Researchers ease patients fear around hormonal contraceptive side effects.
Brett Worly, MD
A recent Ohio State University Wexner Medical Center study found that there’s no evidence supporting a link between hormonal birth control and depression.
Researchers performed a systematic review to examine the association between progestin-only contraception and depression, utilizing studies from database inception to September 2016 on the mental health effects of contraceptives, focusing on externally validated depression measures.
“The main point is that when looking at the entire body of research regarding progestin-only contraception and depression over the past 30 years and focusing on the best available evidence, progestin-only contraception does not cause depression,” lead author, Brett Worly, MD, OB/GYN, Ohio State Wexner Medical Center, told MD Magazine.
The included data was tied to various contraception methods including injections, implants and pills. Researchers reviewed thousands of studies examining the effects hormonal birth control plays on postpartum women, adolescents and those with a history of depression and excluded case studies, review articles and other psychiatric disorders.
Worly and researchers identified 26 studies that met the conclusion criteria including 5 randomized and controlled trials, 11 cohort studies and 10 cross-sectional studies.
The findings all came to the same conclusion: there is minimal evidence linking birth control and depression.
“Unfortunately, many people develop depression for many different reasons, and some people fault their progestin-only contraception, but when looking at large populations, progestin-only contraception does not seem to be the culprit,” Worly added. “This finding should be reassuring for physicians and patients considering progestin-only contraception.”
Patient concerns are valid and it’s important for women to have open and honest discussions with their physicians.
“The challenge is that every woman is different, and each woman needs to work with their healthcare provider to see what contraception choice is right for them,” Worly added.
According to Worly, women unsure of which contraceptive choice is best should be reassured that hormonal contraceptives are safe and should not cause depression. While depression is common, and the development of depression can occur after progestin-only contraceptive, it’s not necessarily because of a causative relationship.
“We are at a time when 50% of all pregnancies are unplanned in the US, and long-acting reversible contraception (LARC) provides a longer term, more efficacious way to contracept without the chance of user error with a birth control pill that is taken too late or missed altogether,” Worly added. “Women should not hesitate to use progestin-only contraception, the most common LARC method, due to fears of depression.”
In the paper, researchers examined papers and studies conducted over the past 30 years, coming to the conclusion that progestin-only contraception is safe for women and should not cause depression.
“These findings also hold true for adolescents and postpartum women. Women who already have depression should not have worsening depression due to progestin-only medication,” concluded Worly.
According to the study, with nearly 37 million women using birth control in the US, 67% of current contraceptive users opt for a non-permanent hormonal method like an oral pill, but among those, 30% have discontinued their use due to dissatisfaction with potential side effects.
Despite perceptions of an increased chance of depression following initiation of progestin contraceptives, a majority of the evidence does not support an association based on validated measures.
The study, "The relationship between progestin hormonal contraception and depression: a systematic review" was published in An International Reproductive Health Journal: Contraceptive February 2018.
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