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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Christin-Maitre S. History of oral contraceptive drugs and their use worldwide. Best Pract Res Clin Endocrinol Metab. 2013;27:3–12.
United Nations. World contraceptive use 2007 http://www.un.org/esa/population/publications/contraceptive2007/contraceptive2007.htm
United Nations. World family planning 2017. http://www.un.org/en/development/desa/population/publications/pdf/family/WFP2017_Highlights.pdf
Robakis T & Rasgon NL. Hormonal influences on behavior. Reference Module in Biomedical Sciences. 2014
Messinis IE. Ovarian feedback, mechanism of action and possible clinical implications. Hum Reprod Update. 2006;12:557–71.
Choi J, Smitz J. Luteinizing hormone and human chorionic gonadotropin: distinguishing unique physiologic roles. Gynecol Endocrinol. 2013;30:174–81.
Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012;86:659–65.
Stanczyk FZ. Pharmacokinetics and potency of progestins used for hormone replacement therapy and contraception. Rev Endocr Metab Disord. 2002;3:211–24.
Nappi RE, Kaunitz AM, Bitzer J. Extended regimen combined oral contraception: a review of evolving concepts and acceptance by women and clinicians. Eur J Contracept Reprod Health Care. 2016;21:106–15.
Trenor CC, Chung RJ, Michelson AD, Neufeld EJ, Gordon CM, Laufer MR, et al. Hormonal contraception and thrombotic risk: a multidisciplinary approach. Pediatrics. 2011;127:347–57.
Diaz S, Peralta O, Juez G, Herreros C, Casado ME, Salvatierra ME, et al. Fertility regulation in nursing women: III. Short-term influence of a low-dose combined oral contraceptive upon lactation and infant growth. Contraception. 1983;27:1–11.
Wildemeersch D. New intrauterine technologies for contraception and treatment in nulliparous/adolescent and parous women. Facts Views Vis Obgyn. 2009;1:223–32.
Toffol E, Heikinheimo O, Koponen P, Luoto R, Partonen T. Hormonal contraception and mental health: results of a population-based study. Hum Reprod. 2011;26:3085–93.
Toffol E, Heikinheimo O, Koponen P, Luoto R, Partonen T. Further evidence for lack of negative associations between hormonal contraception and mental health. Contraception. 2012;86:470–80.
Keyes KM, Cheslack-Postava K, Westhoff C, Heim CM, Haloossim M, Walsh K, et al. Association of hormonal contraceptive use with reduced levels of depressive symptoms: a national study of sexually active women in the United States. Am J Epidemiol. 2013;178:1378–88.
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.
Hassoun LA, Chahal DS, Sivamani RK, Larsen LN. The use of hormonal agents in the treatment of acne. Semin Cutan Med Surg. 2016;35:68–73.
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.
Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiatry. 2016;73:1154–62.
Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with suicide attempts and suicides. Am J Psychiatry. 2018;175:336–42.
Zettermark S, Vicente RP, Merlo J. Hormonal contraception increases the risk of psychotropic drug use in adolescent girls but not in adults: a pharmacoepidemiological study on 800 000 Swedish women. PLoS One. 2018;13:e0194773.
Garbers S, Correa N, Tobier N, Blust S, Chiasson MA. Association between symptoms of depression and contraceptive method choices among low-income women at urban reproductive health centers. Matern Child Health J. 2010;14(1):102.
Moore M, Kwitowski M, Javier S. Examining the influence of mental health on dual contraceptive method use among college women in the United States. Sex Reprod Healthc. 2017;12:24–9.
Callegari LS, Zhao X, Nelson KM, Lehavot K, Bradley KA, Borrero S. Associations of mental illness and substance use disorders with prescription contraception use among women veterans. Contraception. 2014;90(1):97–103.
Steinberg JR, Adler NE, Thompson KM, Westhoff C, Harper CC. Current and past depressive symptoms and contraceptive effectiveness level method selected among women seeking reproductive health services. Soc Sci Med. 2018;214:20–5.
•• 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.
O’Connell K, Davis AR, Kerns J. Oral contraceptives: side effects and depression in adolescent girls. Contraception. 2007;75:299–304.
Graham CA, Ramos R, Bancroft J, Maglaya C, Farley TM. The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods. Contraception. 1995;52:363–9.
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.
Bishop S, Basch S, Futterweit W. Polycystic ovary syndrome, depression, and affective disorders. Endocr Pract. 2009;15:475–82.
Costello MF, Shrestha B, Eden J, Johnson NP, Sjoblom P. Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review. Hum Reprod. 2007;22:1200–9.
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98:4565–92.
Rasgon NL, Rao RC, Hwang S, Altshuler LL, Elman S, Zuckerbrow-Miller J, et al. Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. J Affect Disord. 2003;74:299–304.
Cinar N, Harmanci A, Demir B, Yildiz BO. Effect of an oral contraceptive on emotional distress, anxiety and depression of women with polycystic ovary syndrome: a prospective study. Hum Reprod. 2012;27:1840–5.
Rubinow DR, Schmidt PJ. Gonadal steroid regulation of mood: the lessons of premenstrual syndrome. Front Neuroendocrinol. 2006;27:210–6.
Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998;338:209–16.
•• 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.
•• 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.
Freeman EW, Halbreich U, Grubb GS, Rapkin AJ, Skouby SO, Smith L, et al. An overview of four studies of a continuous oral contraceptive (levonorgestrel 90 mcg/ethinyl estradiol 20 mcg) on premenstrual dysphoric disorder and premenstrual syndrome. Contraception. 2012;85:437–45.
• 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.
Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. 2005;106:492–501.
Marr J, Niknian M, Shulman LP, Lynen R. Premenstrual dysphoric disorder symptom cluster improvement by cycle with the combined oral contraceptive ethinylestradiol 20 mcg plus drospirenone 3 mg administered in a 24/4 regimen. Contraception. 2011;84:81–6.
Pagano HP, Zapata LB, Berry-Bibee EN, Nanda K, Curtis KM. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception. 2016;94:641–9.
Cirillo PC, Passos RBF, do Nascimento Bevilaqua MC, López JRRA, Nardi AE. Bipolar disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder comorbidity: a systematic review. Rev Bras Psiquiatr. 2012;34:467–79.
Teatero ML, Mazmanian D, Sharma V. Effects of the menstrual cycle on bipolar disorder. Bipolar Disord. 2014;16:22–36.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing; 2013.
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.
Jensvold MF, Reed K, Jarrett DB, Hamilton JA. Menstrual cycle-related depressive symptoms treated with variable antidepressant dosage. J Women's Health. 1992;1:109–15.
• 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.
Dias RS, Lafer B, Russo C, Del Debbio A, Nierenberg AA, Sachs GS, et al. Longitudinal follow-up of bipolar disorder in women with premenstrual exacerbation: Findings from STEP-BD. Am J Psychiatr. 2011;168:386–94.
Ghaemi SN, Rosenquist KJ, Ko JY, Baldassano CF, Kontos NJ, Baldessarini RJ. Antidepressant treatment in bipolar versus unipolar depression. Am J Psychiatr. 2004;161:163–5.
Slyepchenko A, Frey BN, Lafer B, Nierenberg AA, Sachs GS, Dias RS. Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1099 women from STEP-BD study. Acta Psychiatr Scand. 2017;136:473–82.
Herzog AG, Blum AS, Farina EL, Maestri XE, Newman J, Garcia E, et al. Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use. Neurology. 2009;72:911–4.
Andreasen AH, Brøsen K, Damkier P. A comparative pharmacokinetic study in healthy volunteers of the effect of carbamazepine and oxcarbazepine on cyp3a4. Epilepsia. 2007;48:490–6.
Nallani SC, Glauser TA, Hariparsad N, Setchell K, Buckley DJ, Buckley AR, et al. Dose-dependent induction of cytochrome P450 (CYP) 3A4 and activation of pregnane X receptor by topiramate. Epilepsia. 2003;44:1521–8.
Robakis TK, Holtzman J, Stemmle PG, Reynolds-May MF, Kenna HA, Rasgon NL. Lamotrigine and GABAA receptor modulators interact with menstrual cycle phase and oral contraceptives to regulate mood in women with bipolar disorder. J Affect Disord. 2015;175:108–15.
Kornstein SG, Harvey AT, Rush AJ, Wisniewski SR, Trivedi MH, Svikis DS, et al. Self-reported premenstrual exacerbation of depressive symptoms in patients seeking treatment for major depression. Psychol Med. 2005;35:683–92.
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.
Young EA, Kornstein SG, Harvey AT, Wisniewski SR, Barkin J, Fava M, et al. Influences of hormone-based contraception on depressive symptoms in premenopausal women with major depression. Psychoneuroendocrinology. 2007;32:843–53.
Berry-Bibee EN, Kim MJ, Simmons KB, Tepper NK, Riley HE, Pagano HP, et al. Drug interactions between hormonal contraceptives and psychotropic drugs: a systematic review. Contraception. 2016;94:650–67.
Haley CL, Sung SC, Rush AJ, Trivedi MH, Wisniewski SR, Luther JF, et al. The clinical relevance of self-reported premenstrual worsening of depressive symptoms in the management of depressed outpatients: a STAR*D Report. J Women's Health. 2013;22:219–29.
Joffe H, Petrillo LF, Viguera AC, Gottshcall H, Soares CN, Hall JE, et al. Treatment of premenstrual worsening of depression with adjunctive oral contraceptive pills: a preliminary report. The Journal of Clinical Psychiatry. 2007;68:1954–62.
Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25:1069–85.
Alonso P, Gratacos M, Segalas C, Escaramis G, Real E, Bayes M, et al. Variants in estrogen receptor alpha gene are associated with phenotypical expression of obsessive-compulsive disorder. Psychoneuroendocrinology. 2011;36:473–83.
Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR. Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord. 2003;17:461–78.
Hill RA, McInnes KJ, Gong EC, Jones ME, Simpson ER, Boon WC. Estrogen deficient male mice develop compulsive behavior. Biol Psychiatry. 2007;61:359–66.
Williams KE, Koran LM. Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum. The Journal of Clinical Psychiatry. 1997;58:330–4.
Vulink NC, Denys D, Bus L, Westenberg HG. Female hormones affect symptom severity in obsessive–compulsive disorder. Int Clin Psychopharmacol. 2006;21:171–5.
Labad J, Menchón JM, Alonso P, Segalàs C, Jiménez S, Vallejo J. Oral contraceptive pill use and changes in obsessive–compulsive symptoms. J Psychosom Res. 2006;60:647–8.
Guiloff E, Ibarra-Polo A, Zanartu J, Tascanini C, Mischler TW, Gomez-Rogers C. Effect of contraception on lactation. Am J Obstet Gynecol. 1974;118:42–5. https://doi.org/10.1016/S0002-9378(16)33643-2.
Roberts TA, Hansen S. Association of hormonal contraception with depression in the postpartum period. Contraception. 2017;96:446–52.
Toffoletto S, Lanzenberger R, Gingnell M, Sundstrom-Poromaa I, Comasco E. Emotional and cognitive functional imaging of estrogen and progesterone effects in the female human brain: a systematic review. Psychoneuroendocrinology. 2014;50:28–52.
Pluchino N, Cubeddu A, Giannini A, Merlini S, Cela V, Angioni S, et al. Progestogens and brain: an update. Maturitas. 2009;62:349–55.
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.
Lisofsky N, Riediger M, Gallinat J, Lindenberger U, Kühn S. Hormonal contraceptive use is associated with neural and affective changes in healthy young women. Neuroimage. 2016;134:597–606.
Petersen N, Cahill L. Amygdala reactivity to negative stimuli is influenced by oral contraceptive use. Soc Cogn Affect Neurosci. 2015;10(9):1266–72.
Rohleder N, Wolf JM, Piel M, Kirschbaum C. Impact of oral contraceptive use on glucocorticoid sensitivity of pro-inflammatory cytokine production after psychosocial stress. Psychoneuroendocrinology. 2003;28(3):261–73.
Montoya ER, Bos PA. How oral contraceptives impact social-emotional behavior and brain function. Trends Cogn Sci. 2017;21(2):125–36.
Aleknaviciute J, Tulen JHM, De Rijke YB, Bouwkamp CG, van der Kroeg M, Timmermans M, et al. The levonorgestrel-releasing intrauterine device potentiates stress reactivity. Psychoneuroendocrinology. 2017;80:39–45.
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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Reproductive Psychiatry and Women's Health
About this article
Cite this article
Robakis, T., Williams, K.E., Nutkiewicz, L. et al. Hormonal Contraceptives and Mood: Review of the Literature and Implications for Future Research. Curr Psychiatry Rep 21, 57 (2019). https://doi.org/10.1007/s11920-019-1034-z
- Oral contraceptive
- Depressive disorders
- Anxiety disorders