St John’s Wort and Your Hormone Levels

St John’s Wort is one of oldest and most popular herbal medications we use.

It is primarily used for mood enhancement and treatment of depression. This herb likely works through the serotonin pathway. There are many known side effects and one is to induce sexual dysfunction.

Information regarding the herbal medicine can be found in many places including the government site listed here: https://nccih.nih.gov/health/stjohnswort/ataglance.htm

If relying on oral contraceptive pills for protection against pregnancy, you may want to consider back up. Some new evidence in the journal Contraception indicates a greater risk of ovulation and breakthrough as well as reduced contraceptive effectiveness when St. John’s wort is taken with standard combined oral contraceptives (COCs). The reason is in the complex metabolism of the estrogen and progesterones in birth control which are metabolized through the CYP3A4 substrate. St. John’s wort is a strong inducer of the CYP3A4 enzyme meaning that it will cause that enzyme to more effectively metabolize those hormones through this pathway. Thus the hormonal concentration could be lowered if this herb is taken in women taking birth control pills. Although the CDC doesn’t add this precaution.

The CDC downgraded St. John’s wort from category 1 to a 2, still meaning the advantages of the method outweigh any possible concerns, stating: “Evidence: Although clinical data are limited, studies with pharmacokinetic and pharmacodynamics outcomes raise concern that St. John’s wort might decrease effectiveness of hormonal contraceptives, including increased risk for breakthrough bleeding and ovulation and increased metabolism of estrogen and progestins. Any interactions might be dependent on the dose of St John’s wort, and the concentration of active ingredients across types of St. John’s wort preparations may vary.” on the CDC website.

Combining St. John’s Wort and oral contraceptive pills could cause increased breakthrough bleeding.

Not every herbal is the same, and some of the products of St. John’s wort have different levels of the active ingredient hypericin and this could lead to greater or lesser effects of the preparation a woman chooses to use.

St. John’s Wort has been used for hot flash treatment, and better sleep, which of course is an important way to improve sex. Black cohosh is probably safe to give with St. Johns Wort if you are a candidate for that medication anyway, which can help with the mood changes and depression not treated by the Black cohosh, but be careful if you are on other medications, or if the preparations you are using have other ingredients that will not mix with each other. So there may be better ways to improve sleep if you want to not disrupt your sex drive.

If you have concerns regarding any herbals and contraceptive use call for appointment! 217-356-3736.