Brief reportThe use of hormonal contraceptive agents and mood disorders in women
Introduction
Mood disorders are highly prevalent. The lifetime prevalence in Australian women has been estimated to be approximately 30% (Williams et al., 2010). Contraceptive agents are additionally widely used, with a recent article reporting that 58.9% of women residing in Sweden between the age of 16 and 31 use contraceptive agents (Wirehn et al., 2010). A similar prevalence has been reported in Australia (Duke et al., 2007). With a high risk of both depression and usage of contraceptive agents, it is important to know if there is relationship between the two.
There are many different contraceptive agents available. Combined contraceptive agents containing both estrogen and progestin and progestin-only agents, are the two major categories. Hormonal contraceptive agents are commonly used in birth control and cycle control, are effective, and also easy to use (Wirehn et al., 2010).
In 1970 Brenda Herzberg wrote that “Depression is a known side-effect of oral contraceptive therapy”. However, recent studies have delivered an ambiguous pattern of results. While a review article concluded that there are some psychological benefits of estrogen (Studd and Panay, 2004), other studies describe no clear association between hormonal contraception and mental disorders (Duke et al., 2007, Robinson et al., 2004). From this, it is evident that more studies are needed, in particular to determine whether relationships differ according to type of contraceptive agent used. Earlier studies have not investigated both combined and progestin only contraceptives, investigated the relationships within large randomly selected population based samples of women, included a wide range of likely confounding variables and used valid psychiatric interviews to determine mood disorders. Therefore, the aim of this study was to investigate the association between contraception use and current mood disorders in a representative population-based sample of women.
Section snippets
Participants
This study examined data obtained from women participating in the Geelong Osteoporosis Study (GOS), a large population-based study designed to investigate the epidemiology of osteoporosis, and other health disorders. Originally 1494 women (participation of 77.1%) were randomly recruited from the electoral rolls for the Barwon Statistical Division (south-eastern Australia) between 1994 and 1997 and have since been prospectively followed for a decade (retention 82.1%) (Pasco, 2011).
Of those who
Results
In this sample, 40 (8%) women were diagnosed with a current mood disorder according to the SCID-I/NP. Of this group, 8 (20%) were identified with bipolar disorder, 20 (50%) with MDD, 4 (10%) with minor depression, 7 (17.5%) with dysthymia, and 1 (2.5%) with both MDD and dysthymia. Characteristics of those with and without a current mood disorder are given in Table 1. Those with a current mood disorder were more inactive, had a significantly higher number of medical conditions during the past
Discussion
In this cross-sectional, population-based study of women, we report that current progestin-only contraceptive users had a three fold increased risk of a current mood disorder, compared to non-progestin users. In contrast, those currently using combined contraceptive agents were at decreased risk of a current mood disorder compared to non users. These associations were independent of sociodemographic characteristics, medical conditions, medication use and other lifestyle factors.
In one of the
Conclusion
In conclusion, this study suggests that women taking progestin-only contraceptive agents have an increased likelihood of current mood disorders, whereas the use of combined contraceptive agents appeared protective against these disorders. Because of the potential adverse effect progestin-only agents have on current mood, caution should be taken when prescribing these agents to women. If clinically indicated, the combined contraceptive agents appear preferable in terms of mood endpoints.
Role of funding source
The funding providers played no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; or in preparation, review, or approval of the manuscript.
Conflict of interest
Gjertrud Svendal has no conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.
Lana Williams has received Grant/Research support from Eli Lilly, Pfizer, The University of Melbourne, Deakin University and the NHMRC.
Julie Pasco has received speaker fees from Amgen, Eli Lilly and Sanofi-Aventis and funding from the Geelong Region Medical Research Foundation, Barwon Health, Perpetual
Acknowledgments
The study was funded by the National Health and Medical Research Council of Australia (NHMRC).
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Symptoms of mental disorders and oral contraception use: A systematic review and meta-analysis
2024, Frontiers in NeuroendocrinologyThe influence of health care utilization on the association between hormonal contraception initiation and subsequent depression diagnosis and antidepressant use
2020, ContraceptionCitation Excerpt :In 1971, depression was declared a known side effect of oral hormonal contraceptives [3] and changes in mood are listed as a possible adverse effect of most hormonal contraceptives on the market today [4]. Prospective research studies have been heterogeneous, demonstrating decreased risk [5–7], no association [8–11], and increased risk [12,13] between hormonal contraceptive use and mood symptoms. Population-based studies, on the other hand, have demonstrated a consistent relationship of hormonal contraceptive use with depression and antidepressant use [14,15].
Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM)
2019, Journal of Sexual MedicineCitation Excerpt :Weight gain as a side effect of POCs has been debated.40,41 An increased likelihood of mood disorders for POC users has been disputed, as well.42,43 SHBG levels decreased slightly during oral LNG contraception, which might be in part responsible for an increased risk for the occurrence of acne.
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2018, Gynecologie Obstetrique Fertilite et SenologieOral contraceptives positively affect mood in healthy PMS-free women: A longitudinal study
2017, Journal of Psychosomatic ResearchCitation Excerpt :Thus, OC-users tended to score lower on outcomes associated with reproductive depression than NC women. This effect has been observed previously in both healthy and clinical samples (e.g. [51,59,60,62].). Although women below the age of 20 may be more susceptible to negative mood effects following OC use [38,42,54], we did not observe this in our sample (mean age 20,6).
The not-so-bitter pill: Effects of combined oral contraceptives on peripheral physiological indicators of emotional reactivity
2017, Hormones and BehaviorCitation Excerpt :Furthermore, COC with an androgenic progestin component (e.g., levonorgestrel) produced more negative effects on mood and emotional well-being than COC containing anti-androgenic progestins (e.g., drospirenone or dienogest; Sundström-Poromaa and Segebladh, 2012). Nevertheless, recent findings also stress that the majority of COC users do not experience overall decreases in mood (Böttcher et al., 2012; Duke et al., 2007; Toffol et al., 2012) with some studies also reporting beneficial effects (Cheslack-Postava et al., 2015; Oinonen and Mazmanian, 2002; Svendal et al., 2012). Although the majority of COC users do not report mood worsening, subtle effects of COC on affective processing have been found in a number of paradigms.