Approximately 250 million women worldwide use hormonal contraceptives to prevent pregnancy and regulate menstruation. However, there is increasing concern that women are not sufficiently advised about the psychological impact associated with certain contraceptives. For most women, finding a contraceptive method that suits them can be challenging due to the side effects associated with the hormones found in the pills, implants, or injections that they may be taking. Mood disorders are the most common symptom causing discontinuation of a contraceptive. Estrogen and progesterone are the hormones most regularly found in contraceptives, and where estrogen is found to be neuroprotective, progesterone is not protective of a woman’s brain. Progesterone has been found to influence the neurochemistry, brain function, and the activity of neurotransmitters gamma-aminobutyric acid, serotonin, and dopamine (which are responsible for controlling mood). Although the mechanism underlying how oral contraceptives influence mood remains controversial, there is significant evidence that there is a relationship between hormonal contraceptive use and mood disorders, such as anxiety and depression.
A cross-sectional study conducted by Martell and colleagues was published in The Journal of Contraception and Reproductive Medicine in January 2023. The study used anonymous surveys to investigate the psychological impact of hormonal contraceptive pills among 188 women from June 2021 to February 2022. Of the 188 women included in the sample, 87.7% used an oral hormonal contraceptive pill as their first form of contraceptive, 48.3% of these women subsequently changed their method because of the side effects, 43.6% of whom reported that mood changes were the main side effect responsible for the change. One respondent said that “Mood/psych(ological) symptoms and libido changes were never discussed when (she) started on hormonal oral contraceptive pills at 18 (years old), and (she) did start developing mood and anxiety symptoms around the same time.” When prescribing hormonal contraceptives, physicians and gynaecologists will inform patients of the several physical symptoms that they may experience, but despite the scale of the impact, there is often limited information provided on the psychological side effects.
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The results of a population-based cohort study by Johansson and colleagues, published in The Journal of Epidemiology and Psychiatric Sciences in May 2023, took data from the UK biobank, which holds extensive data from questionnaires, interviews, and primary and secondary healthcare records from patients across the UK. Johansson and colleagues analysed findings from the health records of 264,557 women and found that 80.6% had used hormonal contraceptives at some point during their lives. The results found that the lifetime risk of depression and depressive symptoms was higher among women who have ever used hormonal contraceptives when compared to those who have never. However, women with sustained contraceptive use did not have an increased risk. A time-based analysis suggested depression risk increased during the two years from initiation of the oral contraceptives, which may suggest that hormonal fluctuations could be responsible for the change in mood.
GlobalData epidemiologists expect that the number of women aged 15 to 49 years on hormonal contraceptives in the UK will increase from 8.6 million in 2023 to 8.9 million in 2032. They also anticipate that the total prevalent cases of depression in women over 18 years old will increase from 2.8 million cases in 2023 to 2.9 million cases in 2029; part of this increase could be attributed to the increase in the use of hormonal contraceptives and the lack of associated education. As we see an increase in the number of women using hormonal contraceptives, it is critical that those prescribing them evaluate which methods are best for the individual and ensure that there is transparency regarding the physical and psychological symptoms that may be associated. The individual’s vulnerability to poor mental health and family history should be discussed to prevent a further increase in cases of depression associated with hormonal contraceptives.
