Can Antibiotics Make Your Birth Control Less Effective?

Whether you use the pill or the patch, here's how antibiotics affect birth control—and if you need to use back-up protection.

Antibiotics and birth control

When it comes to pervasive old wives’ tales (or totally believable rumors) about birth control, you’ve definitely heard at least once that you can’t get pregnant while on your period and the pull-out method is a way to prevent pregnancy. Thankfully those myths have been debunked time and time again, but there’s one that still sends women panicking to their ob-gyns (or to Dr. Google): Antibiotics can seriously mess with your birth control.

For Real, Do Antibiotics Affect Birth Control?

Since antibiotics and birth control pills are both metabolized in the liver, there used to be a concern that the two would interact with each other—and become less effective—if taken at the same time, says Maria Sophocles, M.D., N.C.M.P, FACOG, board-certified ob-gyn in Princeton, New Jersey.

Luckily, that isn’t usually the case. Most broad-spectrum antibiotics (antibiotics that can be used to treat a variety of infectious diseases, like those you'd take for ear, throat, sinus, or urinary tract infections) do not alter the effectiveness of oral contraceptives, the patch, or the ring, according to the Centers for Disease Control and Prevention (CDC). On the flip side, birth control has not been found to make an antibiotic less effective, either, says Dr. Sophocles. “It’s been studied a lot, and the good news is that there’s really only one antibiotic, called rifampin, that substantially alters the effectiveness of a birth control pill,” she says.

Rifampin is an antibiotic most commonly used to treat tuberculosis or occasionally in people who have meningitis infections in their noses or throats. It works by increasing certain enzymes in your body, according to the United Kingdom National Health Service (NHS). These enzymes increase the breakdown of estrogen in the liver—and because estrogen is one of the active hormones in the birth control pill that helps prevent ovulation, it makes the contraceptive less effective, says Sherry A. Ross, M.D., ob-gyn and author of She-ology.

Rifampin doesn't just affect combined oral contraceptives (birth control pills that contain both estrogen and progestin); rifampin can also make progestin-only pills (sometimes called the "minipill"), implant, patch, and vaginal ring less effective at preventing pregnancy, according to the U.K. NHS. FWIW, although it's not entirely clear why, if you’re using an IUD or progestin-only injection, you’re still protected, according to the CDC.

Though rifampin is concern number one when it comes to antibiotics and birth control, another antibiotic called rifabutin (which helps prevent or slow the spread of Mycobacterium avium complex disease, an infection in patients with HIV, and may be used in combination with other medications to treat tuberculosis) could also reduce the effectiveness of birth control. Still, research on the antibiotic is limited, and existing studies show a smaller impact on effectiveness than rifampin, according to the CDC. At the end of the day, though, “whether you’re on the IUD, the pill, the implant, whatever it may be, antibiotics, in general, are fine,” says Dr. Sophocles.

Though the guidelines are clear, if you’re still nervous about the two impacting one another, consider taking your birth control pill in the morning and the antibiotic in the evening, rather than at the same time, says Dr. Sophocles. Or, of course, you can ask your doctor if you should change the way you take your contraception when you're being prescribed the antibiotic.

(P.S. did you know that supplements can mess with your prescription medications, including your birth control?)

How Long Do Certain Antibiotics Affect Birth Control?

Exactly how long an antibiotic can affect birth control depends on the amount of time you’re taking it, says Dr. Ross. And since your doctor may recommend you take rifampin for several months (seriously, most people with TB are prescribed the drug for at least six months because the bacteria die so slowly), using a second method of protection, such as a condom, is super important. “If I were on rifampin and I were taking any type of birth control, I would be using back-up contraception, and I would be very careful,” says Dr. Sophocles.

To prevent unwanted pregnancy, Dr. Sophocles recommends using backup contraception the entire time you’re on rifampin or rifabutin and the first few days you’re off the antibiotic, while Dr. Ross suggests sticking to it for up to a month afterward. After all, missing a single pill can put you at risk of pregnancy, and it can take at least seven days after you first start taking birth control pills for them to effectively protect against pregnancy.

And while you don’t normally need to use additional contraceptives if you’re taking antibiotics other than those two, there’s no harm in playing it safe, especially since condoms prevent STIs, too.

“If you have an easy opportunity to use back-up contraception, use it,” says Dr. Sophocles. “It’s never going to hurt to use it, and it’s a lot better than having an ‘oops.’”

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