MTHFR and Birth Control Pills. Ugh.

Naturally, MTHFR and birth control pills interact – it’s not like this is an easy mutation to live with in other senses, why would it leave our contraceptive options untouched? Complaining aside, I could have saved myself years of miserable experiences with the pill if I had known this.

MTHFR and birth control pills is a bad combination. Photo by Bryancalabro.

MTHFR and birth control pills is a bad combination. Photo by Bryancalabro.

Birth Control Pills Deplete Folate in Your Body

If you’re familiar with MTHFR mutations, then you’ve probably already figured out why this is a no-win situation for us MTHFR gals, but if you’re not then read on. Birth Control Pills are known to deplete folate levels in women and have been known to do so since the ’80s.  This is a problem for all women, but especially those who have compromised folate metabolism in the first place (ahem, that’s us MTHFR folks). This folate depletion is part of the reason for some of the most common side effects of birth control pills – fatigue, mild depression, even acne.  It’s also linked to an increased risk of neural tube defects in babies born to women who have recently stopped using birth control pills.

Due to the risk of neural-tube defects in women who become pregnant after recently stopping birth control pills, a new folate-fortified pill called Beyaz ® has been developed.  In good news, it is supplemented with an active form of folate so if you’re an MTHFR gal and you absolutely must take oral contraceptive pills, this one might be a good option for you.

If you don’t tolerate birth control pills and can’t figure out why, it could be because you have an MTHFR mutation – especially if you have signs of a folate deficiency even though you’re taking your birth control pills WITH a multivitamin or folate supplement.

Birth Control Pills also deplete B12, Magnesium and other nutrients

Not only is folate depleted, but its partner-in-crime B12 is depleted too.  B12 is also highly involved in the methylation cycle, and again this can be an issue for MTHFR folks (especially those with the related MTRR mutation) as well.  Nutrients to watch when taking birth control include:

  • Folate
  • B12
  • Magnesium
  • Vitamin C
  • B2 – Riboflavin
  • B6 – Pyridoxine
  • Zinc
  • Vitamin E
  • Selenium

Of course for MTHFR folks the folate is the biggest factor, but folate always works in tandem with other B vitamins so make sure you’re getting a good B complex supplement if you do choose to take birth control pills.

Birth Control Pills May Also Affect Serotonin Metabolism

In related bad news, Birth control pills may also affect your Serotonin metabolism (which might also be compromised in MTHFR folks because of this.)  This study, published in the Journal of Ayub Medical College, showed that there was a difference in serotonin levels between non-contraceptive users and oral contraceptive users that was statistically significant in pre-analysis but not statistically significant in post-analysis. That means that although there was a difference in the two groups, it wasn’t large enough that we can say with confidence that it wasn’t chance.  There was, however, a significant difference in serotonin levels for those using injectable contraceptives. Injectable contraceptives are a bad idea on so many levels, but let’s add this as another reason not to use them.

What Type of Contraceptive is Best for MTHFR Mutants?

Completely safe relative to MTHFR mutation types (other risks though – do your research!):

  • Condoms, Female Condoms
  • Copper IUD (non-progesterone secreting)
  • Vasectomy or tubal ligation

If you feel you must take hormonal contraception:

  • Use the lowest dose of hormone possible and make sure you’re adding extra supplements to counteract nutritional deficiencies. Consider Beyaz® but remember if you’re an MTHFR mutant you might still need additional active folate, and it doesn’t supplement any of the other nutrients it depletes so you’ll also need those.
  • Avoid using injections, pellets or implants simply because once they’re in you can’t get them out.  That means if your body doesn’t tolerate it you’re stuck with the side effects until the dose wears off.
  • If you’re considering getting pregnant, please stop all oral contraceptives at least a year before you start to try and make sure you work diligently during that year to boost your levels of all of the nutrients that may have been depleted.


8 thoughts on “MTHFR and Birth Control Pills. Ugh.

  1. Morgan


    I have taken LoLo Estrin Fe birth control for 8 years now but found out recently I am heterozygous for the C677T MTHFR gene. I know this means my folate metabolism is less affected (around 30%) than those with homozygous C677T; However, I am still concerned that perhaps I shouldn’t be on birth control? Should I worry about blood clots?

    1. amyneuzil Post author

      Hi Morgan,
      This is a great question, and honestly, there isn’t a great answer. As far as I know, we don’t have a lot of specific data about how each mutation interacts with particular birth control pills. My guess would be that with any MTHFR mutation your clot risk is probably higher than that of someone without any MTHFR issues, but how high is that? I think it comes down to a pro/con list. Taking vitamin E or a baby aspirin a couple of times per week can help with the clotting risk, and so can good fish oil daily (which is great for you in so many ways). So I’d say, if you don’t have side effects with the birth control pills and actually need them for birth control, then take steps to make sure you’re getting good methylfolate and also, make sure you’re working to prevent blood clots. If the birth control is giving you side effects or if you don’t actually need it for birth control, them maybe talk to your doctor about other options. Does that make sense?

  2. Jennifer

    I have homozygous A1298C. I also have PCOS but am not overweight and am not insulin resistant. I am being put on birth control for my PCOS because my ovaries are causing me constant low grade pain. 3-4/10 on the pain scale. What supplements can I take for my MTHFR? Also how do you feel about taking Myo-Inositol 2000mg and D-Chiro-Inositol 50mg? Are they affecting my pathways? Should I continue? I am so confused.

    1. amyneuzil Post author

      Hi Jennifer,
      It really does get confusing, doesn’t it? Yes for sure to the Inositol (both types), and honestly that by itself might clear up the ovarian pain without the birth control (of course, PCOS is unpredictable so it might not be enough.) Start the same way everyone else does with MTHFR – the best starting point is a good multivitamin with methylfolate in it instead of folic acid, then start to slowly increase the dose of the methylfolate with an additional supplement. Just go slow and listen to your body. Multivitamin is the first step! Here’s a whole post about finding the right dose of methylfolate for your body. I hope this helps!

    1. amyneuzil Post author

      Hi Marie,
      Prometrium is a progesterone-only pill, which in most situations is less risky than an estrogen-based pill (for risks like blood clotting, cancer, etc…). Unfortunately, there hasn’t been any research specifically about progesterone use in women with any of the MTHFR mutations. I did find one related study, but it is a case study about a blood clot in a woman who stopped progesterone supplementation. The only really useful information is “little is known about the relationship between the C677T mutation in the methylenetetrahydrofolate reductase gene and the progestogen-based preparations.” If you’d like to read the abstract or follow the full text link, you can do so here. So that is a really long answer but boils down to “we don’t really know.”

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