Herbal Supplements and Birth Control
Updated: May 23, 2020
We’ve received a few questions recently about interactions between herbs and hormonal birth control, so I’ll address them all here.
Erica would like to use Shakeology but wonders if some of its herbal ingredients – ashwaganda (Withania somnifera), reishi (Ganoderma lucidum), and chaga (Inonotus obliquus) – are safe to use together and if they might interfere with the Xulane patch she is using since an ashwagandha-containing supplement interfered with a birth control pill in the past.
Rachel would like to use a supplement called Mental Clarity but has read that the rhodiolia it contains will decrease the effectiveness of the birth control pill that she is taking.
And Lori is concerned that the ashwagandha supplement she uses will interfere with the progesterone only birth control pill that she takes.
The main types of interactions that hormonal contraceptives are vulnerable to are with substances that affect detoxification enzymes in the liver and substances that affect levels of sex hormone binding globulin (SHBG), a protein that transports hormones through the bloodstream.
The relevant interaction for botanicals is the one related to liver detoxification enzymes, so let’s focus on that. Hormones are broken down through detoxification pathways in the liver, which employ a family of enzymes called cytochrome P450 or CYP for short. The specific enzyme that breaks down hormones so they can be excreted is called CYP3A4. Any substance that affects the activity of CYP3A4 can interfere with hormonal contraceptives. If CYP3A4 activity is inhibited the result is too much drug in the bloodstream, if CYP3A4 activity is induced the result is too little drug in the bloodstream. The main concern with herbs and hormonal contraceptives is St. John’s Wort (Hypericum perforatum), which is a potent inducer of CYP3A4 activity.
Ashwaganda, reishi, chaga, and rhodiola are not known to interact with CYP3A4 or SHBG, so I wouldn’t expect them to interfere with hormonal birth control. A quick internet search suggests that these concerns stem from a misunderstanding of herbal adaptogenic activity in the body. Adaptogens have a general normalizing effect, primarily resulting from modulation of the neuro-endocrine stress response. This can have an indirect, normalizing effect on the reproductive system and other body systems but is not known to alter the levels or activity of birth control.
An important caveat: Every body is different. If you and/or your physician believe that an herb has interfered with your birth control in the past it is reasonable to think it could interfere with your current prescription and it would be advisable to avoid it.
You may also be interested this ATH post by Amani Elsawah
(1) Oral Contraceptives Are Susceptible to Several Interactions https://www.pharmacytimes.com/publications/issue/2019/may2019/oral-contraceptives-are-susceptible-to-several-interactions (accessed May 15, 2020).
Renata is a clinical herbalist with a private practice in Greenbelt, MD. She helps women build a solid foundation of wellness while working together to address their unique health concerns so they can live life with vibrance and vitality. She has a BS in Chemistry from University of Maryland, a MS in Therapeutic Herbalism, and a Post Masters Certificate in Clinical Herbalism from Maryland University of Integrative Health. Find her at renalynn.com and on Facebook @renatalynnclinicalherbalist and sign up her newsletter here.