What Vitamins Should I Take While On Birth Control?

Overview

There are many different forms of birth control, but the focus here today will be on hormonal birth control pills (BCP). “The pill”, or oral contraceptives, are a prescription drug used by many people assigned female at birth. BCP contains synthetic hormones and by taking 1 pill a day you are preventing pregnancy. 

There are two types of BCP; the combination pill, which contains both oestrogen and progestin, and the mini pill, which only contains progestin.¹

How Does Birth Control Work?

When you use this type of hormonal BCP, you prevent your ovulation, by suppressing your LH and FSH levels. When there is no ovulation, there is no egg to be fertilised by the sperm and no pregnancy.¹

Side effects of birth control 

Many people use BCP for the good side effects: it can help regulate and ease irregular, heavy, and/or painful periods, like with endometriosis or PCOS. BCP may also be used to skip periods altogether! Some BCP can help mitigate acne breakouts, iron deficiency, bone thinning, cysts in your breasts and ovaries, and certain cancers.

Some BCP users experience negative side effects too, like headaches, nausea, tender breasts, mood swings, spotting, or changes in their periods. For the lucky ones, these side effects will ease off in about 2-3 months. If they don’t, please go see your doctor to discuss another type of birth control, as it is not supposed to make you feel uncomfortable!

Moreover, it was found that using BCP will change your nutritional requirements, and if you are unaware it can even lead to a vitamin deficiency.¹ The World Health Organization (WHO) published a report which pointed out the influence of BCP on nutrient requirements.²  It describes that the key deficiencies of concern are folic acid, vitamin B2, B6, B12, vitamin C, and E. Additionally, a mineral deficiency in magnesium, selenium, and zinc was observed.^2,3

Are vitamin deficiencies a risk for all forms of birth control 

Most vitamin deficiencies are generally linked to forms of birth control containing estrogen, like the most common combination pill. Additionally, there is also a contraceptive patch and a vaginal ring that contains oestrogen.¹  Other forms of hormonal birth control that do not contain oestrogen include the mini pill, contraceptive implant, the contraceptive injection, and an intrauterine system (IUS) all of which use the hormone progestogen.¹ 

What vitamins should I take while on birth control 

If you are using BCP that contains oestrogen, and you worry about a vitamin deficiency you can see your doctor and get a blood test. Additionally, you can get some OTC vitamin supplements. 

Magnesium

You need magnesium for proper brain function and bone health, but also for heart and muscle activity. It helps turn the food we eat into energy and to help the parathyroid glands produce hormones. Magnesium is an essential mineral and is involved in many biological processes. According to the NHS, the amount of magnesium you need if you are a person who was assigned male at birth: is 300 mg a day (19-64 years) and if you are a person who was assigned female at birth (19-64 years) you need 270 mg per day.⁴ Food sources that contain this essential mineral include leafy greens, dairy, nuts, legumes, and whole grains.⁵

Folic acid

Folic acid is a manmade form of folate and is also known as folacin or vitamin B9. It is a very important vitamin when you are trying to conceive, so it is wise to start taking prenatal vitamins when you are taking BCP-containing oestrogen when you are planning to have a baby in the near future. It will help to reduce the risk of birth defects called neural tube defects, such as spina bifida in unborn babies. Folate is key in helping the body form healthy red blood cells, without which you may end up with folate deficiency anaemia. Food sources containing folate include cruciferous vegetables, peas, chickpeas and kidney beans, liver, and of course breakfast cereals fortified with folic acid. Adults need 200 micrograms of folate a day.⁶

Zinc

We need zinc to help process our food. It aids in the breakdown and absorption of carbohydrates, proteins, and fats. It also helps with making enzymes.⁷ 

If you are a person assigned male at birth, you need 9.5 mg a day (aged 19 to 64 years). If you are a person assigned female at birth, 7 mg a day. You should be able to get this from your daily diet if your diet is varied and balanced.⁴ Great sources of zinc are dairy, meat, shellfish, legumes or beans, nuts, bread, and other cereal products.⁴ Seeds, like hemp, pumpkin, and sesame also contain significant amounts of zinc.⁸

Vitamin B12

Vitamin B12, also known as cobalamin, helps your body make red blood cells and keeps the nervous system functioning. It has a role in the synthesis of DNA and fatty acids.⁹ It also helps with the release of energy from the food you eat. When you lack vitamin B12 in your system it can lead to vitamin B12 deficiency anemia. Great sources of B12 are meat, fish, dairy and eggs. Adults (aged 19-64) need roughly 1.5 micrograms per day. When you are practicing veganism, please note that vitamin B12 is not found in fruits and veg.⁶

Vitamin E

We all know about vitamin E and its qualities to help keep your skin healthy, but it also strengthens your immune system. Good sources of vitamin E include nuts and seeds, wheatgerm but also plant oils like; sunflower and olive oil. 

If you are a person assigned male at birth, you need 4 mg a day (aged 19 to 64 years). If you are a person assigned female at birth, 3 mg a day.
Fun fact: any vitamin E that you do not need right away, your body stores for the future so you do not need a daily supply in your diet. However, if you do choose to take supplements, be sure to not take more than 540 mg (800 IU).¹⁰

Iron

A lack of iron will cause you to feel tired and drained as iron is important in making red blood cells. These cells carry oxygen around your body. If you fall short, you may get iron deficiency anaemia.

Good sources of iron include red meat, liver, beans, nuts, and fortified bread, and cereals.

If you are a person assigned male at birth, you need 8.7 mg a day (aged over 18). If you are a person assigned female at birth, 14.8 mg a day (aged over 19-50) and 8.7 mg if you are 50+.
Some people with heavy monthly periods, risk becoming anaemic. In this case, you may want to take iron supplements. Please take no more than 20 mg per day as this could have some side effects like constipation. Always keep the iron supplements out of reach of children, as an iron overdose in children can be fatal!¹¹

The mechanism by which BCP deplete vitamin levels in your body is still being heavily studied as they are not fully understood yet. The general consensus is that the use of oral contraceptives containing oestrogen causes lower levels of the above-mentioned vitamins and potentially more. 

For folate and vitamin B12 it is believed that BCP impairs the uptake pathway and so decreases the serum levels, possibly through the tryptophan levels available to the brain, altering the tryptophan metabolism.^9,12  Tryptophan is an essential amino acid needed to make vitamin B3 (niacin) and serotonin.³ For this, we also need the active form of vitamin B6: coenzyme pyridoxal phosphate. Vitamin B6 is also thought to modulate magnesium levels.^3,9,12  

Vitamin E is formed from antioxidants like vitamin C. Studies have shown that oestrogen increases oxidative stress in the body, using up antioxidants more rapidly and thus depleting vitamin C levels. When the vitamin C levels are low, subsequently the vitamin E levels will be low too.^11,12

We can see how all these factors may well work together to achieve homeostasis and when there is an imbalance it has consequences for the other counterparts in the system.

Which vitamins can interfere with birth control?

Because of the delicate hormonal balance created, certain supplements or vitamins can cause interference with the normal functioning of BCP. Antibiotics are one of these groups that can decrease the effectiveness of birth control, but also antifungals, antiretroviral, anti-seizures meds out there and even melatonin can tamper with the effectiveness.^13,14

It is suggested that vitamin C can also decrease the effectiveness of BCP because it can cause your oestrogen levels to rise.⁹ Moreover, the herbal supplement St. John’s wort can also reduce the efficiency of your BCP.¹⁵

Studies have shown that taking BCP can cause your body to store vitamin A. Because of this, you might want to hold off on taking extra vitamin A as this could lead to toxicity.¹⁶ Additionally, the same goes for iron and copper.¹⁷

Summary 

When using BCP that contains the hormone oestrogen you want to make sure that your vitamin levels are doing well too. Even subtle changes in your metabolism can build up to have negative effects when you are using BCP over the years. Speak to your doctor if you feel unwell or unhappy with your form of birth control as it is there to improve your quality of life and not to impair it.