A Review of the Effects of Oral Contraceptives on Nutrient Status, with Especial Consideration to Folate in UK

Abstract

Oral contraceptives (OCs) are widely used by a significant number of women, often commencing at early adolescence. Whilst most research has investigated the physiological effects of OCs, some studies have identified impacts upon nutritional status of certain vitamins and minerals. In this context, a report published by the World Health Organization (WHO) is relevant, since women who take OCs-especially in less well-developed countries might not always have adequate diet. Furthermore, women whose life style is unhealthy, those with malabsorption pathologies, or have genetic polymorphisms that affect vitamin metabolism might also be at risk of the negative impacts on an individual’s nutrient status. This literature review investigates the effects that oral contraceptives might have upon nutrient status. It identifies potential interactions with Vitamins A, B1, B2, B6, B12, C, and E and folic acid as well as magnesium, zinc, selenium, copper, co-enzyme Q10, and beta-carotene status. It then examines the possible consequences that induced depletion of folic acid might cause with especial focus on neural tubes defects in UK, where food supplementation with this vitamin is not yet mandatory. It suggests that in those using this form of contraception or hormone replacement therapy, it is valid to consider appropriate nutritional supplements as a complementary first line strategy in order to prevent possible vitamin and mineral deficiencies.

Raising awareness of drug‐micronutrient interactions

“…Indeed, the associated potential for chronic micronutrient disruption may involve vitamin and mineral depletion that possibly extends over decades. 50 • Awareness of specific drug-micronutrient interactions and patient risk factors…”

“…47 NICE additionally recommends that electrolytes should be monitored for all thiazides and related diuretics as well as loop diuretics during treatment. 47,48 Oestrogens Natural or synthetic oestrogens used in hormone replacement therapy (HRT) or hormonal contraception, such as estradiol, estriol and ethinylestradiol, are associated with a range of micronutrient interactions, involving for example depletions in magnesium, selenium, zinc, CoQ10, vitamins B2, B6, B9 and B12 along with vitamins C and E. 1,7,50 This has focused attention on the need to consider appropriate nutritional supplementation, in par ticular folic acid in users of oral contraceptives. 50…”

Hematological parameters of reproductive-age women using hormonal contraceptives at University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia: A comparative cross-sectional study

“…who reported long-term implant use had a higher risk of anemia compared to short-term use. This is due to decreased intestinal reabsorption of folate, which resulted in decreased serum folate levels [ 27 , 28 ]. Implant users also experienced increased and prolonged menstruation which resulted in blood loss [ 29 ].…”

“…decreased serum folate levels [27,28]. Implant users also experienced increased and prolonged menstruation which resulted in blood loss [29].…”

Hematological Profile Changes Among Oral Contraceptive Users: A Narrative Review

“…40 Oral contraceptive decreases intestinal re-absorption of folate and vitamin B-12 which resulted in significantly decreased serum levels of these vitamins in women taking OC pills, even when controlling for intake through diet, and may end up in megaloblastic anemia. [41][42][43][44]…”