Contraception and other medicines, including HIV and TB medicines

Many women take medicine every day, for HIV, TB, epilepsy or other conditions. Some of these medicines can make hormonal contraception work less well. This does not harm your health. But it can raise your chance of an unplanned pregnancy. This guide from Network One Health explains what to know.

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The short answer

• All contraceptive methods are medically safe to use with HIV medicines.
• Most HIV medicines do not affect contraception.
• A few medicines can lower the hormone levels from some methods.
• The copper IUD and the Depo-Provera injection are not affected by these medicines.
• Your contraception does not make your HIV or TB medicine work less well.

Always tell your nurse, doctor or pharmacist every medicine you take, at every visit.

Which medicines can affect contraception?

These medicines speed up how your body clears hormones. Doctors call them “enzyme inducers”.

Some HIV medicines (antiretrovirals, ARVs):

• Efavirenz (found in some combination pills, such as TEE)
• Nevirapine
• Some protease inhibitors, such as lopinavir or atazanavir boosted with ritonavir

TB medicines:

• Rifampicin
• Rifabutin

Some epilepsy medicines (anticonvulsants):

• Phenytoin, carbamazepine, ethosuximide, phenobarbitone (barbiturates), primidone, topiramate and oxcarbazepine

If you are not sure what is in your treatment, bring your pills or your clinic card. We can check.

What about dolutegravir (TLD)?

Many people in South Africa now take TLD. This is one pill that contains tenofovir, lamivudine and dolutegravir.

Dolutegravir is unlikely to affect hormonal contraception. The South African guideline advises that hormonal contraception with dolutegravir is an effective combination. Tenofovir and lamivudine also do not affect contraception.

If you are on HIV treatment and are thinking about pregnancy, talk to your clinic first. They can help you plan.

Which methods are affected?

If you take one of the medicines listed above:

• Pills (combined pill and mini pill): may work less well.
• Vaginal ring and patch: may work less well.
• Implant: may work less well, especially with efavirenz. Even so, it still works better than most other methods in everyday use.
• Nur-Isterate injection (2-monthly): may work less well. There is limited information.
• Emergency pills: may work less well. See below.

With rifampicin, hormone levels can drop by more than 40%. That is why pills are not advised during this TB treatment.

Which methods are not affected?

• Copper IUD. No hormones, so medicines do not affect it.
• Depo-Provera injection (3-monthly). It stays very effective. You do not need to have it more often.
• Hormone IUD. Not expected to be affected in a meaningful way.
• Condoms. Not affected by medicines.

The South African guideline names the copper IUD and the Depo-Provera injection as first choices for women who want very effective protection and take these medicines.

You still have a choice. If you prefer another method, you can still use it after a full discussion. Adding condoms gives you extra protection.

Epilepsy medicines: a few extra points

• Epilepsy itself does not stop you using any method.
• The mini pill is not advised with the epilepsy medicines listed above.
• Lamotrigine does not reduce contraception. But the combined pill can make seizures harder to control when lamotrigine is taken on its own. Talk to your doctor.

Common antibiotics

Ordinary antibiotics, antifungal medicines and medicines for parasites do not lower the effect of hormonal contraception, according to the South African guideline. Rifampicin and rifabutin are the exceptions.

Emergency contraception if you take these medicines

If you need emergency contraception and take one of these medicines, the copper IUD is the first choice. It can be placed up to 5 days after sex. Emergency pills include levonorgestrel and ulipristal, and both may work less well with these medicines. If you choose emergency pills, you may need a higher dose. Discuss this with your clinician or pharmacist. Tell them about your medicines, including any you took in the last 4 weeks.

Dual protection: why condoms still matter

Women in South Africa have a high risk of HIV, whatever contraception they use. Dual protection means using condoms as well as another method. Condoms help protect you from:

• HIV and other STIs (sexually transmitted infections)
• Pregnancy, if your main method works less well because of medicines

Other ways to lower HIV risk include PrEP (daily medicine to prevent HIV), PEP (medicine after a possible exposure), and a partner with HIV who takes treatment every day and has an undetectable viral load.

When to get help

Contact your clinic if you miss a period while using contraception, or if you start or stop a medicine. In an emergency, go to your nearest hospital emergency unit or call 10177.

What to expect at Network One Health

We ask about all your medicines, without judgement. We then help you choose a method that fits your treatment and your life. Never stop your HIV, TB or epilepsy medicine to protect your contraception. Talk to us first.

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Ready to talk? Ask us to call you or WhatsApp Noma on 065 072 5315 for bookings and questions.