Hormonal Contraceptives and Mood: Review of the Literature and Implications for Future Research
Purpose of Review
We examine recent studies that investigate the effects of hormonal contraception on mood in different populations of women, including women in the general population and women with diagnosed psychiatric and gynecologic disorders. We address the mechanisms of several types of hormonal contraceptives and assess how these may affect mood and gynecologic disorders.
The effects of hormonal contraceptives seem to be most relevant in selected subsets of women, as they may promote improved mental health in particular psychiatric disorders such as PMDD.
Currently, there is no consistent evidence for negative effects of most hormonal contraceptives in the general population. Even though some studies reveal that certain individuals appear susceptible to negative mood effects from some forms of hormonal contraceptives, more research is needed to better identify these susceptible individuals.
KeywordsOral contraceptive Mood Depressive disorders Anxiety disorders PCOS
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.United Nations. World contraceptive use 2007 http://www.un.org/esa/population/publications/contraceptive2007/contraceptive2007.htmGoogle Scholar
- 3.United Nations. World family planning 2017. http://www.un.org/en/development/desa/population/publications/pdf/family/WFP2017_Highlights.pdf
- 4.Robakis T & Rasgon NL. Hormonal influences on behavior. Reference Module in Biomedical Sciences. 2014Google Scholar
- 12.Wildemeersch D. New intrauterine technologies for contraception and treatment in nulliparous/adolescent and parous women. Facts Views Vis Obgyn. 2009;1:223–32.Google Scholar
- 18.Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009:7, CD002120. https://doi.org/10.1002/14651858.CD002120.pub3.
- 26.•• Lundin C, Danielsson KG, Bixo M, Moby L, Bengtsdotter H, Jawad I, et al. Combined oral contraceptive use is associated with both improvement and worsening of mood in the different phases of the treatment cycle—A double-blind, placebo-controlled randomized trial. Psychoneuroendocrinology. 2017;76:135–43 This large randomized, double-blind, placebo-controlled trial showed small positive mood benefit in the premenstrual phase and a smaller negative effect on mood in the intermenstrual phase, the latter effect driven by a subpopulation of susceptible women.CrossRefGoogle Scholar
- 29.Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology. 2013;6:1–13. https://doi.org/10.2147/CLEP.S37559.
- 37.•• Schmidt PJ, Martinez PE, Nieman LK, Koziol DE, Thompson KD, Schenkel L, et al. Premenstrual dysphoric disorder symptoms following ovarian suppression: triggered by change in ovarian steroid levels but not continuous stable levels. Am J Psychiatr. 2017;174:980–9 This single-blind study of ovarian suppression followed by exogenous hormone treatment in women with PMDD demonstrated that it is the abrupt transition, rather than steady-state hormone concentration, that is associated with mood disruption.CrossRefGoogle Scholar
- 38.•• Dubey N, Hoffman JF, Schuebel K, Yuan Q, Martinez PE, Nieman LK, Rubinow DR, et al. The ESC/E (Z) complex, an effector of response to ovarian steroids, manifests an intrinsic difference in cells from women with premenstrual dysphoric disorder. Molecular Psychiatry 2017:22:1172. This RNA-seq study of cultured cells from women with PMDD showed that PMDD sufferers underexpress an estrogen-regulated gene silencing complex and that the effects of gonadal steroids on expression of these genes differ between PMDD sufferers and controls.Google Scholar
- 40.• Eisenlohr-Moul TA, Girdler SS, Johnson JL, Schmidt PJ, Rubinow DR. Treatment of premenstrual dysphoria with continuous versus intermittent dosing of oral contraceptives: results of a three-arm randomized controlled trial. Depress Anxiety. 2017;34:908–17 This randomized controlled trial showed positive benefits in all treatment arms, underscoring the powerful placebo effect in PMDD.CrossRefGoogle Scholar
- 47.Balzafiore D, Robakis T, Borish S, Budhan V, Rasgon N. The treatment of bipolar disorder in women. In: Carvalho AF, Vieta E, editors. The treatment of bipolar disorder: integrative clinical strategies and future directions: Oxford University Press; 2017.Google Scholar
- 49.• Yonkers KA, Kornstein SG, Gueorguieva R, Merry B, Van Steenburgh K, Altemus M. Symptom-onset dosing of sertraline for the treatment of premenstrual dysphoric disorder: a randomized clinical trial. JAMA Psychiatry. 2015;72:1037–44 This large multicenter RCT supported the rapid efficacy of symptom-onset dosing of antidepressants for PMDD, with no evidence of withdrawal effects on cessation.CrossRefGoogle Scholar
- 58.Kornstein SG, Toups M, Rush AJ, Wisniewski SR, Thase ME, Luther J, et al. Do menopausal status and use of hormone therapy affect antidepressant treatment response? Findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR* D) study. J Women's Health. 2013;22:121–31.CrossRefGoogle Scholar
- 74.Gingnell M, Engman J, Frick A, Moby L, Wikstrom J, Fredrikson M, et al. Oral contraceptive use changes brain activity and mood in women with previous negative affect on the pill — a double-blinded, placebo-controlled randomized trial of a levonorgestrel-containing combined oral contraceptive. Psychoneuroendocrinology. 2013b;38:1133–44.CrossRefGoogle Scholar