What supplements are recommended for a woman using hormonal contraceptives (birth control)?

Supplements Needed for Women Using Hormonal Contraceptives

Women using hormonal contraceptives should take supplements containing folic acid, vitamins B2, B6, B12, vitamin C, vitamin E, magnesium, selenium, and zinc to prevent nutrient depletion associated with contraceptive use. 1

Key Nutrient Depletions with Hormonal Contraceptives

Research has identified several important nutrient depletions that occur in women taking hormonal contraceptives:

Vitamins

• Vitamin B Complex:

  • Vitamin B6 (Pyridoxine): Multiple studies show significant depression in plasma pyridoxal 5'-phosphate concentrations in oral contraceptive users 2
  • Vitamin B2 (Riboflavin): Decreased levels observed in contraceptive users 1, 3
  • Vitamin B12: Some studies show lower levels, though functional indicators are not significantly impacted 2
  • Folic Acid: Reduced red cell and serum folate levels in contraceptive users 4

• Other Vitamins:

  • Vitamin C: Depleted with oral contraceptive use 1, 3
  • Vitamin E: May be depleted in some users 1

Minerals

• Zinc: Significant depletion observed 1, 3
• Magnesium: Reduced levels in contraceptive users 1
• Selenium: Lower levels reported 1

Supplement Recommendations

Based on the evidence, women using hormonal contraceptives should consider:

1. Daily multivitamin containing:
   • B-complex vitamins (particularly B6, B2, B12)
   • Folic acid (400 mcg minimum)
   • Vitamin C
   • Vitamin E
   • Zinc
   • Magnesium
   • Selenium

Clinical Considerations

When to Start Supplementation

• Ideally, start supplements when beginning hormonal contraceptive use
• Supplementation is particularly important for women who:
  • Have inadequate dietary intake
  • Follow restrictive diets
  • Have unhealthy lifestyle habits
  • Have conditions affecting nutrient absorption 1

Special Populations Requiring Additional Attention

• Women planning pregnancy after discontinuing contraceptives should be particularly vigilant about folate and B6 supplementation 2
• Women with poor nutritional status at baseline may need higher supplement doses

Common Pitfalls to Avoid

• Not recognizing the need: Many clinicians fail to advise women about potential nutrient depletions when prescribing contraceptives
• Assuming all contraceptives have the same effect: Higher estrogen formulations may have more significant nutrient impacts 2
• Overlooking individual risk factors: Women with poor diet or malabsorption conditions need more careful monitoring

Monitoring Considerations

• Consider baseline assessment of nutritional status for women with risk factors for deficiency
• Monitor for signs of deficiency, particularly if contraceptive use continues for several years
• Pay special attention to folate and B6 status in women discontinuing contraceptives who may become pregnant

While some older studies with higher-dose contraceptives showed more dramatic nutrient depletions, current research still supports the need for supplementation, particularly for B vitamins, vitamin C, and certain minerals in women using hormonal contraceptives 1, 2.