Peony + Segesterone Acetate, Ethinyl Estradiol
Segesterone Acetate, Ethinyl Estradiol brand name: Annovera.
Segesterone Acetate, Ethinyl Estradiol falls into 4 drug categories that Peony can interact with; the most serious is rated moderate. Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full interaction reportPeony and Segesterone Acetate, Ethinyl Estradiol
These two interact in 4 distinct ways. Each one is explained separately below.
Why Are There 4 Interactions?
Peony interacts with whole categories of medication. Segesterone Acetate, Ethinyl Estradiol falls into 4 of those categories, so it can interact with Peony in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES
1 of 4Why this applies to Segesterone Acetate, Ethinyl Estradiol
Segesterone Acetate, Ethinyl Estradiol falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Peony interacts with.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Annovera is a vaginal ring that slowly releases two hormones, ethinyl estradiol and segesterone acetate. The estrogen part is partly broken down by a liver enzyme called CYP1A2. In lab tests, peony seems to mildly slow that same enzyme down. In theory, that could let a bit more estrogen linger in your body, which might bump up the usual estrogen-related complaints like nausea, breast tenderness, headaches, bloating, or mood changes.
Here is the honest part: this is only seen in test-tube studies, not in real people, so it is more a hunch than a proven problem. The amounts of peony and how it is absorbed matter too. I would not panic, but do mention any peony product to your pharmacist or doctor so they can keep an eye on things.
- Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
ESTROGENS
2 of 4Segesterone Acetate, Ethinyl Estradiol also falls under ESTROGENS.
In vitro and animal research shows that peony extract has estrogenic activity. Theoretically, peony might compete for estrogen receptors and/or cause additive estrogenic effects.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Annovera is a vaginal ring that releases two hormones, a progestin (segesterone) and an estrogen (ethinyl estradiol), to prevent pregnancy. Here's the thing about peony: in lab dishes and animal studies, compounds in peony root seem to act a little like estrogen and may tug at the same receptors your body's hormones use. So in theory, taking large amounts of peony alongside your ring could either add to your estrogen activity or compete with it.
I want to be honest, though. This is a theoretical concern only, based on test-tube and animal data, not real-world cases. If anything ever did happen, you might notice more estrogen-type effects like breast tenderness, nausea, or breakthrough bleeding. Occasional culinary or tea amounts are unlikely to matter, but before using concentrated peony supplements, please check with your pharmacist or doctor.
- Xu Y, Li X, Chen T, et al. Radix Paeoniae Alba increases serum estrogen level and up-regulates estrogen receptor expression in uterus and vagina of immature/ovariectomized mice. Phytother Res. 2019;33(1):117-29. [RETRACTED].
CONTRACEPTIVE DRUGS
3 of 4Segesterone Acetate, Ethinyl Estradiol also falls under CONTRACEPTIVE DRUGS.
In vitro and animal research shows that peony extract has estrogenic activity. Concomitant use might also increase the risk for estrogen-related adverse effects.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Annovera is a vaginal ring that releases two hormones, segesterone (a progestin) and ethinyl estradiol (an estrogen), to prevent pregnancy. The concern with peony is mostly on paper. In lab dishes and animal studies, compounds in peony seem to act a little like estrogen and may compete at estrogen receptors. In theory, that could either nudge your hormone balance or add to estrogen-type effects.
Because this is only theoretical (we don't have solid human studies here), I wouldn't panic. Still, it's reasonable to watch for extra estrogen-related effects like breast tenderness, nausea, headaches, bloating, or breakthrough bleeding. To be safe, please run peony past your pharmacist or doctor before combining it with Annovera.
- Xu Y, Li X, Chen T, et al. Radix Paeoniae Alba increases serum estrogen level and up-regulates estrogen receptor expression in uterus and vagina of immature/ovariectomized mice. Phytother Res. 2019;33(1):117-29. [RETRACTED].
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
4 of 4Segesterone Acetate, Ethinyl Estradiol also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Annovera works by steadily releasing two active hormones, segesterone acetate and ethinyl estradiol. Both of these are cleared from your body partly by a liver enzyme called CYP3A4. The idea here is that peony root might gently slow that enzyme down, which could let a bit more hormone linger in your system. In theory, that might nudge up estrogen-related side effects like nausea, breast tenderness, headaches, bloating, or mood changes.
That said, this is a very weak signal. The concern comes only from lab and animal studies, not from real people, and the effect seen was mild. I wouldn't lose sleep over it, but since you're relying on this ring for contraception, it's worth a quick chat with your pharmacist or doctor before adding peony.
- Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
What These Ratings Mean
Every interaction above is graded three ways — here’s the key to each label.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
- ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
- PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
- UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
- AHigh-quality meta-analysis (quantitative systematic review).
- BCase-control study.
- CConsensus.
- DAnecdotal evidence.
These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.
Peony Also Interacts With Other Medications
Peony has 810 moderate known drug interactions in our database — the Segesterone Acetate, Ethinyl Estradiol one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Peony
We haven’t checked that one against Peony yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Peony. Pick one to open its full report.
See Every Supplement That Interacts With Segesterone Acetate, Ethinyl Estradiol
This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Segesterone Acetate, Ethinyl Estradiol page lists 229 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: Beer (major), Grapefruit (major), Siberian Cocklebur (major), St. John's Wort (major) and Wine (major).
By severity: 5 major · 193 moderate · 31 minor.
From our pharmacist’s overview on the Segesterone Acetate, Ethinyl Estradiol page
“St. John's wort is the interaction I would explain first to anyone using Annovera (segesterone acetate with ethinyl estradiol, a vaginal ring for birth control).”
Reviewed by 2 · Jul 18, 2026
Open the Segesterone Acetate, Ethinyl Estradiol interaction page
Taking Peony as Part of a Dietary Supplement Product? Check It for Interactions
We hold 71 real supplement products containing Peony, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Peony. Your product may carry other ingredients that interact with Segesterone Acetate, Ethinyl Estradiol too, on top of Peony — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Peony and Segesterone Acetate, Ethinyl Estradiol Sit Against Everything Else
Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.
#213 of 1,452 supplements looked up here in the last 7 days
#2,672 of 2,830 medications looked up here in the last 7 days
Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.
About Peony
What is Peony?
- Menstrual cramps and irregular periods
- Muscle cramps and spasms
- Anxiety and stress
- Inflammation and pain
- Polycystic ovary syndrome (PCOS)
Peony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formulas. Human evidence for most uses is limited or preliminary, so it should not replace proven treatments. Talk to your pharmacist or doctor before using it, especially if you are pregnant, breastfeeding, or taking other medicines.
Other Drugs & Peony
Browse every other medication we’ve checked against Peony — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
810 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Theophylline ›
- Nifedipine ›
- Ibuprofen ›
- Aspirin ›
- Hydrocortisone ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Lidocaine ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Oxybutynin ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Miconazole ›
- Acetaminophen ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Ivabradine ›
- Ketoprofen ›
- Lofepramine ›
- Medroxyprogesterone ›
- Medroxyprogesterone Acetate ›
- Nortriptyline ›
- Rifampin ›
- Testosterone Undecanoate ›
- Aripiprazole ›
- Bendamustine ›
- Bivalirudin ›
- Caffeine (otc Drug) ›
- Ciclesonide ›
- Clonazepam ›
- Cyclobenzaprine ›
- Dapsone ›
Showing 60 of 810 moderate interactions — see all 810 on the Peony page.
No interaction 2,019 drugs checked — show the list
We also checked Peony against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Metoprolol ›
- Rosuvastatin ›
- Escitalopram ›
- Docusate ›
- Valacyclovir ›
- Hydroxyurea ›
- Tirzepatide ›
- Methamphetamine ›
- Semaglutide ›
- Sumatriptan ›
- Lisdexamfetamine ›
- Metformin ›
- Lisinopril ›
- Amoxicillin ›
- Bupropion ›
- Acyclovir ›
- Methotrexate ›
- Doxycycline ›
- Fluoxetine ›
- Amphetamine ›
- Pregabalin ›
- Lamotrigine ›
- Azithromycin ›
- Gabapentin ›
- Dextroamphetamine ›
- Isotretinoin ›
- Methylene Blue ›
- Duloxetine ›
- Ciprofloxacin ›
- Bisoprolol ›
- Levothyroxine, Liothyronine ›
- Candesartan Cilexetil ›
- Cephalexin ›
- Cyclopentolate ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Roxithromycin ›
- Mannitol ›
- Levetiracetam ›
- Pegunigalsidase Alfa-iwxj ›
- Ezetimibe ›
- Daptomycin ›
- Levothyroxine Sodium ›
- Dexmethylphenidate ›
- Mitomycin ›
- Valsartan ›
- Amoxicillin, Clavulanate Potassium ›
- Spironolactone ›
- Hexobarbitone ›
- Thyroid Hormone ›
- Phentermine, Topiramate ›
- Carbidopa, Levodopa ›
- Factor 7a ›
- Levodopa ›
- Minoxidil ›
- Hethylphenidate Hcl ›
- Cefaclor ›
- Lenvatinib ›
Showing the 60 most looked-up of 2,019 medications checked with no known interaction — see the full Peony list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Segesterone Acetate, Ethinyl Estradiol Is Linked to Lower Levels of 7 Nutrients
Natural Medicines records Segesterone Acetate, Ethinyl Estradiol as a medicine that can lower these. This is not an interaction with Peony — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Segesterone Acetate, Ethinyl Estradiol nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Peony and Segesterone Acetate, Ethinyl Estradiol Together: Common Questions
Can you take Peony with Segesterone Acetate, Ethinyl Estradiol?
Why are there 4 interactions listed for Peony and Segesterone Acetate, Ethinyl Estradiol?
How serious is the Peony and Segesterone Acetate, Ethinyl Estradiol interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.