John’s wort and birth control

Don’t combine St. John’s wort and birth control. St. John’s wort can cause birth control pills to be less effective.

St. John’s wort influences our liver enzymes to break down the hormones in birth control pills too fast. This can cause irregular menstruation, breakthrough bleeding, or even unintended pregnancies.

Most studies focused on birth control pills, but it’s also possible that St. John’s wort interacts with other types of hormonal contraception, like patches and vaginal rings.

5. Avoid combining activated charcoal and birth control

It’s best to avoid combining activated charcoal and birth control. Depending on when activated charcoal is taken in relation to birth control pills, it can potentially make them ineffective.

Activated charcoal is sometimes included in “detox” products and supplements marketed to relieve bloating. But it’s traditionally been used in emergency situations to treat people who ingested toxic substances or poisons. It strongly binds to almost anything in the digestive tract, preventing absorption. If your birth control pill isn’t fully absorbed and metabolized before taking activated charcoal, the supplement will prevent your body from absorbing the pill.

6. Avoid combining fenugreek and birth control

Fenugreek and birth control don’t seem to directly interact. But it’s still a good idea to avoid combining them.

There’s a lack of safety and interaction studies when it comes to taking fenugreek supplements. But they can cause digestive-related side effects, such as nausea and vomiting. Liver injuries have also been reported by people taking fenugreek. As discussed above, these side effects can affect how your body absorbs and metabolizes birth control pills.

What’s more, there’s little evidence to support fenugreek’s proposed benefits. Because there’s a lack of safety and effectiveness data, you may want to avoid taking fenugreek and birth control.

Good to know: This information only pertains to fenugreek supplements. The amount of fenugreek that’s present in spices and foods is considered safe.

7. Combining probiotics and birth control may have some benefits

It’s likely safe to combine probiotics and birth control pills. There are no known interactions between them. And in some cases, taking probiotics might even be beneficial.

Some studies suggest that taking probiotics may help support vaginal health. There is also a recently completed clinical trial looking at whether probiotics could help reduce menstrual cramp pain. The results of this study haven’t been published yet.

More research is needed to confirm if probiotics have these reproductive health benefits. Your prescriber can help you decide if adding a probiotic to your lifestyle is right for you.

8. Avoid combining maca root and birth control

It’s a good idea to avoid combining maca root and birth control. There isn’t enough data to determine if there is an interaction between the two.

But we do know that maca root seems to influence hormones in the body, including increasing progesterone and estrogen levels. Because birth control pills also contain these hormones, there is concern for an interaction. More research is still needed to determine maca’s full effect on birth control.

9. Magnesium and birth control may have some benefits

In general, it’s OK to combine magnesium and birth control pills. In fact, this supplement may even have some benefits. Studies have linked birth control to lower levels of minerals, including magnesium.

But magnesium may have side effects. It can cause diarrhea, and severe or persistent diarrhea can interfere with birth control pill absorption. If this magnesium side effect happens to you, using a nonoral birth control option can help you avoid this interaction.

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Written by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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