MTHFR Mutation? Oral Contraceptives Not Recommended

Birth control, in the form of oral contraception, is known to lower folate levels in women.

Obviously, this is undesirable when women discontinue the ‘Pill’ in order to become pregnant.

The paper, Oral contraceptives: effects on folate and vitamin B12 metabolism, sums up ‘the Pill’ on folate levels:

Oral contraceptives impair folate metabolism and produce some degree of ‘folate depletion…. Since pregnant women are predisposed to the development of a folate deficiency and thus to complications associated with this deficiency, we were concerned that women who became pregnant shortly after stopping the use of oral contraceptives might be at a higher ‘risk of these complications. Martinez and Roe demonstrated that this concern was valid and that women who became pregnant within 6 months after discontinuing oral contraceptives had lower levels of serum and erythrocyte folate than those who had not used these compounds. It is reasonable to ensure that a woman who stops using the Pill and contemplates pregnancy either has adequate folate stores or takes folate supplements before becoming pregnant.

This is a significant enough of a concern; however, it gets potentially worse.

Add in MTHFR defects which are present in over 50% of certain populations.  Mexican and Italian ancestry are most at risk for MTHFR defects.

MTHFR is an enzyme that is needed to make the most active form of folate, methylfolate.

Those with C677T MTHFR mutations produce dysfunctional MTHFR enzymes. This limits the production of methylfolate. Specifically, the heterozygous MTHFR C677T mutation limits the MTHFR enzyme by approximately 30% and those with homozygous C677T MTHFR defect limits the MTHFR enzyme by approximately 70%.

If women take specific types of oral contraceptives and also have the MTHFR C677T mutation, then their methylfolate levels are highly likely to drop below normal thereby causing significant issues.

What are the potentially significant issues caused by the mix of oral contraception and MTHFR C677T defects? Anything that relates to diminished levels of folate and methylfolate – that is a long list.

Safe Birth Control Options
Special thanks to Keyena McKenzie, ND for providing these options

Not satisfied with those birth control options and you want to remain on ‘the Pill’?
Be sure to keep your methylfolate and methylcobalamin levels healthy. Consider taking 1/2 to 1 tablet daily of Active B12 with Methylfolate. Simply place under your tongue in the morning and allow to dissolve. If you have the MTHFR C677T mutation, you may need more than 1 tablet daily. Watch for the methylfolate side effects – if you get them – you may be taking too much methylfolate.

Questions for you – please comment below:

  1. Did you know about the connection between ‘the Pill’, decreased folate levels and MTHFR?
  2. What do you use for birth control?
  3. Do you think ‘the Pill’ contributed to your pregnancy complications due to diminished folate levels?



27 Responses to “MTHFR Mutation? Oral Contraceptives Not Recommended”

  1. Jennifer March 16, 2012 at 2:30 am # Reply

    Great article! I understand completely and I heed your warnings but what about ladies that have issues outside of a MTHFR diagnoses only. What are their options?

    Example…I am a MTHFR homozygous C677T. I also have PCOS, I have since I hit puberty, I’m 39 now. Currently even though I eat clean (sugar free, dairy free, wheat/gluten free etc), supplement and do just about everything else you recommend, my PCOS is not under control. In fact, I’m having a very bad spell with it this last year and my hormones are very unbalanced, the worst they have ever been. Months ago my RE doctor told me that I was quite estrogen dominant.

    Fast forward to last weekend, I ended up in the ER with ‘severe dysfunctional uterine’ bleeding. Other words, I was soaking a pad every 15 mins. I was losing a lot of blood and hence didn’t really have a choice, I had to take hormones. They put me on a BC pill called Cryselle. It stopped the bleeding that I have been dealing with in varies degrees for 3 years now in less then 24 hours, so very quickly.

    My RE doctor has been for months trying to get me to take BC pills as well as Metformin but I’ve refused, I wanted to heal naturally. I don’t want to be on BC pills forever but I also don’t want to bleed to death which frankly I almost did this last weekend, I had to have a blood transfusion and all.

    I know many ladies with PCOS that have to take BC pills due to hormones issues so I’m not alone here. I also understand that I need to fix the root causes and for the last many years, I’ve been working on that.

    I have loss about 50 pounds so far and other things have improved as well due to lifestyle choices but the PCOS and all it’s nasty side effects have not improved in the least, BC pills are the only thing that have ever improved for me. I have been on them in the pass from when I was 24-31 yrs and honestly those were the best years of my life health wise. I then when off of them to try to heal naturally but it has not worked and now I am forced to be on them again or I will just continue to bleed and bleed and eventually it could develop in to something worst.

    I have a history of PE’s but only after I had surgery, at not other time but regardless, I am very scared I am going to get clots again. My hematology doctor knows about my MTHFR and my PE’s, he said as long as there is not a strain on my body like surgery, a long flight, pregnancy etc that I am no more liking to have a PE again then an average women so he cleared me to take BC pills. He swears I only had a PE because of the surgery. I just don’t want him to be wrong, I almost didn’t survive it last time.

    I know I can’t be the only lady who has both PCOS and MTHFR. What are we suppose to do both in the long term and short term?

    What can you do supplement wise when you have to take BC pills when you have MTHFR?

    If you are supplementing and taking care of your MTHFR does that level you out in regards to taking other things like BC pills that would normally tax our system?

    Any ideas, suggestions would be most gratefully appreciated.

    Thank you!!!

    • Dr Ben March 27, 2012 at 5:06 am # Reply

      Hello Jennifer –

      While this website is about MTHFR, I always address the full picture of the individual.

      PCOS is very common – especially with the prevalence of xenoestrogens.

      Read this article about Endometriosis and MTHFR

      PCOS is a blood sugar imbalance issue as well – need to alter diet, lifestyle and add in certain supplements.

      It can be reversed and is often done by integrative doctors.

      Due to the complexity of PCOS, I do recommend a consult.

      Taking birth control pills for PCOS is not addressing the cause of PCOS at all – it is putting a bandaide over the tack in your foot. We need to take the tack out.

      You are doing excellent by losing weight – congrats on that – that is a big step forward.

      In terms of taking Metformin, that is something that I would recommend right now – at least until you stabilize. The benefits of Metformin do outweigh the cons at this point.

      It is possible to balance the blood sugars with supplements and diets – perhaps – all the way? Not sure – depends on the response of your fasting blood sugars when these are introduced.

      I do recommend Metformin though at this point.

      Getting recent lab work for your female hormones, fasting blood sugar and testosterone levels are important to receive – along with thyroid workup.

    • Kate October 26, 2014 at 5:39 pm # Reply

      Jennifer- I would also investigate NaPro Technology.

  2. Natalie March 18, 2012 at 8:18 pm # Reply

    I have a similar situation as Jennifer. I also have PCOS. I have taken a maximum dose of metformin daily for the past 4 years, and am also presently on a max dose of spironolactone. (However, since reading “Metabolic Cardiology,” and suffering a recent bout of liver enlargement and tenderness–relieved by a liver/gall bladder flush, I am rethinking this plan). I have avoided OCPs like the plague for most of my life. However, after weaning my daughter, I went into a pre-mature menopausal state, at the age of 31, despite the metformin and a low glycemic diet. After several months of amenorrhea, severe pelvic pain, and worsening of an arrhythmia I have had since childhood (i.e., PSVT), along with onset of a new arrhythmia (i.e., non-sustained RVOT V-TACH), I decided to seek relief from my cardiac and menopausal symptoms via hormone therapy. I used Yasmin and Evamist (prescribed by my conventional OB-GYN) for 6 months months and felt better. The menopausal symptoms subsided and the cardiac symptoms were much improved. However, I worried about the fact that the progestin and estrogen in the Yasmin were not bio-identical (the estrogen in the Evamist was bio-identical). Having forms of hormones in my body that are not chemically identical to those that the human body manufactures seemed like a recipe for a liver problem to me (especially combined with the metformin and spironolactone I have been taking). I went several months with no hormones and have returned to my miserable menopausal state–I am now 33, and am not ready for menopause. A week ago, I started a Vivelle Dot patch (consisting of bio-identical 17-Beta estradiol) and am cycling with oral Prometrium (i.e., bio-identical progesterone USP) ten days per month to ensure turnover of my uterine lining (and protective apoptosis throughout the body, from what I have read). I would rather use bio-identical creams in organic bases, under the supervision of an doctor versed in functional medicine, but right now I have to use what my health insurance covers and what my conventional OB-GYN knows. I have been taking a large amount of folic acid (4 g per day–as is recommended for women who have had a child with a neural tube defect) since 2009, because I have been terrified of neural tube defects secondary to metformin’s interference with folic acid. (I am a NICU BSN-level RN, and am all too familiar with the realm of NTDs). I recently discovered your site and suspect that my daughter and I have some permutation of the MTHFR mutation. I will tell you about my daughter later. I had never heard of MTHFR prior to finding your site, although I had heard about defects in methylation in Dr. Bock’s book. Thank you for such a wonderful free site! My question, like Jennifer, is what are we hormonally abnormal women who either have, or seem to have, MTHFR to do? Will bio-identical hormones be less toxic to the body and interfere less with metabolic processes (such as those disrupted by the MTHFR mutations) as I suspect? If I choose to stay on the bio-identical hormone regimen, and do have MTHFR, then should I supplement with methylfolate? (From what I have read, my fertility is in danger if I do not stay on the regimen–and I already know that my well being is in danger if I do not stay on it.) Would I theoretically need more methylfolate secondary to taking metformin (just as I required a higher dose of folic acid)? I understand your ability to respond is limited outside of an official consultation, but I was just wondering what you have done with your patients similar to Jennifer and me, in terms of hormones and methylfolate, and how they have responded? Thank you!

    • Dr Ben June 3, 2012 at 9:19 pm # Reply

      Natalie –

      This is a complex issue and I cannot state too much due to the complexity –

      What I can say is since Metformin does inhibit the folic acid pathway, and you suspect MTHFR, taking nutrients such as methylfolate and methylcobalamin are needed.

      Taking high dose folic acid is now showing not to be best thing to do – I would consider reducing that amount and increasing your intake of methylfolate and leafy greens.

      Testing for MTHFR is highly recommended if you suspect it.

      Vitamin C, probiotics, liver support, B12 and methylfolate all help to balance levels of hormones – along with a healthy diet and lifestyle.

  3. MBZ March 22, 2012 at 10:41 pm # Reply

    I’m assuming if condoms are safe, then so are diaphragms? Because the more choices, the better. Also, Paraguard is not recommended for women with serious autoimmune conditions, according to two different CNMs I’ve visited.

    • Dr Ben March 22, 2012 at 11:20 pm # Reply

      Good point on the diaphragms. Issue with those though is typically spermicide is used as well and most spermicides – if not all – are not very pure.

      I can see your point with Paraguard and autoimmunity. There seems to always be exceptions.

  4. MBZ March 22, 2012 at 11:28 pm # Reply

    Sadly, there’s no perfect solution. I’m here on your site because my 2.5 year old is about to be tested for MTHFR — his “autistic-like” traits have slowly resolved as we do methylb12, b6 (NOT P5P, which was a disaster), R5P, probiotics, L-carnosine, zinc, vitamin D and methylfolate, and I want to learn his MTHFR profile. (We’ll test me, my husband, and our other kids depending on his test results).

    I have two different autoimmune conditions (one thyroid, one rheumatological) and the birth control issue is HUGE for women with hormone sensitivity. Even the Mirena — which has a tiny dose of progesterone built into the device — caused severe neurological problems for me.

    So it’s barrier methods, or permanent sterility, and some doctors question the long-term health implications of vasectomies and tubals/Essure. (Especially vasectomies for men with a family history of prostate cancer — and MTHFR and prostate cancer are possibly linked!).

    As for spermicide, wouldn’t that be a problem with condoms, too? Using a condom without spermicide dramatically reduces the effectiveness. So perhaps the answer is to be celibate, but that’s no fun!

    • Starlene @ GAPS Diet Journey July 9, 2012 at 6:13 am # Reply

      @MBZ – have you looked into fertility awareness? I think all women (and men too) should know how to determine our times of fertility. Men are fertile 24/7/365 but women are fertile only 24-48 hours each month with a number of days before and after ovulation. Fertility awareness combined with a barrier method is very predictable. Two great books are Taking Charge of Your Fertility by Toni Weschler, and Garden of Fertility by Katie Singer.

      • Dr Ben July 12, 2012 at 12:11 am # Reply

        Starlene –

        Thank you for your comment – great information you provided.

  5. Kate November 30, 2012 at 7:40 am # Reply

    What about the Mirena IUD? It has a synthetic progesterone in it, but since it is not administered orally is it ok?
    Thank you

  6. Kayla March 4, 2013 at 3:45 pm # Reply

    What about being able to take Plan B? It’s a Progestogen-only pill and doesn’t contain estrogen, which is linked to blood clots.

  7. Martha Goudey September 15, 2013 at 3:54 pm # Reply

    When the ND saw my lab test last year she said, “OH, you are homozygous, which is probably why you had so much trouble with the birth control pill and getting pregnant. This, 50 years later. I was 17 when I started taking ortho-novum 5 mg (now they give .5) for four years straight so I could work while my husband went to college (it was the 60s, what can I say). I went off the pill at age 22 and was unable to conceive. We divorced four years later and it wasn’t until I was 35 that I conceived my son, who turned 31 on Thursday. He was fine…still is. I have no idea if my MTHFR status affected my ability to conceive or if it was the high dose at a young age.

  8. Amy October 2, 2013 at 3:49 pm # Reply

    I am homozygous C6777 with two healthy kids and plan to have no more. I need some form of birth control. I had stayed away from the Paraguard because of fear of Copper toxicity. Does the copper affect those with MTHFR? My doctor is willing to put me on a low hormone dose of OCP. What is my best option, health wise?

  9. caitlyn October 22, 2013 at 12:23 am # Reply

    I have one copy of the MTHFR genetic mutation. I quickly came of birth control 2 years ago once I discovered the mutation. However I am 25, and recently got married. I am looking for an alternative contraceptive (other than condoms or in addition too) that will not deplete my B vitamins, or affect any other processes that that the MTHFR mutation already affects. What is recommended? I am meeting with my OBGYN soon to discuss this, but i fear that she won’t know the answer to this question. I thank you for your time and help!

  10. Michelle February 14, 2014 at 3:58 pm # Reply

    I would not do paraguard iud with the mthfr mutation! I have c677t one bad copy and I had the copper iud for 2 1/2 years, I became so copper toxic because my body couldn’t detox the copper. It has taken me a year on methylfolate and methylb12 to feel somewhat normal but I am still trying to detox the copper. I got my iud out in October. Right now my husband and I practice natural family planning.

  11. Denise March 15, 2014 at 2:36 pm # Reply

    I am 51 years old with 5 children. I just found out I have MTHFR. My CRP levels are very high and my uterine lining is very thick. My doctor want to put me on 75mg of progesterone. Is this safe to do? Just trying to find out as much information as possible as I start this journey. Thank you for your website. I am anxiously awaiting your program delivery.

  12. Crosswind July 23, 2014 at 6:53 pm # Reply

    I have one copy of MTHFR. What if we also have Severe PMS (possibly PMDD) since age 15? now age 42… I’ve been researching & reading that it’s possibly linked to ovulation. Ladies who take Meds that suppress ovulation, like the birth control pill are feeling better. I worry about blood clots, since I read this can increase with Mthfr + pill. I’m sure it makes a difference whether we have one or two copies of Mthr gene mutation, but do you have an opinion or research on this? Anyone have experience they can share? Thx

    • Crosswind July 23, 2014 at 7:15 pm # Reply

      …and I have no children. I was recently prescribed customized Biodentical Progesterone cream. But, I’m not sure that is enough or if that affects ovulation?

    • Crosswind July 23, 2014 at 7:21 pm # Reply

      Since IUD is recommended as safer above, i want to add that I’ve heard some awful side effects of IUD. I knew a massage therapist who had hers removed to plan kids with her new husband. She had 2 kids with her previous husband that died, but wanted a child with her new husband. She discovered she could no longer have kids because the IUD left too much scar tissue on her female parts. Sad. He left her because she was infertile. He was younger & wanted kids. No IUD for me. I don’t want kids, but i don’t want scar tissue either.

  13. becky November 10, 2014 at 8:40 pm # Reply

    Recently found out I’m compound heterozygous. My gyn wants to switch me to progesterone only oral contraceptive. Is this ok? Your article just talks about oral contraceptives not progesterone and estrogen.

    • Dr Lynch November 13, 2014 at 2:15 am # Reply

      Hi Becky – I am not sure. Interesting idea and seems at first glance ok but I am not the best at hormones.

      • becky November 26, 2014 at 4:15 pm # Reply

        I supplementing l-methylfolate, b12, b6, lipoic acid necessary if my homocystine, b12, etc are in optimum range?

  14. Emily November 15, 2014 at 7:27 pm # Reply

    I have a double defect c677t and have been suffering from severe anxiety for years. I just started with a new neurologist who is familiar with MTHFR and genetics. He’s so thoughtful and smart. My anxiety is much higher the week before menses. He had suggested I try birth control, but not until he could further research if their is a heightened risk of stroke in patients with MTHFR. I am not currently taking any medication. I stopped deplin (7.5mg) because it made me extremely irritable and a very uncomfortable feeling of constant, extreme, uncontrollable anger. I tried the multivitamin from seeking health with L-5-MTHF, but only to have it trigger severe panic attacks. I have tried Niacin, but it always makes my heart rate go extremely high and stay that way for a prolonged period (about 138-150bpm). So supplementing while on birth control may not be my best option. Any opinion or advice would be greatly appreciated.


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