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Is there an interaction between St John’s Wort and hormonal contraceptives?

Publisher: East Anglia Medicines Information Service

Keywords: contraceptives, contraceptives-oral, contraceptives-post coital, contraceptive devices, condoms, progestogen, ethinyloestradiol, levonorgestrel, intrauterine devices, hypericum, hypericin, enzyme induction, pregnancy, drug interactions, St. John's Wort

Date published: 03/02/2012 11:23

Review date: 31/01/2014 11:00

Summary
by: Victoria Gibson
  • The interaction between oral contraceptives and St John's Wort appears to be established. Its incidence is not known, but the limited poor quality evidence so far, suggests that breakthrough bleeding may be a problem.  Pregnancy resulting from this interaction has occurred but appears to be uncommon and it is not known who is most at risk.
  • Health professionals supplying hormonal contraception should ask women about their current and previous drug use including prescription, over the counter, herbal, recreational drugs and dietary supplements.
  • Women using hormonal contraception should be informed about the potential for interactions with other drugs and the need to seek the advice of a health professional before starting any new drugs including herbal of dietary supplements.
  • The recommendation of the CSM/MCA and the Faculty of Sexual and Reproductive Health Care (FSRH) in the UK, is that women taking oral contraceptives (both combined and progestogen-only pills) should either avoid St John's Wort or they should use an alternative form of contraception, unaffected by enzyme inducers [e.g. progestogen only injectable, copper bearing intrauterine devices (Cu-IUDs) or the levonorgestrel containing intrauterine device].
  • If St John's Wort is continued, the general guidelines for the use of liver enzyme inducers with hormonal contraceptives issued by the FSRH Clinical Effectiveness unit should be followed.

 

About this library entry
Category: Drug Interactions | Family planning | Herbal medicine
NeLM area:  Evidence > Medicines Q & A
QandA214.2SJWandhormonalcontraceptives.doc

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