Our expert says:
Efficacy of oral contraceptives MAY definitely be reduced owing to alteration of gut flora and consequent interruption of the enterohepatic cycle of oral contraceptives. Ethinyloestradiol is not conjugated and there is more ethinyloestradiol passed in the stool. Pregnancy and breakthrough bleeding may occur.
If a patient is to take long-term antibiotic therapy (e.g. for acne vulgaris) then additional contraception should be used for the first month (the manufacturers suggest two weeks, but various sources recommends a full month) after starting the oral contraceptive pill. After this period gut flora should have adjusted to the effects of antibiotic therapy and additional use of the oral contraceptive pill so that additional contraceptive protection should not be required.
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