Since its inception in 1960, hormonal birth control has empowered women, giving them autonomy and the freedom to choose their path in life. Today, 14% of women ages 15-49 take an oral contraceptive. 10.4% of women ages 15-49 use an IUD (of which there are hormonal and one non-hormonal option, the copper IUD), or a hormone-releasing contraceptive implant. (Source)
While hormonal birth control has, in many ways, been an incredible boon to women, it also has the potential to create several health problems, including potential gut microbiome imbalances, mood challenges, and antioxidant and nutrient deficiencies. (Source, Source, Source)
In this article, we’ll be focusing on how hormonal birth control can cause antioxidant and nutrient deficiencies and how to help replenish them to support overall health.
Types of Hormonal Birth Control and How They Work
Before diving into the potential nutrient deficiencies caused by hormonal birth control, it will help to understand several popular types of hormonal birth control and how they work.
- The combination birth control pill: This option combines non-bioidentical, synthetic estrogen (ethinyl estradiol) and non-bioidentical, synthetic progesterone (progestin). The pill works by shutting down brain signaling to the ovaries, preventing ovulation. No ovulation = inability to get pregnant. It also prevents pregnancy in several other ways, including making the lining of the uterus less hospitable to the implantation of an embryo.
- Progestin-only pill (mini pill): This option delivers only non-bioidentical, synthetic progesterone (progestin) with no synthetic estrogen. It prevents pregnancy by thickening cervical mucus, making it harder for sperm to travel to an egg. Like the combination pill, it also changes the lining of the uterus, making it less hospitable to an embryo.
- Hormonal birth control implant (Implanon and Nexplanon): The implant is a small rod inserted into the arm that releases progestin. It prevents ovulation and thickens cervical mucus.
- Birth control shot (Depo-Provera): The Depo-Provera shot contains progestin and prevents pregnancy like other progestin-containing birth control options do.
- Hormonal IUD: The hormonal intrauterine device (IUD) is a small T-shaped device inserted into the uterus by a medical provider. The hormonal version of the IUD releases progestin.
- Birth control patch: This transdermal (applied to the skin) patch contains synthetic estrogen and progestin. It must be changed weekly. It prevents pregnancy through the same mechanisms described above for other estrogen and progestin-containing birth control options.
- Vaginal ring: The vaginal ring is a small ring inserted into the vagina for three weeks and then removed for one week each cycle. It also contains synthetic estrogen and progestin.
The critical thing to remember is that hormonal birth control introduces non-bioidentical, synthetic hormones into the body. These hormones are not molecularly the same as the hormones your body makes. Thus, there is a heavy burden to the body as it continuously processes these hormones, which can negatively influence nutritional status.
How Hormonal Birth Control Depletes Nutrients and Antioxidants
Research shows that taking the birth control pill can deplete many nutrients, including folate, riboflavin, vitamin B6, vitamin B12, vitamin C, vitamin E, magnesium, selenium, and zinc. Non-pill forms of hormonal birth control, such as IUDs and implants, may have similar nutrient-depleting effects. (Source)
How does hormonal birth control deplete the body of nutrients? It may have to do with the non-bioidentical, synthetic estrogen and progestin used in birth control products; these non-bioidentical hormones may alter how the body absorbs and metabolizes nutrients, leading to lower nutrient levels. (Source) Why is this a concern? The body requires these nutrients to function optimally.
VITAMIN B9 – FOLATE
For example, hormonal birth control can lessen folate, also known as vitamin B9. Folate deficiency increases the risk of adverse pregnancy outcomes, including abnormalities in fetal development. This is very concerning since many women who come off hormonal birth control want to conceive but may have an undiagnosed folate deficiency. Folate deficiency can drive serious problems during pregnancy, including impaired fetal nervous system development. Folate deficiency also causes mood challenges, problems with red blood cell development, and cardiovascular complications. (Source, Source)
VITAMIN B2 – RIBOVLAVIN
Riboflavin, or vitamin B2, is also drained by hormonal birth control. Riboflavin is essential for cellular energy production and antioxidant function. A deficiency can impair methylation and cause cardiovascular complications, among many other symptoms. (Source)
VITAMIN B12 – COBALAMIN
Vitamin B12 is crucial for a healthy brain and mood. It supports the fatty myelin sheath around neurons, allowing them to conduct signals properly. It also helps form neurotransmitters, communication molecules that support things like appetite, mood, and the sleep/wake cycle. A vitamin B12 deficiency can adversely affect your emotional state and cognition. (Source)
VITAMIN B6 – PYRIDOXINE
Hormonal birth control also exhausts the body’s supplies of vitamin B6, which is necessary for converting the food you eat into energy and neurotransmitter synthesis, including GABA (your body’s primary calming neurotransmitter) and serotonin (your “feel-good” neurotransmitter). (Source, Source)
MINERALS + ANTIOXIDANTS
The minerals magnesium, selenium, and zinc are also influenced by hormonal birth control as are the antioxidant vitamins C and E. Magnesium regulates cortisol and estrogen metabolism and supports healthy blood sugar control, selenium aids thyroid health, and zinc is vital for healthy mood and immune function. (Source, Source, Source, Source, Source, Source)
Emerging research indicates that hormonal birth control increases oxidative stress, an imbalance between the production of free radicals called reactive oxygen species (ROS) and the availability of antioxidants to quench them. Hormonal birth control may reduce the activity of enzymes involved in synthesizing glutathione, your body’s premier antioxidant molecule. (Source)
Vitamins C and E are necessary for glutathione recycling, while selenium is a cofactor for the enzyme glutathione peroxidase, which utilizes glutathione to quench free radicals. Therefore, depletion of vitamin C, vitamin E, and selenium by hormonal contraceptives may lower glutathione levels even further.
Why does birth control increase oxidative stress? Remember, oxidative stress is caused by free radical activity. Research suggests that the process of detoxifying these synthetic hormones causes more free radical production, drawing down the body’s natural glutathione levels leaving the body more susceptible to oxidative damage. (Source)
Hormonal Birth Control’s Many Side Effects
Women on hormonal birth control frequently experience side effects, ranging from uncomfortable to debilitating. Potential side effects include:
- Weight management
- Changes in appetite
- Mood challenges
- Loss of libido
Nutrient depletions caused by hormonal birth control may play a role in these troubling side effects. For example, vitamin B12 deficiency is known to cause fatigue and mood issues, while low magnesium can trigger nervousness and lower resilience to stress. (Source, Source)
How to Replenish Nutrients While on Hormonal Birth Control
Interestingly, preliminary research suggests that supplementing with specific nutrients while on hormonal birth control may help alleviate many of these symptoms and help bring your body back into balance! (Source)
Start with Your Diet!
Your diet is the ideal place to start for improving nutrient stores in your body. Here are the top food sources of the nutrients most likely to be exhausted by birth control:
- Folate: Liver, leafy greens, legumes (beans), beets, avocado, and strawberries
- Riboflavin: Liver, mushrooms, leafy greens, eggs, legumes, and squash
- Vitamin B6: Root vegetables, bananas, red meat, poultry, sunflower seeds, and pumpkin seeds
- Vitamin B12: Sardines, salmon, tuna, cod, shrimp, scallops, liver, beef, poultry, and eggs
- Vitamin C: Bell peppers, dark leafy greens, citrus fruits, and kiwi
- Vitamin E: Nuts, seeds, dark leafy greens, fatty fish, liver, avocados, and olives
- Magnesium: Dark green vegetables, nuts, seeds, fish, and avocado
- Selenium: Brazil nuts, red meat, poultry, fish, shellfish, and mushrooms
- Zinc: Oysters, red meat, poultry, nuts, seeds, and legumes
Dietary Supplements to Replenish Nutrients and Antioxidants
Because of environmental and health factors such as soil nutrient depletion, chronic stress, and gut issues, diet alone is often insufficient for optimizing nutrient levels. This is where supplemental vitamins, minerals, and antioxidants come in!
Choose a Highly Bioavailable Multivitamin
A high-quality multivitamin is a proactive place to start for many women on hormonal birth control as they typically contain all of the foundational vitamins mentioned above.
When selecting a multivitamin, choose one that provides nutrients in their most bioavailable forms. For example, folate should be supplied as methylfolate or folinic acid, not as folic acid, a synthetic form of folate that is much less bioavailable. The same applies for B12, choose a supplement using the methylated form of B12 called methylcobalamin.
Glutathione Supplementation for Oxidative Stress
In addition, glutathione supplementation may be beneficial for replenishing this vital antioxidant depleted by hormonal birth control.
While our bodies can synthesize glutathione, the amount of glutathione our bodies can produce may not be enough to keep up with birth control-induced glutathione depletion. A bioavailable glutathione supplement can increase your levels of this crucial antioxidant, combating oxidative stress and restoring balance to your body.
The Bottom Line on Hormonal Birth Control and Nutrient Deficiencies
The importance of a nutrient-dense diet and quality supplementation for women on hormonal birth control cannot be overstated. While birth control pills, IUDs, implants, injections, and patches offer women the power to control their reproductive health, they can deplete numerous nutrients and lower overall well-being.
By eating a balanced diet and incorporating a thoughtful supplement routine, women can help counteract birth control-induced nutrient deficiencies, support oxidative stress, and feel healthy and vibrant in their bodies!
by Lindsay Christensen, MS, CNS, LDN, A-CFHC, CKNS
Fallah, S., Valinejad Sani, F., & Firoozrai, M. (2011). Effect of contraceptive pills on the activity status of the antioxidant enzymes glutathione peroxidase and superoxide dismutase in healthy subjects. Contraception, 83(4), 385–389. https://doi.org/10.1016/j.contraception.2010.07.026
FastStats – Contraceptive Use. (2019). Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/contraceptive.htm
Kolanu, B. R., Vadakedath, S., Boddula, V., & Kandi, V. (2020). Activities of serum magnesium and thyroid hormones in pre-, peri-, and post-menopausal women. Cureus. https://doi.org/10.7759/cureus.6554
Mu, E., & Kulkarni, J. (2022). Hormonal contraception and mood disorders. Australian Prescriber, 45(3), 75–79. https://doi.org/10.18773/austprescr.2022.025
Ortizo, R., Lee, S. Y., Nguyen, E. T., Jamal, M. M., Bechtold, M. M., & Nguyen, D. L. (2017). Exposure to oral contraceptives increases the risk for development of inflammatory bowel disease. European Journal of Gastroenterology & Hepatology, 29(9), 1064–1070. https://doi.org/10.1097/meg.0000000000000915
Pickering, G., Mazur, A., Trousselard, M., Bienkowski, P., Yaltsewa, N., Amessou, M., Noah, L., & Pouteau, E. (2020). Magnesium status and stress: The vicious circle concept revisited. Nutrients, 12(12), 3672. https://doi.org/10.3390/nu12123672
Porcaro, G. & Angelozzi, P. (2019). Supplementation with specific micronutrients reduces the adverse effects of combined oral contraceptive treatment. International Journal of Medical Device and Adjuvant Treatments, 2, e194. DOI: 10.32113/ijmdat_20197_194
Riboflavin. (2014, April 22). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/vitamins/riboflavin#disease-prevention
Sanchez Z, L. (2022). Navigating potential nutrient depletions in college women taking birth control pills and creation of a booklet guide “Eat for your hormones.” Nutrition Masters Projects. https://doi.org/10.57709/30445023
Tardy, A.-L., Pouteau, E., Marquez, D., Yilmaz, C., & Scholey, A. (2020). Vitamins and minerals for energy, fatigue and cognition: A narrative review of the biochemical and clinical evidence. Nutrients, 12(1), 228. https://doi.org/10.3390/nu12010228
Traber, M. G., & Stevens, J. F. (2011). Vitamins C and E: Beneficial effects from a mechanistic perspective. Free Radical Biology and Medicine, 51(5), 1000–1013. https://doi.org/10.1016/j.freeradbiomed.2011.05.017
Ventura, M., Melo, M., & Carrilho, F. (2017). Selenium and thyroid disease: From pathophysiology to treatment. International Journal of Endocrinology. https://www.hindawi.com/journals/ije/2017/1297658/
Vitamin B12. (2014, April 22). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12#disease-prevention
Yosaee, S., Clark, C. C. T., Keshtkaran, Z., Ashourpour, M., Keshani, P., & Soltani, S. (2022). Zinc in depression: From development to treatment: A comparative/dose-response meta-analysis of observational studies and randomized controlled trials. General Hospital Psychiatry, 74, 110–117. https://doi.org/10.1016/j.genhosppsych.2020.08.001