Takaisin Tulosta

Depression and hormonal contraception

Further information
Jorma Komulainen and Heidi Alenius

Further information – Published: 12.4.2017

A summary of the study by Skovlund et al. (2016) «Skovlund CW, Mørch LS, Kessing LV ym. Association ...»1

  • A large Danish prospective cohort of all 15 to 34 year old women who lived in Denmark between 2000 and 2013 (1 061 997 women in total).
  • Exclusion criteria:
    • Before entering study: diagnosis of depression, antidepressant medication, psychiatric illness, cancer, venous thrombosis or fertility treatment.
    • Moved to Denmark after 1995
  • Endpoints:
    • Starting first antidepressant medication
    • First diagnosis of depression
  • Confounding factors acknowledged:
    • Age
    • Level of education
    • PCO and endometriosis
    • BMI (available for only part of women)
    • Smoking (yes or no, available for only part of women)
  • Data sources: The National Prescription Register, Psychiatric Central Research Register, Statistic Denmark, National Health Register, National Birth Register
  • Results:
    • 55.5% of women used or had used hormonal contraception
    • 133 178 women started their first antidepressant medication during study period
    • Absolute risks: no hormonal contraception = 1.7%/yr; combined hormonal comtraception = 2.1%/yr (NNH = 250); progestin-only contraception = 2.5%/yr (NNH = 125)
    • 23 077 women were diagnosed with depression for the first time during study period
      • Absolute risks: no hormonal contraception = 0.31%/yr; combined hormonal contraception = 0.34%/yr (NNH = 3 333); progestin-only contraception = 0.40%/yr (NNH = 1 111)
  • Risk ratios, when adjusted for age, calendar year, educational level, PCO and endometriosis (compared to those who did not use hormonal contraception)
    • Antidepressant medication:
      • Combined hormonal contraception RR 1.2 (CI 1.22 – 1.25)
      • Progestin-only contraception RR 1.3 (CI 1.27 – 1.40)
    • Diagnosis of depression:
      • Combined hormonal contraceptives RR 1.1 (CI 1.08 – 1.14)
      • Progestin-only contraception RR 1.2 (CI 1.04 – 1.31)
    • There seemed to be differences between products.
    • Young women (aged 15 to 19) had the biggest risks.
  • The strength of the study is that the exposure (hormonal contraception) has come before the first antidepressant medication or depression treatment, and therefore the association has been possible to analyze.
  • The limitation of the study is that not all confounding factors could be addressed, and therefore no definite conclusions on the causal relationship may be drawn.

A summary of the study by Lindberg et al. (2016) «Lindberg M, Foldemo A, Josefsson A ym. Differences...»2

Other, smaller studies


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  2. Lindberg M, Foldemo A, Josefsson A ym. Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: a nationwide population-based study with age-specific analyses. Eur J Contracept Reprod Health Care 2012;17:106-18 «PMID: 22385398»PubMed
  3. Toffol E, Heikinheimo O, Koponen P ym. Hormonal contraception and mental health: results of a population-based study. Hum Reprod 2011;26:3085-93 «PMID: 21840911»PubMed
  4. Toffol E, Heikinheimo O, Koponen P ym. Further evidence for lack of negative associations between hormonal contraception and mental health. Contraception 2012;86:470-80 «PMID: 22465115»PubMed
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  8. Duke JM, Sibbritt DW, Young AF. Is there an association between the use of oral contraception and depressive symptoms in young Australian women? Contraception 2007;75:27-31 «PMID: 17161120»PubMed
  9. Joffe H, Cohen LS, Harlow BL. Impact of oral contraceptive pill use on premenstrual mood: predictors of improvement and deterioration. Am J Obstet Gynecol 2003;189:1523-30 «PMID: 14710055»PubMed
  10. Castilho JL, Jenkins CA, Shepherd BE ym. Hormonal Contraception and Risk of Psychiatric and Other Noncommunicable Diseases in HIV-Infected Women. J Womens Health (Larchmt) 2015;24:481-8 «PMID: 25751720»PubMed