Birth control pills for Hashimoto patients

Dear Alice,

I am seeing a guy I love and we are both thinking of consummating our relationship soon. We are both adults and this will be the first time for both of us. This is great, but also a bit scary in terms of the necessary protection.

To add to that, I have Hashimoto's, a reason why I am a bit worried about taking birth control pills. I would seriously prefer birth control pills (while using the condoms of course), but friends who have had hypothyroidism have warned me against birth control unless I begin taking thyroid supplements (which I have been advised are premature at this stage). I would really like to know if this is a valid concern and in which case, what I should do.

Hope to hear from you,

Dear xoxo,

Kudos to you for being so thoughtful and intentional about birth control and sexually transmitted infection (STI) prevention as you approach your first time! Generally speaking, birth control may be used amongst those with Hashimoto's thyroiditis, whether or not they're using thyroid hormone replacement therapy. That being said, sometimes treatment for Hashimoto's can interact with the hormones in birth control pills (more on this later). Additionally, taking birth control with estrogen may also have an effect on your thyroid, as it increases the thyroxine-binding globulin, which may lead to an increased need for thryoid hormone replacement therapy. Therefore, to find the method of contraception that's most effective for your individual case, you may want to contact a health care provider to talk more about your possible birth control options.

For readers less familiar with Hashimoto’s, also known as Hashimoto’s thyroiditis, it’s an autoimmune disease that involves the thyroid. The thyroid regulates the body’s energy use through hormones called T3 and T4 and is located at the base of the neck. This condition causes the body to make antibodies that damages thyroid cells thereby affecting the body’s ability to make these hormones. This leads to low levels of thyroid hormones, also known as an underactive thyroid or hypothyroidism. The disease is most common among folks assigned female at birth, especially during middle age and is more likely to develop in people who have or have family members with thyroid or autoimmune conditions. It can be caused by genetics, pregnancy, too much iodine, some drugs, and exposure to radiation. At first, a person with Hashimoto’s may not show symptoms for long periods of time. One of the first signs of Hashimoto's for many is an enlarged thyroid (goiter), which can cause swelling at the front of the throat. As the disease progresses over time, with increasing thyroid damage, symptoms may include:

  • Fatigue
  • Weight gain
  • Pale or puffy face
  • Feeling cold
  • Joint and muscle pain
  • Constipation
  • Depression
  • Slowed heart rate
  • Problems getting pregnant

List from the Office on Women's Health

In addition, not treating an underactive thyroid has the potential to lead to birth defects, miscarriage, infertility, high cholesterol, heart failure, seizures, coma, and death. As you probably know, xoxo, people with Hashimoto’s disease can seek treatment with a daily pill of synthetic T4, also called thyroid hormone replacement therapy.

For someone on thyroid hormone replacement therapy, certain medications (including some forms of birth control) can interact with the synthetic thyroid hormone in such a way that a higher than typical dose of thyroid hormone may need to be prescribed. Additionally, even if thyroid hormone replacement therapy remains unnecessary, taking oral contraceptives still have the potential to affect the thyroid. As such, in either scenario, a health care provider can help you determine if hormonal birth control is for you to use or not, and if so, which formulation may be best for you. In addition, you may want to also look into other forms of contraception. 

It's great that you're considering the impact that your diagnosis may have on birth control options and taking care of your sexual health. Here’s to happy firsts and thinking ahead!

Last updated Nov 10, 2017
Originally published Mar 23, 2012