Grapefruit and Birth Control Pills: Your Questions Answered

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Jan 26, 2024.

Eating grapefruit or drinking the juice shouldn't lower the effectiveness of your birth control pill, but it might elevate estrogen levels in your blood, increasing side effects like breast tenderness, nausea, or irregular periods. Orange juice is not expected to cause this interaction.

It is not proven that side effects may increase, but theoretically may occur due to enzyme effect that occurs in your body. Drug interactions involving grapefruit or its juice can be variable among people and the significance is often difficult to predict.

Grapefruit and birth control: Is there an interaction?

Have you received a medication at the pharmacy with a sticker that warns to avoid grapefruit or grapefruit juice? While this may seem like an unusual warning, it’s more common than you might think. In fact, grapefruit can interact with hundreds of medications.

If you drink grapefruit juice with your birth control can it lower its effectiveness? Can you get pregnant if you drink grapefruit juice with your birth control pill? Let's look into this a little further.

Combination oral contraceptives, the pill that most women use, contain both estrogen and progestins hormones. Theoretically, consuming grapefruit with birth control pills might increase the estrogen levels in your blood.

This shouldn't lower the effectiveness of your birth control, but it might increase the chances for side effects like breast tenderness, nausea, changes in uterine bleeding, blood clots, or breast cancer. Many of these side effects have not been proven with grapefruit or grapefruit juice but might be possible.

• Studies have shown that estrogens (contained in oral contraceptives or in hormone replacement therapy) are partially metabolized (broken down) by the intestinal cytochrome P450 3A4 (CYP3A4) enzymes. These enzymes are commonly found in our intestines and liver and affect many different types of drugs.¹¹
• Grapefruit contains compounds known as furanocoumarins. The compounds can block (inhibit) these enzymes responsible for breaking down estrogens. When grapefruit and the pill are consumed, blood levels of estrogen may rise, resulting in a risk for new or worsened side effects.

One small study looked at how grapefruit juice (containing 887 mg/mL of naringin) affected estrogen levels and compared this to the effect of drinking herbal tea.¹ In contrast to herbal tea, grapefruit juice significantly increased estrogen peak plasma levels (Cmax) to 137% and the area under plasma concentration-time curve (AUC) from 0 to 8 hours to 128%.

This means that higher levels of estrogen were found in the body. A possible explanation is that grapefruit juice slows down the break down of ethinylestradiol. These levels are unlikely to affect the overall safety profile of estrogen, but the authors suggested the clinical importance should be investigated.^2,3

Does grapefruit make the pill less effective?

Probably not. Estrogen levels increase when the combined oral birth control pill is taken. Higher estrogen levels (as seen with the study above) should not lower the effectiveness of the birth control. However, birth control drug interactions or greater estrogen side effects like breast tenderness or nausea might occur. Grapefruit, grapefruit juice and birth control combined decrease the activity of the enzymes that break down estrogen, leading to the higher blood levels of estrogen.

But some medications can increase the activity of enzymes in your body. This could increase the break down of estrogen and progestin and possibly lower the effectiveness of your birth control pill. Inducers of CYP3A4 enzymes may reduce plasma concentrations of these hormones. Reduced blood levels of birth control hormones may result in changes in monthly bleeding, decrease in birth control effectiveness and unintended pregnancy. 

Examples of drugs that may lower hormone levels and decrease birth control effectiveness include:

• phenobarbital, carbamazepine, felbamate and some other anticonvulsant seizure drugs
• rifampin used to treat tuberculosis
• St. John's Wort

Birth control drug interactions are numerous. Always have your pharmacist or doctor check for interactions each time you start or stop any new medication. This includes over-the-counter (OTC) drugs, herbals, dietary supplements and vitamins.

You may need to use a back-up method of birth control, such as a condom and spermicide, to help prevent pregnancy. Do not stop medications on your own without checking with your doctor or other healthcare provider.

Tip: Check for interactions with the Drugs.com Interaction Checker

Can I drink grapefruit juice with birth control?

If you eat grapefruit or drink grapefruit juice, be sure to tell your doctor, pharmacist or other health care provider. Let them know how much grapefruit you consume each day. In most cases, you should be able to continue consuming grapefruit with birth control without any issues.

While grapefruit normally will not lower the effectiveness of the birth control pill, you may need to discuss the possibility of greater estrogen side effects, like breast tenderness, nausea or changes in menstrual bleeding with your doctor.

If you must avoid grapefruit juice with your medicine, don't forget to check the labels of other fruit juices to see if they contain grapefruit juice.

Can't I just consume grapefruit and my birth control pill at different times?

As reported in one study, taking your medications and grapefruit or grapefruit juice at different times may not lessen the possibility for an interaction.⁴ The CYP450 enzymes, found in the intestine and the liver, can stay blocked after eating or drinking grapefruit -- sometimes for more than 24 hours.⁶

Consumption of a single 6 oz. glass of grapefruit may result in higher estrogen levels, but daily use of grapefruit may lead to a more significant, unpredictable effect. Even drugs that are only given once a day cannot be separated from the grapefruit effect if taken at a separate time, hours apart.

If you need to avoid grapefruit while you are taking a medicine, it may be best not to consume grapefruit at all, either the juice or whole fruit.³ Ask your healthcare provider to review this drug interaction for you.

Does orange juice affect birth control?

Most other fruits like orange juice or cranberry juice are fine to eat or drink if you take birth control. But some other citrus fruits (similar to the grapefruit) may have the same effect.

• The seville orange (often used in marmalades), the pomelo, tangelos (a cross between tangerines and grapefruit), and limes also contain furanocoumarins that may cause the same interactions as grapefruit, leading to higher estrogen levels.³
• Higher estrogen levels won’t change the effectiveness of the pill but may lead to side effects like breast tenderness or nausea.
• This effect is variable and may not be clinically significant in every person.

Orange juice may not interact with birth control but can have some other drug interactions. The non-sedating antihistamine Allegra (fexofenadine) has been shown to interact with several fruit juices, including grapefruit juice, orange juice and apple juice, and may decrease the levels of fexofenadine in the body. Lower levels of fexofenadine may reduce the effectiveness of the antihistamine, and your allergy symptoms may worsen.¹²

Fexofenadine (Allegra) should be taken with water. Do not drink large amounts of grapefruit, orange, or apple juice with this medicine. Allegra ODT, an orally dissolving tablet, can be taken with or without water.

Learn More: Does Birth Control Interact With Alcohol?

Can grapefruit cause serious side effects when mixed with birth control?

Rare but serious side effects have been described when estrogen was combined with large quantities of grapefruit.

A 2009 case report in The Lancet described a women who rarely ate grapefruit, but started a weight-loss diet plan that included 225 grams of grapefruit every morning (roughly one grapefruit). She also used a low-dose combined oral contraceptive containing drospirenone (a progestin) and ethinyl estradiol (an estrogen) for one year.

Three days after starting the grapefruit diet, she experienced an acute venous thrombosis (a serious blood clot in a deep vein of the leg) and the authors theorize it may have been in part due to the interaction of the grapefruit, enzyme inhibition, and the estrogen in the birth control pill leading to enhanced risk of a blood clot.⁷ Drospirenone has been associated with a higher risk for blood clots venous thromboembolism (VTE) compared to some other other progestins.

Learn More: What are the benefits compared to the risks of taking birth control pills?

Does grapefruit affect natural estrogen levels in the body?

Elevating levels of naturally occurring estrogen (such as estrone or estradiol) in the body by consuming grapefruit could theoretically increase the risk for estrogen side effects and possibly breast cancer. 

A pilot study in 59 postmeonpausal women found that eating grapefruit (not the juice) can increase levels of endogenous estrogen.⁴ The results showed that whole grapefruit intake had significant effects on endogenous estrone-3-sulfate. Peak effects were seen at 8 hours, increasing by 26% from baseline.  No changes in mean estrone or estradiol with whole fruit intake were observed.

In contrast, fresh grapefruit juice, bottled grapefruit juice, and grapefruit soda intake all had significant effects on lowering estradiol.

The authors conclude that there is an important interaction between grapefruit intake and endogenous estrogen levels and suggest further research is warranted, but whether this affect is clinically important in women was not proven.

It's important to note that other studies have found a protective effect of grapefruit and citrus juice with regards to breast cancer risk, and the risk of other cancers, as well.^8,9

Does cranberry juice affect birth control?

Cranberry juice has not been shown to interact with birth control, but has been shown to have an interaction with the blood thinner warfarin (an anticoagulant). Ask your doctor before using warfarin together with cranberry. Using these medications together can cause you to bleed more easily. You may need to have more frequent warfarin blood tests or a change in dose.

List of popular birth control pills

There are many options for birth control pills. Some of the more commonly used birth control pills prescribed in the U.S. include:

• Lo Loestrin Fe (ethinyl estradiol / norethindrone systemic)
• Sprintec (ethinyl estradiol / norgestimate systemic)
• Lutera (ethinyl estradiol / levonorgestrel systemic)
• Yaz (drospirenone / ethinyl estradiol systemic)
• Aviane (ethinyl estradiol / levonorgestrel systemic)
• Tri-Sprintec (norgestimate and ethinyl estradiol tablets)
• Yasmin (drospirenone / ethinyl estradiol)

Learn More: See a list of other popular birth control options

Bottom Line

Combining grapefruit and oral contraceptives may lead to higher estrogen levels, which might cause side effects like breast tenderness, nausea, and changes in uterine bleeding. Taking your pill with grapefruit juice is unlikely to decrease the effectiveness of the oral contraceptive.

More serious side effects like blood clots or an increased risk of breast cancer are theoretical concerns, too (but not proven). 

Important drug interactions with grapefruit juice may occur with other medicines, so always check with your doctor or pharmacist for the impact. Have your pharmacist complete a drug interaction screen each time you start or stop any new medication.

If there is a recommendation to avoid grapefruit juice, it's best to avoid it completely when you are taking the medication, not just when you swallow your pill.

This is not all the information you need to know about grapefruit juice and birth control pills for safe and effective use and does not take the place of your doctor’s directions. Review your full product information and discuss this information and any questions you have with your doctor or other health care provider.

See also

• Birth Control Pills (Oral Contraceptives)
• Birth Control Pills and Your Period
• Birth Control Pills: Benefits, Risks & Side Effects
• Birth Control Pills: Why do I get breakthrough bleeding?
• Emergency Contraception: What You Need to Know
• Emergency Contraceptives: Morning After Pills & OTC Options
• Missed your birth control pill? Here's what to do
• Non-hormonal Methods of Birth Control
• What are the options for permanent birth control?

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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