Hormonal contraceptives, including the birth control pill, are the second most popular form of contraception for women between the ages of 15 and 49. An estimated 64.9 percent of women in this age range are currently using contraception, according to the Centers for Disease Control and Prevention (CDC), and of these women, 12.6 percent are using oral contraceptive pills, which is second only to female sterilization in popularity.


Birth control pills are a popular option not only for preventing contraception, but also for helping to regulate irregular or painful periods, treat hormonal acne, and prevent ovarian cysts. However, hormonal contraceptives often cause a number of unpleasant side effects that can be uncomfortable and inconvenient.


Birth control pills like Loestrin Fe 1/20 are a common choice for women of child-bearing age, but what are the side effects of the medication and how can they be prevented?



What is Loestrin Fe 1/20?


Loestrin Fe 1/20 is a combination hormone medication that is comprised of norethindrone, a type of progestin, and ethinyl estradiol, a type of estrogen. The 7 inactive pills contain a small amount of ferrous fumurate (Fe). 


Loestrin Fe 1/20 is primarily used as an oral contraceptive, or birth control pill, but it can also help regulate irregular menstrual periods, decrease blood loss and reduce pain associated with periods, lower the risk of ovarian cysts, and treat hormonal acne in women who are menstruating.


The medication is sold under a number of different brand names, as well as under the generic name norethindrone - E. Estradiol-Iron. Loestrin Fe 1/20 can only be obtained with a prescription.


How does Loestrin Fe 1/20 work?


Loestrin Fe 1/20 works to prevent pregnancy in three main ways. 


  • Prevent Ovulation 


The hormones in the medication prevent eggs from fully developing and being released during ovulation. 


  • Prevent sperm from reaching egg


The combination of hormones in Loestrin cause the mucus around the cervix to thicken, which prevents sperm from passing through into the uterus.


  • Thin Uterine Lining 


Thinning the uterine lining makes implantation of a fertilized egg less likely. 


While Loestrin prevents pregnancy, it is not effective as emergency birth control and should not be taken by women who are currently pregnant. It also is not appropriate for girls who have not started menstruating. 



What are the side effects of Loestrin Fe 1/20?


Like many hormonal oral contraceptives, Loestrin Fe 1/20 is associated with both common and serious side effects. Common side effects associated with Loestrin Fe 1/20 usually do not require medical attention and may decrease in intensity or disappear after a patient’s body adjusts to the medication.


It is always important to talk to your healthcare professional if you believe you are experiencing side effects. 


Common side effects associated with Loestrin Fe 1/20 include:

  • Nausea
  • Weight gain 
  • Headaches
  • Mood changes - depression, anxiety, emotional outbursts
  • Acne 
  • Breakthrough bleeding
  • Fatigue
  • Sleep disruption 
  • Breast tenderness
  • GI distress including bloating and pain
  • Decreased libido 


Other side effects to watch for:


If you experience any of the following, they could be an indication of a more serious issue and should be reported to your healthcare professional as soon as possible.

  • Absent, irregular, or missed menstrual periods
  • Change in vision
  • Chest pain or discomfort
  • Cough up blood 
  • Fainting
  • Fever
  • Hive-like swelling of the face, tongue, throat, legs, feet, hands, or genitals
  • Irregular vaginal bleeding that is medium to heavy and occurs between regular menstrual periods
  • Pain or discomfort in the arms, back, neck, or jaw
  • Pain in the chest, legs, or groin
  • Rash
  • Severe headaches that come on suddenly
  • Unusual tiredness or weakness
  • Dizziness or lightheadedness
  • Yellowing of the eyes
  • Pain, tenderness, or swelling of the foot or leg
  • Redness of the skin
  • Slow or fast heartbeat
  • Sudden slurred speech or loss of coordination
  • Trouble breathing
  • Vomiting



Are there any risks associated with Loestrin Fe 1/20?


As is the case with many types of hormonal contraceptives, Loestrin Fe 1/20 is associated with the risk of serious cardiovascular events in women who smoke while using these contraceptives. Cardiovascular events that may occur include stroke, heart attack, blood clots, and high blood pressure.


The risk of experiencing cardiovascular issues increases with the age of the woman and the number of cigarettes that are smoked. Women ages 35 and older are considered to be at especially high risk, and it is strongly advised not to smoke at all while using Loestrin Fe 1/20. 


Women with a history of blood clots or blood clotting disorders should speak to their healthcare provider about their medical history before using a hormonal contraceptive like Loestrin Fe 1/20, as hormone treatments can increase the risk of experiencing dangerous blood clots.


Women who have diabetes may have their blood sugar affected by Loestrin Fe 1/20, so they should check their blood sugar regularly and talk to their doctor about their results.


Women should be sure to give their doctor a complete medical history and a comprehensive list of all prescription medications, over the counter medications, vitamins, supplements, and herbs that they are taking in order to prevent any potential drug interactions.



Can the side effects of Loestrin Fe 1/20 be prevented or avoided?


Unfortunately side effects from oral contraceptives like Loestrin are common. And many times women can feel like their observations and complaints are not acknowledged. It is not an ideal medication experience to find yourself using a medication you need and dealing with side effects that impact your daily life such as mood disruptions, nausea and fatigue.


Healthcare professionals may try to switch the type of birth control in an effort to mitigate side effects. Sometimes this works and other times it does not.


If switching medications doesn’t resolve issues, many times women are faced with the decision of continuing their birth control while suffering with side effects or stopping birth control and risk not addressing their health condition or contraception needs.


While the reason women experience side effects on birth control is not fully understood, there may be some explanations for certain side effects associated with nutrient depletions while using the medication. This is something called Medication Induced Nutrient Depletions (M.I.N.D) and well documented in decades of pharmacology research. These nutrients depleted on birth control are used to maintain many important functions in your body associated with energy levels, mood, hormone balance, sex drive, sleep quality, skin health and more. 


The World Health Organization has stated that hormonal birth control depletes the body of key nutrients including folate, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc that should be addressed with nutrient therapy to balance the body8. This is something called Medication Induced Nutrient Depletions (M.I.N.D) and well documented in decades of pharmacology research. 


These nutrients depleted by birth control are used to maintain many important functions in your body including:


  • Inflammatory Control


Women using hormonal contraceptives have higher levels of inflammation in their blood (lipid peroxidase and C-reactive protein) that if left unchecked may contribute to symptoms associated with increased inflammation such as headaches, fatigue and depression 1, 2, 3. In interventional studies, therapeutic doses of antioxidants normalized inflammatory markers.


  • Mood & Sleep


Research shows 80% of women using oral contraceptives have altered tryptophan metabolism within 30-90 days of initiation of use6, 7. This pattern has been correlated with depression, anxiety and low libido in OC users and corrected with therapeutic vitamin B6 doses8, 9. Tryptophan is an important amino acid used to make “feel good” serotonin and “sleep well” melatonin as well as a molecule responsible for regulating inflammation and even blood sugar via kynurenine metabolism10


  • Thyroid Function


The thyroid gland is a butterfly shaped gland located at the base of the neck responsible for making thyroid hormone that regulates body temperature, metabolism, energy levels, hair growth, skin appearance, gut health and more. The nutrients depleted on birth control are important for proper thyroid function. Without adequate levels of these nutrients, thyroid function may be suboptimal.


  • Sex Drive


Libido is a complex topic with a multifaceted reasons for alterations in drive. Women on birth control tend to have a shift in estrogen/testosterone ratios along with higher sex hormone binding globuin levels (4 times higher than non OC users) that can negatively impact libido11.  


  • Mitochondrial Health


The mitochondria are little energy generators that make energy in the form of ATP in every cell. The mitochondria is important for energy levels, brain health, hormonal production and balancing inflammation. The mitochondria run on nutrients that birth control depletes and more recent animal research suggests OCs may induce structural and functional changes in the mitochondria of  the liver and kidneys4,5.  


  • Liver Function 


The liver weighs around 3 pounds and is roughly the size of a football. It is an extremely active organ responsible for processing substances such as hormones and preparing them for excretion from the body.


The liver metabolizes hormones made by the body and those taken in medications like birth control12. It is important that the liver metabolizes the hormones in birth control so that the hormonal metabolites don’t stick around and cause problems like PMS symptoms.


The liver requires several key nutrients depleted by birth control to function properly. Ensuring you have adequate amount of nutrient such as vitamins C and E, zinc and B vitamins will help your liver function optimally13


Birth control is a vital medication women use for contraception and medical purposes. The common complaints women report while using birth control should be validated and addressed to ensure long term success and quality of life for women everywhere. 


There are several steps women can take to minimize common complaints with Loestrin Fe use including:


  • Keep a Journal 


It’s recommended that women who are considering taking hormonal birth control track their baseline health prior to taking birth control and also after they begin using hormonal contraceptives in order to determine if any changes in symptoms may be linked to their use of contraceptives. 


  • Medical History


It is important to work with your healthcare professional and review your medical history as well as your family history. Individuals with a history of any of the common side effects or family history may be at higher risk for experiencing certain side effects with birth control. 


  • Lifestyle 


A healthy foundation can benefit your overall health including your mental health while using birth control. Focus on staying hydrated, getting quality sleep, eating nutrient rich foods and less junk food, aim for movement most days of the week and find meaningful community and work. This can go very far to support your overall well being while using birth control


1. Bloodwork 


Work with your healthcare professional to monitor biomarkers while using birth control use. These include stress markers such as cortisol, inflammatory markers such as lipid peroxidase and c-reactive protein along with key nutrients known to be depleted while using birth control (B12 as MMA, folate as FIGLU, B6 as xanthurenic acid, red blood cell magnesium, zinc and selenium).


2. Nutrient Therapy 


Medication Induced Nutrient Depletions (M.I.N.D.) are important to address to ensure long term success with your medication use. Using therapeutic doses of required nutrients can ensure a great tolerance of your birth control long term. 


Preventing unwanted pregnancy is important, but some women find that the side effects of taking oral contraceptives outweigh the benefits of taking the medication. Fortunately, side effects from hormonal forms of birth control aren’t a foregone conclusion.


According to the  World Health Organization (WHO), hormonal contraceptives such as Loestrin Fe 1/20 can cause nutritional deficiencies of vitamins and minerals such as vitamins B2, B6, B12, C, and E,  folic acid, magnesium, selenium, and zinc in women who are using them.


It is believed that these nutritional deficiencies are the cause of many of the side effects of medications like Loestrin Fe 1/20, including feelings of depression. Although researchers have yet to conclusively establish a link between hormonal contraceptives and depression, depression is the most common reason why women stop taking hormonal birth control. 


When examining the nutritional impact of birth control, it’s not surprising that feelings of depression are common, as lower levels of vitamin B6 have been linked to depression in women taking oral contraceptives. Additionally, having low folate levels reduces the likelihood that a depressed individual will respond to treatment with antidepressants when compared to people with high folate levels.


Other common side effects of oral contraception, such as headaches, difficulty sleeping, fatigue, and low libido may also be caused by nutritional deficiencies resulting from the hormones contained in the medication.


Because of the way birth control impacts biochemistry, the shift in nutrient levels is believed to contribute to the incidence of side effects in many women. With many of the side effects of hormonal forms of birth control caused by nutritional deficiencies, it may be possible to prevent, diminish, or avoid side effects of the medication through the use of a dietary supplement that is formulated to correct the nutritional deficiencies that can result from long term use of hormonal contraception.


Addressing the nutritional deficiencies can help reduce the number of side effects experienced as well as their intensity, particularly when it comes to troublesome issues like low libido, weight gain, depression, mood swings, and headaches. 










  • Webb JL.Nutritional effects of oral contraceptive use: a review. J Reprod Med. 1980 Oct;25(4):150-6
  • Anderson KE et al. Effects of oral contraceptives on vitamin metabolism. Adv Clin Chem. 1976;18:247-87.https://pubmed.ncbi.nlm.nih.gov/769494/
  • https://pubmed.ncbi.nlm.nih.gov/6889807/
  • https://academic.oup.com/fampra/article/22/5/532/609084
  • https://pubmed.ncbi.nlm.nih.gov/23813101/
    1. https://pubmed.ncbi.nlm.nih.gov/16409223/
    2. https://link.springer.com/chapter/10.1007/978-3-642-72631-6_29
    3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488002/

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