St John’s Wort and the contraceptive pill

St John’s Wort is a popular over the counter herbal remedy used to treat mild to moderate depression, mild anxiety, insomnia and even seasonal affective disorder. However, despite doctors making it clear that it can stop the contraceptive pill from working many women are still unaware of this.

St John’s Wort not only affects the contraception pill but has also been found to affect the effectiveness of the implants as well, leading to unplanned pregnancies and breakthrough, dysfunctional bleeds.


How does St John’s Wort work? 

The herbal remedy is thought to work is a similar way to standard antidepressant treatments. It increases the activity of certain brain chemicals, serotonin and noradrenaline, that play an important part in regulating your mood. The plant contains many substances, including hypericin and hyperforin, that increase its antidepressant properties. Though, exactly how is not yet fully understood.


How does it affect the contraceptive pill? 

St John’s Wort treatment contains an enzyme called cytochrome P40 which increases the rate of metabolism of the pill. This reduces the effectiveness of the pill by causing a reduced concentration of the contraceptive in the body.

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Does St John’s Wort interact with other medication? 

Yes. St John’s Wort has a number of significant interactions with other medication as well as the contraceptive pill. These include prescription and over the counter medication. Some of the most common interactions, other than the contraception pill, are:

  • Antidepressants: you shouldn’t take St John’s Wort at the same time as prescription antidepressants such as SSRIs. The combination of the two can cause serotonin syndrome or make your depression worse.
  • Sleeping pills taken in conjunction with St John’s Wort may lead to prolonged effects.
  • Anaesthetics: whether you are receiving a general or local anaesthetic, you should always inform your anaesthetist of any prescription or herbal medication you have taken.

Before taking St John’s Wort with any other medication it is always important to speak your GP or a pharmacist for advice.

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What are the alternatives to St John’s Wort? 

There are a variety of alternative treatments for depression and anxiety. These including talking therapies, such as cognitive behavioural therapy (CBT), medications such as selective serotonin reuptake inhibits (SSRIs) and alternative treatments such as mindfulness.

Different people find different combinations and treatments helpful. Talking to a doctor about your different options can be a useful guide, you may find that you need to try a few different treatments before the right one fits. Rest assured a doctor will be able to advise you on any drug interactions so  that your contraception is still effective.

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