Birth Control and Nutrition

Collaboration with Jessica Beal, PharmD 

I’ve always loved collaborating with Jess, whether on social posts or providing guidance to my mentees through the mentorship program. So, when she mentioned wanting to share information on nutrient-drug interactions, I knew immediately that it would be immensely valuable for our community! I’m thrilled to share this valuable resource, especially for our female athletes, to help them make more informed decisions about birth control options. Personally, I found this process challenging, as I didn’t receive much information about how birth control could impact my sport-specific needs. We hope this blog fills in some of those gaps—and this is just the beginning!

Introduction

A common yet often overlooked dilemma that athletes face is choosing a birth control method that not only aligns with their body and personal goals but also makes sense with their specific sport-related concerns. (Martin et al., 2018) found that 49.5% of elite female athletes were currently using hormonal birth control (HBC) at the time of their survey, while 69.8% used HBC at some point. For many, birth control is used to help manage period symptoms that can affect their overall well-being and sport performance and/or for family planning purposes. To simplify, HBC works by intentionally disrupting the body’s hormone levels. They typically contain synthetic estrogen and/or progestin (the man-made version of progesterone). These impact ovulation, cervical mucus, and uterine lining to prevent pregnancy—but these hormones have other repercussions. 

While this blog won’t dive into the specific considerations for choosing a birth control method, don’t worry; we plan to explore this in the future. We want to focus on an aspect that is often under-communicated: the nutritional implications of using hormone birth control. Specifically, we want to highlight certain nutrients commonly depleted by hormone birth control, which can impact mood, energy, and hormone balance. These nutrient gaps are essential to be aware of, as they may influence an athlete’s performance, overall well-being, and informed decision-making. 

Nutrients to Consider

In this blog, we are focusing on four main nutrients: 

• B Vitamins (Thiamine, Riboflavin, Niacin, Pantothenic Acid, Pyridoxine, Biotin, Folate, and Cobalamin) 

• Magnesium

• Zinc

• Vitamin C (Ascorbic Acid)

B vitamins are involved in blood cell production, energy production and nutrient metabolism, nerve function, and gene expression (Gropper et al., 2021). 

Birth control increases the liver metabolism of these B vitamins, accelerating their breakdown and reducing their availability for energy production, mood regulation, and brain function — contributing to fatigue, mood swings, and brain fog.

Magnesium, like many B vitamins, also plays a wide range of roles in the body, including over 300 reactions. Magnesium is involved in bone mineralization, enzymatic reactions, oxidative phosphorylation, nucleic acid synthesis, platelet activity, hormone receptor binding and signal transmission, cell membrane ion transfer, calcium regulation, and insulin signaling (Gropper et al., 2021). 

In the context of athletes, magnesium may be excreted faster than the average population due to magnesium being lost through sweat, muscle contraction, and high stress [Article]. Estrogen in birth control further increases renal (kidney) excretion of magnesium, causing faster depletion.

Magnesium is critical for muscle relaxation, sleep, and stress response so low levels can trigger anxiety, poor sleep, muscle cramps, and low energy.

Zinc is involved in most metabolic pathways (including carbohydrates, fats, proteins, and nucleic acids). Zinc is also a structural component of gene expression, which impacts numerous physiological pathways in the body (Gropper et al., 2021). 

HBC can increase copper absorption while decreasing zinc absorption, creating an imbalance.

Zinc is essential for immune function, hormone regulation, and tissue repair — so low levels can lead to hormone imbalances, poor recovery, and slower wound healing.

Vitamin C is a water-soluble vitamin, antioxidant, reducing agent for copper and iron, cofactor for collagen synthesis, supports neurotransmitters and–yup, you guessed it–much more!

• Birth control increases oxidative stress and metabolic demand for antioxidants, like Vitamin C, reducing circulating levels and increasing loss of Vitamin C through the urine.

• Lower Vitamin C impairs progesterone production, affecting mood stability, fertility, and overall hormone balance.

• We need vitamin C to unlock the iron we take in through food or supplements, and iron-deficiency anemia is a major driver of exhaustion and infertility after being on birth control.

  
  

This is NOT just a minor inconvenience - it can profoundly impact your mood, energy, and hormonal health.

More Than Blood

Remember that you may not always see a red flag for nutrient deficiencies even if you regularly get blood tests (such as a CBC, CMP, and lipid panels, the most commonly ordered lab tests). This could be because specific tests for certain nutrients must be ordered separately (some labs offer nutrient deficiency testing packages) or because magnesium status, in particular, can be difficult to assess with standard blood work. RBC magnesium testing is recommended for a more accurate picture of magnesium levels (Razzaque, 2018).

Regardless, symptoms of nutrient deficiencies can still manifest as:

• Anxiety, low mood, or irritability

• Fatigue or burnout despite getting enough sleep

• Slow recovery from workouts or injury

• Hormonal imbalances or irregular cycles

"So what do we do now?"

Best Approach

Athletes can order specific nutrient tests to get a more accurate representation of nutrient levels, especially when on or coming off birth control. 

Athletes could even stay ahead of the game by supplementing with key nutrients like B vitamins, magnesium, zinc, and vitamin C with third-party, sport-tested brands.

Additionally, focus on nourishing foods that are high in these target nutrients and support hormone health. Whole foods like oily fish, avocado, nuts and seeds, berries, cruciferous vegetables, leafy greens, root vegetables, and probiotics can support optimal hormone balance. 

If you’ve been struggling with low energy, mood swings, or poor recovery while on birth control— your nutrients may need some replenishment.

Keep in mind, if you’re on HBC and do have vitamin deficiencies, it doesn’t necessarily mean they’re caused by your birth control method. As a reminder, other common causes of nutrient deficiencies include:

• Inadequate dietary intake of vitamins and minerals

• Malabsorption in the gut

• Rapid excretion of nutrients

• Increased nutrient demand (based on your own unique metabolic needs and your medical history/medications)

Taking HBC doesn’t guarantee to be nutrient-deficient, but the above factors may indicate a higher risk.

Disclaimer

This post is not about limiting the options available to women or infringing on their right to make choices about their bodies. Birth control can be an empowering option. The purpose of this post is to provide education about aspects of birth control that may not always be discussed, specifically concerning potential nutritional deficiencies. Adding certain targeted nutrients can address these deficiencies and enhance your overall health and experience while using birth control.

Resources

Gropper, S., Smith, J., & Carr, T. (2021). Advanced nutrition and human metabolism (8th ed.). Wadsworth Publishing.

Martin, D., Sale, C., Cooper, S. B., & Elliott-Sale, K. J. (2018). Period Prevalence and Perceived Side Effects of Hormonal Contraceptive Use and the Menstrual Cycle in Elite Athletes. International Journal of Sports Physiology and Performance, 13(7), 926-932. Retrieved Mar 24, 2025, from https://doi.org/10.1123/ijspp.2017-0330

Razzaque M. S. (2018). Magnesium: Are We Consuming Enough?. Nutrients, 10(12), 1863. https://doi.org/10.3390/nu10121863

About the Author

Jourdan Delacruz is a 2X Olympian and represented Team USA in the sport of Weightlifting at the 2020 and 2024 Olympic Games. Jourdan holds a bachelor's in nutrition and dietetics from the University of Northern Colorado. She is pursuing her master's degree in sports nutrition to become a sport-registered dietitian. Jourdan founded Herathlete, a brand committed to supporting female athletes through education and community.

Special Contribution

Jessica Beal-Stahl, PharmD, is a clinical sports pharmacist and the founder of The Athlete’s Pharmacist. She specializes in female athletes, optimizing hormones, and understanding medication impacts on performance. Consulting with athletes, teams, and healthcare providers, Jessica takes an integrative approach, ensuring no foundational aspect is overlooked in pursuit of peak performance and well-being.

You can connect with Jess on Instagram @jess_rx or through email at jbealrx@gmail.com

Be sure to check out her services and offerings at www.theathletespharmacist.com