Drug & supplement interaction

Senna + Ethinyl Estradiol, Norethindrone, Ferrous Fumarate

Ethinyl Estradiol, Norethindrone, Ferrous Fumarate brand names: Estrostep Fe, Loestrin Fe, Microgestin FE, Junel Fe 1.5/30, Loestrin Fe 1.5/30, and others.

Moderate Interaction
Medically reviewed by · Updated October 2026
The bottom line Moderate

Senna has a moderate interaction with Ethinyl Estradiol, Norethindrone, Ferrous Fumarate. Theoretically, taking senna may interfere with the absorption of exogenous estrogens.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Senna and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate

Here is the interaction we found between these two, with the evidence behind it.

Moderate

ESTROGENS

Why this applies to Ethinyl Estradiol, Norethindrone, Ferrous Fumarate

Ethinyl Estradiol, Norethindrone, Ferrous Fumarate falls under ESTROGENS — the group Senna interacts with.

Theoretically, taking senna may interfere with the absorption of exogenous estrogens.
Some preliminary clinical evidence suggests that senna reduces the absorption of estradiol and decreases serum concentrations of estrone and estrone sulfate by decreasing intestinal transit time.
Severity Moderate Likelihood Possible Evidence B

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the worry with your birth control pill, which contains ethinyl estradiol (an estrogen) plus norethindrone. Senna is a stimulant laxative, so it speeds things along and moves food through your gut faster. The concern is that when things pass through quickly, your body may have less time to soak up the estrogen, so a little less of it gets into your bloodstream.

Honestly, this is mostly theoretical and based on weak early studies, so it's not something to panic over. An occasional dose of senna for a day or two is unlikely to throw off your pill. But using senna regularly or every day could, in theory, make your birth control slightly less reliable. If you find yourself needing a laxative often, please check in with your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Lewis, S. J., Heaton, K. W., Oakey, R. E., and McGarrigle, H. H. Lower serum oestrogen concentrations associated with faster intestinal transit. Br.J Cancer 1997;76(3):395-400. PubMed
  2. Lewis, S. J., Oakey, R. E., and Heaton, K. W. Intestinal absorption of oestrogen: the effect of altering transit-time. Eur.J Gastroenterol.Hepatol. 1998;10(1):33-39. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • 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.
Evidence the quality of the studies behind the rating (graded A–D)
  • 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.

Keep it in perspective

Senna Also Interacts With Other Medications

Senna has 139 moderate known drug interactions in our database — the Ethinyl Estradiol, Norethindrone, Ferrous Fumarate one above is one of them. If you take anything else, check it against the full list below.

Moderate 139 No known interaction 2,691 (incl. Ethinyl Estradiol, Norethindrone, Ferrous Fumarate)
Taking anything else?

Check Another of Your Medications Against Senna

Covers the 2,830 medications we’ve checked against Senna. Pick one to open its full report.

From our Q&A

Questions About Senna or Ethinyl Estradiol, Norethindrone, Ferrous Fumarate

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Senna or Ethinyl Estradiol, Norethindrone, Ferrous Fumarate, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Ethinyl Estradiol, Norethindrone, Ferrous Fumarate

This page covers Senna only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ethinyl Estradiol, Norethindrone, Ferrous Fumarate page lists 240 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Grapefruit (major), Siberian Cocklebur (major) and St. John's Wort (major).

By severity: 6 major · 196 moderate · 38 minor.

From our pharmacist’s overview on the Ethinyl Estradiol, Norethindrone, Ferrous Fumarate page

“If you take a birth control pill that combines ethinyl estradiol, norethindrone, and iron (Loestrin Fe, Estrostep Fe, Microgestin Fe), a few supplements can genuinely undermine it, and I want you to know which ones first. Six of the 240 ingredients on file carry a major rating.”

Reviewed by 2 · Jul 18, 2026

Open the Ethinyl Estradiol, Norethindrone, Ferrous Fumarate interaction page

One more smart check

Taking Senna as Part of a Dietary Supplement Product? Check It for Interactions

We hold 120 real supplement products containing Senna, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Senna. Your product may carry other ingredients that interact with Ethinyl Estradiol, Norethindrone, Ferrous Fumarate too, on top of Senna — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Senna and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate 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.

Supplement Senna
Top 25%

#205 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Ethinyl Estradiol, Norethindrone, Ferrous Fumarate
Top 10%

#190 of 2,830 medications looked up here in the last 7 days

29 days ago today

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.

Supplement

About Senna

What is Senna?

Senna
  • Short-term constipation relief
  • Bowel cleansing before procedures
  • Occasional irregularity
  • Traditional digestive remedy

Senna is a plant-based stimulant laxative that is widely used and generally effective for short-term relief of constipation. It is best used occasionally and for only a few days at a time, since long-term use can lead to dependence and other problems. Talk with a pharmacist or doctor before using it regularly or if you have ongoing constipation.

Read the full Senna monograph & all interactions
Keep checking

Other Drugs & Senna

Browse every other medication we’ve checked against Senna — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
139Moderate
0Minor
2,690No known interaction
139 Moderate 2,690 No interaction
Moderate

139 interactions

Showing 60 of 139 moderate interactions — see all 139 on the Senna page.

No interaction 2,690 drugs checked — show the list

We also checked Senna against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,690 medications checked with no known interaction — see the full Senna list.

See the full Senna interactions page
See every supplement checked against Ethinyl Estradiol, Norethindrone, Ferrous Fumarate, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

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

Keep exploring
Senna monograph › Uses, safety, and every drug interaction in one place Ethinyl Estradiol, Norethindrone, Ferrous Fumarate supplement interactions › Every supplement checked against Ethinyl Estradiol, Norethindrone, Ferrous Fumarate, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Senna and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate Together: Common Questions

Can you take Senna with Ethinyl Estradiol, Norethindrone, Ferrous Fumarate?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Senna and Ethinyl Estradiol, Norethindrone, Ferrous Fumarate interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Ethinyl Estradiol, Norethindrone, Ferrous Fumarate and Senna?

Our pharmacists answer your medication & supplement questions — free.

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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.