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St. John's wort + OCs may increase breakthrough bleeding: preliminary findings.(News)
LA JOLLA, CALIF. -- Taking St. John's wort with oral contraceptives causes significantly more breakthrough bleeding, as well as a trend toward less ovarian suppression, the development of more preovulatory follicles, and an increased tendency to develop transient follicular cysts, results of a small study suggest.
Although these findings are preliminary, there "may be a slight increase in someone's risk of unintended pregnancy if they are taking both agents together," Patricia Aikins Murphy, Ph.D., the study's lead investigator, said at the annual meeting of the Association of Reproductive Health Professionals.
St. John's wort, a popular herbal supplement used to treat depression and other mood disorders, has been implicated in the induction of cytochrome P450, the family of enzymes responsible for drug metabolism. This in turn may increase drug metabolism and reduce serum levels of the drug. "Any agent that could induce more rapid metabolism of contraceptive steroid raises the theoretical risk of contraceptive failure and unintended pregnancy," Dr. Murphy explained.
Cautions about the use of St. John's wort with birth control pills have been published during the past 3 years by the Food and Drug Administration and other organizations based on case reports, said Dr. Murphy, an associate research scientist in the department of ob.gyn. at Columbia University, New York.
In her study, which was funded by the National Center for Complementary and Alternative Medicine, Dr. Murphy and her associates enrolled 16 women aged 18-35 years who were eligible to take oral contraceptives.
All participants took a low-dose oral contraceptive (20 [micro]g ethinyl estradiol and 1 mg norethindrone) for four cycles. They also took a ground-cellulose placebo for cycles one and two and St. John's wort (300 mg t.i.d.) for cycles three and four.
A single-blind, placebo-controlled sequential trial design was chosen because "we didn't know what the effect of St. John's wort might be, or how long it might last, so it became difficult to figure out how to time the crossover," Dr. Murphy noted.
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Source: HighBeam Research, St. John's wort + OCs may increase breakthrough bleeding: preliminary...