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Primary Research · 2003

Interaction of St John's wort with low-dose oral contraceptive therapy: a randomized controlled trial

Evans et al. · Anaesthesia, 2003

Key finding

Breakthrough bleeding incidence: control 6/17 (35%), cycle A (SJW BID) 13/17 (77%, p<0.015), cycle B (SJW TID) 15/17 (88%, p<0.001). Dose-response evident. No ovulation detected during SJW combination (progesterone remained suppressed), but follicle-like structures observed sporadically. Authors conclude SJW should be used with caution in women on OCs due to bleeding and reduced progestin levels potentially elevating pregnancy risk.

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Open source

https://pmc.ncbi.nlm.nih.gov/articles/PMC1884294/

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