Can you take birth control and bioidentical hormones (BH) at the same time?

Taking Birth Control and Bioidentical Hormones Simultaneously

It is not recommended to take birth control pills and bioidentical hormones at the same time due to potential interactions, redundancy in hormonal effects, and lack of evidence supporting this combination. 1

Understanding the Contraindications

Birth control pills (combined hormonal contraceptives or progestin-only pills) and bioidentical hormones serve different purposes but both affect the body's hormonal balance:

• Birth control pills contain synthetic or bioidentical hormones specifically formulated for contraception
• Bioidentical hormones are typically used for menopausal symptom management and are designed to be structurally identical to endogenous hormones

Potential Issues with Combined Use

1. Redundant Hormonal Effects

   • Birth control pills already provide hormonal regulation
   • Adding bioidentical hormones creates unpredictable hormone levels
   • No standardized dosing guidelines exist for this combination 2

2. Safety Concerns

   • Combined use may increase risks associated with excess hormones:
     • Thromboembolism risk
     • Hypertension
     • Cardiovascular complications 3

3. Lack of Evidence

   • No clinical trials support the safety or efficacy of concurrent use
   • The FDA has not approved any combined regimen 4

Appropriate Alternatives

For Women Seeking Contraception

If contraception is the primary goal:

• Combined hormonal contraceptives (estrogen + progestin) are effective but contraindicated in women with:

  • Severe hypertension (≥160/100 mmHg)
  • Vascular disease
  • High risk of thromboembolism 3

• Progestin-only pills (POPs) are appropriate for women who:

  • Are breastfeeding
  • Have contraindications to estrogen
  • Have cardiovascular risk factors 1

For Women Seeking Hormone Therapy

If managing menopausal symptoms is the goal:

• FDA-approved bioidentical hormone options include:
  • 17β-Estradiol for menopausal symptoms
  • Progesterone for endometrial protection
  • Combination products like Bijuva (1mg estradiol/100mg progesterone) 5

Clinical Decision Algorithm

1. Determine primary need:

   • Contraception
   • Menopausal symptom management
   • Both

2. If contraception is needed:

   • Choose appropriate contraceptive based on medical history
   • Consider non-hormonal options if hormone therapy is already being used

3. If menopausal symptom management is needed:

   • Consider FDA-approved bioidentical hormone options
   • Discontinue contraceptives if no longer needed for pregnancy prevention

4. If both are needed:

   • Consider using a bioidentical hormonal contraceptive that may also address menopausal symptoms
   • Avoid combining separate products

Important Monitoring Considerations

• Blood pressure measurement is essential before initiating any hormonal therapy 3
• Regular follow-up to assess efficacy and side effects
• Monitor for signs of thromboembolism, especially in the first months of use

Common Pitfalls to Avoid

• Unregulated compounded bioidentical hormones lack standardization and quality control 2, 4
• Salivary hormone testing to guide dosing is not evidence-based and should be avoided 4
• Self-adjustment of doses based on symptoms without medical supervision increases risks

Remember that while both birth control and bioidentical hormones may contain similar hormones, they are formulated for different purposes and at different doses. Using them together creates unpredictable hormone levels and potential safety concerns.