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PMID 7400861

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This interaction can lead to: Less symptom control, such as not controlling hot flashes during menopause Less medicine effectiveness, such as with gender-affirming therapy A higher risk of pregnancy More side effects, such as headaches or breakthrough menstrual bleeding Review medicine interactions with the PWH, including all their prescription, over-the-counter, and herbal treatments Be cautious when adding any other medicines that induce or inhibit P450 enzymes (for more info, see Lynch, 2007) Caution PWH to avoid eating grapefruit or drinking grapefruit juice while on these medicines grapefruit is a P450 inhibitor and can decrease hormone breakdown (for more info, see Monroe, 2013) Together, you both may decide to: Change the hypersomnia medicine to one that doesnt interact with hormone medicines Change the dose of the hormone medicine Adjust the birth control method, such as to: Switch to a different method of birth control that isnt affected, such as an IUD Shorten or eliminate the hormone-free interval of cyclic birth control methods Change the hormone dose Add a barrier method, such as also using a contraceptive diaphragm or condom Cardiovascular complications Although P450 inducers should lower the available hormone doses, its necessary to avoid prescribing ethinyl estradiol doses of 50 mcg or higher