HORMONAL CONTRACEPTION AND MOOD DISORDERS: CURRENT EVIDENCE ON DEPRESSION, ANXIETY AND EMOTIONAL WELL-BEING

Abstract

Hormonal contraception remains one of the most widely used methods of pregnancy prevention worldwide and is an integral part of contemporary reproductive healthcare. In addition to its contraceptive role, hormonal therapy is frequently prescribed for dysmenorrhea, endometriosis, acne, polycystic ovary syndrome, heavy menstrual bleeding, and premenstrual disorders. Although these benefits are well established, the potential relationship between hormonal contraceptive use and mental health has become a subject of growing scientific and clinical interest. Particular attention has been directed toward depression, anxiety, emotional instability, reduced well-being, and suicidal behavior (Mu & Kulkarni, 2022).

This review summarizes current evidence on the association between hormonal contraceptive methods and mood-related outcomes. It considers combined oral contraceptives, progestin-only pills, hormonal intrauterine devices, implants, injectable contraceptives, transdermal patches, and vaginal rings. Several large observational studies suggest that hormonal contraception may be associated with an increased risk of depressive symptoms, antidepressant use, or first diagnosis of depression, especially among adolescents, first-time users, and women using progestin-only formulations (Skovlund et al., 2016). Longitudinal findings further indicate that exposure to oral contraceptives during adolescence may be linked to later vulnerability to major depressive disorder (Anderl et al., 2020).

The evidence, however, is not uniform. Some women report worsening mood symptoms after initiating hormonal contraception, whereas others experience improved emotional stability, particularly when contraception reduces menstrual-related mood fluctuations or symptoms of premenstrual dysphoric disorder (Lewis et al., 2019). Proposed mechanisms include changes in serotonergic signaling, neurosteroid synthesis, GABAergic activity, stress reactivity, and hypothalamic-pituitary-adrenal axis regulation (Ciarcia & Huckins, 2024). Overall, psychiatric responses to hormonal contraception vary considerably between patients. Factors such as age, psychiatric history, hormonal formulation, biological susceptibility, and psychosocial context should therefore be considered carefully during contraceptive counseling.