Birth Control with Hepatitis C

Making a birth control plan is always a very personal decision. Hep C adds some additional factors to think about when you are making that choice. Your options depend on which phase of hepatitis you are dealing with.

Many types of birth control use hormones to prevent pregnancy. Some have only progesterone while others have both estrogen and progesterone. Estrogen can be harmful in some stages of hepatitis because it is processed by the liver. Too much estrogen can cause problems.

Types of birth control

No hormones

These options include:

• No birth control
• Condoms (female or male)
• Diaphragm/cervical cap
• Copper IUD
• Permanent methods, like tubal sterilization or vasectomy

Methods with progesterone but no estrogen

These options include:

• “Morning-after pills” (emergency contraception), like Plan B
• Progesterone-only pills (also called Mini Pills)
• IUDs with progesterone, like Mirena, Skyla, or Kyleena
• DepoProvera injection
• Implants like Nexplanon

Methods with both estrogen and progesterone

These include:

• Most birth control pills
• Nuvaring
• Birth control patches like OrthoEvra
• Injectable birth control with both estrogen and progesterone (not currently available in the US)

If your hep C has been treated and cured, it doesn’t affect your birth control options.

Most people living with hep C have chronic hep C. People with chronic hep C can use all types of birth control. While birth control pills are processed by the liver, they have been shown not to worsen liver damage or increase the chance of liver cancer in people with hep C.^1,2

If you have acute hep C, birth control methods containing estrogen are not recommended. Methods with progesterone or hormone-free methods are safer choices. Non-urgent surgery like tubal ligation is usually not recommended during acute hep C.²

Birth control during hepatitis C treatment

If you plan to take medications to treat hep C, the decision becomes a little more complicated. There are two main reasons for this:³

1. Ribavirin may cause birth defects or miscarriage
2. Some hep C treatments affect the liver. This changes how the body handles hormones, especially estrogen. Too much estrogen can increase the chance of dangerous blood clots in the legs or lungs.

So the types of birth control that are safe to use during treatment depends on which medications you are using.

• Drug manufacturers recommend not to get pregnant while taking Ribavirin, or while your partner is taking ribavirin, and for 6 months after finishing.
• Viekira Pak (Technivie) and Mavyret affect how the liver handles estrogen. Methods with progesterone only, or with no hormones, are likely safer choices.^4,5
• Research shows that Zepatier, Harvoni, Vosevi, and Epclusa components don’t cause problems with a specific pill type (ethinyl estradiol and norgestimate), such as brand names Sprintec or Ortho-Cyclen.^6-8

There’s no single best type of birth control. Talk with your health care team to come up with a birth control plan that works best for you.