Documented concern based on cited evidence — not a personalized safety check, not medical advice, and not a decision to combine or avoid. That decision belongs with your prescriber.

Documented concern — monitor and disclose

Clinically relevant documented concern. Disclose the supplement to your clinician and keep monitoring in place.

Mechanism and evidence

Hyperforin induces CYP3A4 and the P-glycoprotein transporter, which can speed the clearance of contraceptive steroid hormones. In a controlled trial of a hyperforin-rich extract, hormone exposure fell 13 to 15 percent with breakthrough bleeding and probable ovulation in some cycles; a low-hyperforin extract (Ze 117) stayed within bioequivalence limits. Labels do not disclose hyperforin content, so the buyer cannot tell which kind of extract is in the bottle.

Evidence tier: rct

The tier names the strongest cited study design. Some anchors studied the supplement on its own, or a related drug in the same class — in those pairs the grade rests on that evidence plus established pharmacology, as agreed with our medical reviewer.

What to discuss with your prescriber

  • Because St John's wort can reduce the effectiveness of hormonal contraceptives, combining the two should include a conversation with your doctor about whether an additional method of contraception is needed.
  • Breakthrough bleeding or spotting on the combination is a reason to use backup contraception and speak with your prescriber or pharmacist.
  • The effect depends on the hyperforin content of the specific extract, which varies between products and batches and is not stated on labels.

← All reviewed pairs for Oral contraceptives (combined pill)