The possibility of antibiotics affecting birth control medication is always a hot topic due to the possible severe consequences of an interaction. The interaction is based mostly on the theory that since birth control pills partially rely on the normal bacteria in your gut to help metabolize and absorb estrogen in the body, altering that bacteria can lessen how effective birth control is. Studies regarding this matter have continually shown that most antibiotics DO NOT cause any problems with hormonal contraceptive concentrations. Most, if not all of the studies come to the conclusion that most antibiotics (such as amoxicillin and minocycline) do not significantly change levels of oral contraceptives in the vast majority of patients and that back-up contraception is not necessary if contraceptives are used reliably during antibiotic use. It was found however that a select FEW patients DID have lower levels of hormones after taking antibiotics. There were however, no clinical effects associated with this
The only antibiotics class which causes an actual severe interaction with birth control is known as the rifamycin class of antibiotics. They greatly speed up how fast birth control is broken down in the liver. Fortunately, minocycline is not in that class.
Most of the studies relate to short term antibiotic use and during long-term antibiotic administration, the risk for drug interaction is less clear. The best possibility to help reduce the risk of a possible interaction is to take a medium to high dose of a combined (both estrogen and progestin) oral contraceptive. In addition, a non oral method of contraception such as intravaginal rings and patches would bypass this interaction almost entirely.
Oftentimes various literature and website sources report that separating doses of an antibioitic and birth control (taking in the morning and evening) may help matters, but there is no evidence that this is a better way to go. Usually that method works well if there is an actual drug-drug interaction between two products. In this case, we are worried about an altered levels of bacteria in the gut, not two drugs interacting with each other. Long term administration will likely change the normal levels of bacteria in the gut for an extended period of time, so separating doses likely won't have much benefit.
So as far as a best recommendation, people are probably fine taking both birth control and antibiotics together. It is very important make sure to stay consistent on the time you take the birth control. Always watch out for breakthrough bleeding, spotting and any similar side effects as that could indicate a fluctuation of your hormonal levels in the body.
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