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I have a couple of questions for you.

1. I noticed on Columbia Univ.'s web page (www.goaskalice.columbia.edu) that using Vitamin C increases the amount of estrogen absorbed by 50%, and can cause spotting. Is this true?
2. At the University where I work a group of students prepared an informational page on contraception for the newspaper. One of the things that they said was that when you are on pills, every few years you need to take a year off to give your body a break. Is this true?

Vitamin C, also known as ascorbic acid, is a water soluble vitamin which strengthens bone, aids in iron absorption and promotes healing. The recommended daily allowance is 60 milligrams (a bit higher, 100 mg, if a person smokes). From 4-8 ounces of orange juice meets the requirement. Other sources of vitamin C are citrus fruits, strawberries, cantaloupe, tomatoes, broccoli, potatoes and greens.

Huge doses (0.5 to 1 gram OR 500 to 1000 mg) of Vitamin C have been suggested to prevent the common cold because of the antioxidant properties of ascorbic acid. This remains a debatable issue - a recommendation of still unproven value.

Intermittent use of very high doses of ascorbic acid may be a clue to the suggestion that vitamin C causes increased spotting in women on pills. The effect of ascorbic acid is to increase the absorption of estrogen. This occurs because the ascorbic acid competes with the ethinyl estradiol (EE) in the bowel wall for conjugation to sulfate. Hence less EE conjugation occurs and more is available for absorption. If a woman takes very high doses of ascorbic acid she is making her pill a higher estrogen pill. If she then stops taking ascorbic acid, she is in effect lowering the amount of estrogen absorbed and this could lead to withdrawal bleeding. Guillebaud suggests that this is not a concern with 30 microgram pills (See reference below)

Abuse of vitamin C is common and causes nausea, abdominal cramps and diarrhea.

Two excellent books for women Stewart: Understanding Your Body Bantam Books, 1987) and The PDR Family Guide to Women's Health (Medical Economics, 1994) both actually suggest taking 200 mg of ascorbic acid three times a day to prevent spotting if it occurs while using an IUD. This advice was derived from a study by Margolis in 1964.

So what can we conclude?
First, the recommended daily allowance of vitamin C for most people is 50 to 60 mg per day; 80 mg per day if pregnant; 100 mg per day if smoking. Second, use of mega-doses of vitamin C is controversial and may cause problems. Third, mega-doses of vitamin C may increase serum estrogen levels and this per se could cause spotting or could cause spotting when the mega-doses are stopped (withdrawal bleed). Fourth, Planned Parenthood (All About Birth Control Three Rivers Press , 1998) recommends that women who use the pill should take no more than 100 mg of Vitamin C supplementation per day. This seems like good advice and it probably would not lead to spotting problems in women on current low-dose pills

Taking A Break

Virtually all agree that there is not a need for a break from taking pills.

Professor John Guillebaud of the Margaret Pyke Center in London has prepared the longest answer to this question so I will summarize them: "From the point of view of preservation of fertility the answer is a categorical no." The reversibility of the pill is not dependent on the duration of use.

In relation to circulatory disease (and this is primarily in relation to smokers) a break only has an effect by altering the total exposure to pills. A break would be expected to have no benefit unless it influenced the total accumulated duration of pill use.

Guillebaud concludes: "The main problem with breaks of a few months ..was well shown in a study in which one quarter of young women had unplanned pregnancies during a planned break of just 6 months"

Guillebaud points out that a woman who has taken pills for 10 years has had 130 breaks of one week each from taking pills. These breaks add up to 2 and a half years of not taking pills over a 10 year period. There is increasing evidence that during the pill-free-interval (the week off of pills) the body tends to restore metabolic changes toward normal.

John Guillebaud's book: Contraception: Your Questions Answered (Churchill Livingstone - 1993) is a marvelous source of information on all contraceptives)