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Ból K, Brudzińska A, Wybrańczyk Ł, Właszczuk A. EFFECT OF HORMONAL CONTRACEPTION ON DEPRESSION IN WOMEN. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1062-1067. [PMID: 37326090 DOI: 10.36740/wlek202305126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Oral contraceptives are the most frequently chosen method of preventing pregnancy in Poland. Mood changes are one of the most common reasons why young women quit therapy. Depression is a severe disorder that affects millions of people around the world. Some long-term studies suggest an increased relative risk of antidepressant use during contraceptive use compared to non-users. Scientists note an increased risk of suicide as well. Other researchers suggest that there is insufficient evidence to support these findings. Some indicate strong correlation between most hormonal contraceptives and following usage of antidepressant drugs in female adolescents. There is still no consensus in the scientific community. Analyzes of many studies provide ambiguous information. Large-scale studies with properly selected test groups and particular therapies taken into consideration are required in order to accurately assess the risk of depression and mood disorders. In this article, we try to present different approaches to the subject of effects of various types of hormonal contraception methods on depression in women.
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Affiliation(s)
- Klaudia Ból
- DEPARTMENT OF PHYSIOLOGY, MEDICAL UNIVERSITY OF SILESIA, FACULTY OF MEDICAL SCIENCES IN KATOWICE, POLAND
| | - Aleksandra Brudzińska
- DEPARTMENT OF PHYSIOLOGY, MEDICAL UNIVERSITY OF SILESIA, FACULTY OF MEDICAL SCIENCES IN KATOWICE, POLAND
| | - Łukasz Wybrańczyk
- DEPARTMENT OF PHYSIOLOGY, MEDICAL UNIVERSITY OF SILESIA, FACULTY OF MEDICAL SCIENCES IN KATOWICE, POLAND
| | - Adam Właszczuk
- DEPARTMENT OF PHYSIOLOGY, MEDICAL UNIVERSITY OF SILESIA, FACULTY OF MEDICAL SCIENCES IN KATOWICE, POLAND
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Saloranta TH, Gyllenberg FK, But A, Gissler M, Heikinheimo O, Laine MK. Use of reproductive health services among women using long- or short-acting contraceptive methods - a register-based cohort study from Finland. BMC Public Health 2022; 22:1185. [PMID: 35701805 PMCID: PMC9199191 DOI: 10.1186/s12889-022-13581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-acting reversible contraceptives (LARCs) have superior contraceptive efficacy compared to short-acting reversible contraceptives (SARCs) and choosing LARCs over SARC methods reduces the need for abortion care. However, little is known how initiating these methods associates with the subsequent overall need of reproductive health services including family planning services, and visits for gynecological reasons in primary and specialized care. METHODS We followed altogether 5839 non-sterilized women aged 15-44 years initiating free-of-charge LARC methods (n = 1689), initiating or switching SARC methods (n = 1524), or continuing with the same SARC method (n = 2626) at primary care family planning clinics in the City of Vantaa, Finland, 2013-2014 for 2 years using Finnish national health registers. We assessed the use of reproductive health services, namely attending public primary or specialized health care for gynecological reasons or attending the family planning clinics by applying unadjusted and adjusted negative binomial regression models on visit counts. RESULTS A total of 11,290 visits accumulated during the two-year follow-up: 7260 (64.3%) at family planning clinics, 3385 (30.0%) for gynecological reasons in primary, and 645 (5.7%) in specialized health care. Altogether 3804 (52.4%) visits at the family planning clinics were for routine checkup, and 3456 (47.6%) for other reasons. Women initiating LARC methods used reproductive health services for reasons other than routine checkups similarly as women initiating or switching SARC methods (adjusted incidence rate ratio 0.93, 95% CI 0.82-1.05), while women continuing with SARC methods used the services less frequently (0.65, 0.59-0.72). Women initiating free-of-charge LARC and those continuing with the same SARC method used services less for abortion care than women initiating or switching SARC (adjusted incidence rate ratios 0.05, 95% CI 0.03-0.08 and 0.16, 95% CI 0.11-0.24, respectively). CONCLUSIONS While women initiating LARC methods have lower need for abortion care compared to women initiating SARC methods, women initiating both LARC and SARC methods have similar overall need for reproductive health services. In contrast, women continuing with their SARC method need reproductive health services less than women initiating LARC or a new SARC method. These service needs should be acknowledged when planning and organizing family planning services, and when promoting long-acting reversible contraception.
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Affiliation(s)
- Tuire Helene Saloranta
- Myyrmäki Health Center, Jönsaksentie 4, 01600, Vantaa, Finland.,Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland
| | - Frida Katrin Gyllenberg
- Myyrmäki Health Center, Jönsaksentie 4, 01600, Vantaa, Finland.,Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3 (Teutori 3. krs), 20014, Turku, Finland.,Region Stockholm, Academic Primary Health Care Centre, Solnavägen 1 E, 113 65, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Solnavägen 1, 17177, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, FI-00029 HUS, Helsinki, Finland.
| | - Merja Kristiina Laine
- Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland.,Folkhälsan Research Center, Topeliuksenkatu 20, 00250, Helsinki, Finland
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Toffol E, Partonen T, Heikinheimo O, But A, Latvala A, Haukka J. Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15-49 years in Finland: a nationwide, register-based, matched case-control study. BMJ Open 2022; 12:e053837. [PMID: 35193911 PMCID: PMC8867378 DOI: 10.1136/bmjopen-2021-053837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The relationship between the use of contraception and of psychiatric medications is understudied. We examined whether the current and past use of psychotropic medications is associated with the use and type of hormonal contraception (HC). DESIGN Nationwide register-based matched case-control study. SETTINGS All fertile-aged (15-49 years) girls and women living in Finland in 2017; data from several national registers. PARTICIPANTS 294 356 girls and women with a redeemed prescription of HC in 2017, and their same-sized control group of non-users (n=294 356) identified through the Prescription Centre. MAIN OUTCOME MEASURES Associations between the use of psychotropic medications and the use of HC, and the type of HC tested in logistic regression models. RESULTS Altogether 19.5% of the HC users, and 18% of the HC non-users received at least one prescription for a psychotropic medication in 2017. Among HC users, the proportions of occasional and regular users of psychotropic medications in 2013-2016 were 4.5% and 14.8%, while among HC non-users the respective figures were 4.3% and 14.6%, respectively. In multivariable logistic regression models both the use of psychotropic medications in 2017, and their occasional or regular use between 2013-2016 were associated with higher odds of HC use, although with small to very small effect sizes (ORs between 1.37 and 1.06 and 95% CIs 1.22 to 1.53, and 1.03 to 1.09, respectively). After adjustment for covariates, when fixed combinations of progestogens and oestrogens for systemic use was the reference category, women using almost any class of psychotropic medications had higher odds of using other types of HC. CONCLUSIONS Fertile-aged girls and women with current and past use of psychotropic medications have higher odds of using HC, with a specific pattern in the type of contraceptives used. Further research is warranted to examine whether our observations indicate a reduction of unwanted pregnancies in women with psychiatric disorders.
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Affiliation(s)
- Elena Toffol
- Department of Public Health, University of Helsinki Faculty of Medicine, Helsinki, Finland
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki Faculty of Medicine and Helsinki University Hospital, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki Faculty of Medicine, Helsinki, Finland
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki Faculty of Medicine, Helsinki, Finland
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Shelef DQ, Raine-Bennett T, Chandra M, Adler N, Marshall CJ, Steinberg JR. The association between depression and contraceptive behaviors in a diverse sample of new prescription contraception users. Contraception 2022; 105:61-66. [PMID: 34481788 PMCID: PMC8805450 DOI: 10.1016/j.contraception.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Among women initiating new prescription contraception, we investigated the relationship between recent depression and a range of contraceptive behaviors. STUDY DESIGN We used medical and pharmacy records of 52,325 women ages 19 to 29 who initiated prescription contraception (pills, patches or rings, injectables, and long-acting reversible contraceptives) in 2014-2016 at a large integrated healthcare system in Northern California. Women had continuous enrollment for a year before and after initiating, and no records of prescription contraceptive use in the year before initiating. Depression in the year prior to initiation was dichotomized into (1) no depression indicator (reference group) or (2) depression diagnosis or redeemed antidepressant. Multinomial logistic regression models examined the associations between depression and method type initiated, and contraceptive patterns, timing of discontinuation, inconsistent use, and switching methods over a year after initiating, adjusting for sociodemographics and testing for interactions between depression and having a recent birth or abortion. RESULTS Women with recent depression were more likely to initiate methods other than the pill, and the association was stronger for patches or rings vs pills among those with a recent birth compared to those without. Among women initiating all methods and the pill, those with depression were more likely to discontinue their method, use it inconsistently, and switch from it than use it continuously for a year. CONCLUSION Women with recent depression were less likely to initiate the pill; and when the pill was initiated, those with depression were more likely to discontinue use, use it inconsistently, and switch from it. IMPLICATIONS Women with recent depression indicators should be followed closely to ensure they have the support they need to meet their reproductive goals. Those who wish to avoid pregnancy may benefit from methods that do not require daily use.
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Affiliation(s)
- Deborah Quint Shelef
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, United States.
| | - Tina Raine-Bennett
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States; Medicines360, San Francisco, CA, United States
| | - Malini Chandra
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Nancy Adler
- Department of Psychiatry & Pediatrics, University of California, San Francisco, CA, United States
| | | | - Julia R Steinberg
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, United States
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Lundin C, Wikman A, Lampa E, Bixo M, Gemzell-Danielsson K, Wikman P, Ljung R, Sundström Poromaa I. There is no association between combined oral hormonal contraceptives and depression: a Swedish register-based cohort study. BJOG 2021; 129:917-925. [PMID: 34837324 DOI: 10.1111/1471-0528.17028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether users of hormonal contraceptives (HCs) are at increased risk of depression compared with non-users. DESIGN Register-based cohort study. SETTING Sweden. SAMPLE Women aged 15-25 years between 2010 and 2017 with no prior antidepressant treatment, psychiatric diagnose or contraindication for HCs (n = 739 585). METHODS Women with a prescription of HC were identified via the Swedish Prescribed Drug Register (SPDR). Relative risks (RRs) for first depression diagnosis in current HC-users compared with non-users were modelled by Poisson regression. Adjustments included age, medical indication for HC-use and parental history of mental disorders, among others. MAIN OUTCOME MEASURES Depression, captured by a redeemed prescription of antidepressant treatment, or a first depression diagnosis in the SPDR and the National Patient Register. RESULTS Compared with non-users, women on combined oral contraceptives (COCs) and oral progestogen-only products had lower or no increased risk of depression, relative risk (RR) 0.89 (95% CI 0.87-0.91) and 1.03 (95% CI 0.99-1.06) after adjustments, respectively. Age-stratified analyses demonstrated that COC use in adolescents conferred no increase in risk (RR 0.96, 95% CI 0.93-0.98), whereas use of progestogen-only pills (RR 1.13, 95% CI 1.07-1.19), contraceptive patch/vaginal ring (RR 1.43, 95% CI 1.30-1.58), implant (RR 1.38, 95% CI 1.30-1.45) or a levonorgestrel intrauterine device (RR 1.59, 95% CI 1.46-1.73) were associated with increased risks. CONCLUSIONS This study did not find any association between use of COCs, which is the dominating HC in first time users, and depression. Non-oral products were associated with increased risks. Residual confounding must be addressed in the interpretation of the results. TWEETABLE ABSTRACT There is no association between combined hormonal contraceptives and depression.
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Affiliation(s)
- C Lundin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - E Lampa
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - M Bixo
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - K Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - P Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - R Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I Sundström Poromaa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Rowlands IJ, Mishra GD, Lucke JC. Association between young women's physical and mental health and their method of contraception in a longitudinal, population-based study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:129-136. [PMID: 32522842 DOI: 10.1136/bmjsrh-2019-200479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Women's physical and mental health are strongly inter-related and may influence patterns of contraceptive use. We examined the longitudinal associations between young women's physical and mental health and method of contraceptive use over a 5-year period. METHODS Data from 4952 young women (≤27 years) participating in the Australian Longitudinal Study on Women's Health who completed four self-reported surveys between 2013 and 2017 were analysed. Women's contraceptive use was categorised as: contraceptive pill/oral contraceptives, long-acting reversible contraception (LARC), condom, other methods and none. Multinomial logistic regression was used to determine the longitudinal associations between women's physical and mental health and method of contraception. RESULTS Over the 5-year period the percentage of pill users decreased from 60% (95% CI 58% to 61%) to 41% (95% CI 39% to 42%) and LARC users increased from 13% (95% CI 12% to 14%) to 21% (95% CI 20% to 22%) as did non-users from 9% (95% CI 8% to 9%) to 17% (95% CI 16% to 18%). Compared with women using the pill, women who used LARCs were more likely to be overweight (OR 1.34; 95% CI 1.17 to 1.53) and obese (OR 1.84; 95% CI 1.55 to 2.19), current smokers (OR 1.45; 95% CI 1.23 to 1.71) and reported fair or poor general health (OR 1.50; 95% CI 1.28 to 1.76) and very high levels of psychological distress (OR 1.47; 95% CI 1.24 to 1.76). Similar results were also found among women who used condoms or no contraception. CONCLUSIONS Findings suggest that obesity, smoking and poor physical and mental health play an important role in young women's contraceptive use.
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Affiliation(s)
- Ingrid J Rowlands
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jayne C Lucke
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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7
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Bello JK, Salas J, Meyer D, Heiden-Rootes K, Davis DM, Keegan Garrett E, White MM, Schmeidler P. Mental health diagnoses and early removal of long-acting reversible contraception. J Affect Disord 2020; 262:333-336. [PMID: 31740110 DOI: 10.1016/j.jad.2019.11.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/26/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Having a mental health diagnosis is associated with contraceptive non-adherence and user-related contraceptive failures of short-acting methods. There is a lack of research on the relationship between mental health diagnoses and early discontinuation of highly effective long-acting reversible (LARC) methods such as the intrauterine device (IUD) and subdermal implant (SDI). METHODS Using a Primary Care and Obstetrics and Gynecology Patient Data Registry, we conducted a cross-sectional analysis of the relationship between any mental health diagnosis (any anxiety disorder or depression) and early LARC removal (<1 year post-insertion) among 385 reproductive-aged (14-50 years) women in 2008-16. Adjusted logistic regression was used to calculate odds ratios and 95% confidence intervals. RESULTS Almost 10% (n = 37) of the sample had an early LARC removal, of which 62.2% were hormonal IUD and 37.8% were SDI. Women with a mental health diagnosis had a higher prevalence of early LARC removal (13.6% vs. 8.0%, p = =.090). Although non-significant, there was a trend in adjusted analyses indicating twice the odds of early removal for women with a mental health diagnosis versus no diagnosis (OR = =2.04, 95% CI = =0.97-4.27). LIMITATIONS This study is limited by a small sample size and availability of variables from a reportable medical record database. Pregnancy intentions and side effects of method use could not be accounted for which may have impacted timing of removal. CONCLUSIONS Understanding why women choose early LARC removal can inform counseling to help women make informed choices about their contraceptive method that meets their reproductive needs.
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Affiliation(s)
- Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Dixie Meyer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Katie Heiden-Rootes
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Dawn M Davis
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Elizabeth Keegan Garrett
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Mattie M White
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States; Veteran's Administration St. Louis Health Care System, Saint Louis, MO, United States
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Rapkin AJ, Korotkaya Y, Taylor KC. Contraception counseling for women with premenstrual dysphoric disorder (PMDD): current perspectives. Open Access J Contracept 2019; 10:27-39. [PMID: 31572029 PMCID: PMC6759213 DOI: 10.2147/oajc.s183193] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022] Open
Abstract
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) affecting up to 7% of reproductive age women. Women with PMDD are of reproductive age; therefore, contraception and treatment of PMDD are important considerations. The disorder as described in the DSM-V is characterized by moderate to severe psychological, behavioral and physical symptoms beginning up to two weeks prior to menses, resolving soon after the onset of menstruation and significantly interfering with daily functioning. PMDD develops in predisposed individuals after they are exposed to progesterone at the time of ovulation. It has been hypothesized that PMDD is in part attributable to luteal phase abnormalities in serotonergic activity and to altered configuration of ℽ-aminobutyric acid subunit A (GABAA) receptors in the brain triggered by the exposure to the neuroactive steroid progesterone metabolite, allopregnanolone (Allo). A large body of evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can be effective in the treatment of PMDD. Combined hormonal contraceptive (CHC) pills, specifically the 20 mcg ethinyl estradiol/3mg drospirenone in a 24/4 extended cycle regimen has been shown to significantly improve the emotional and physical symptoms of PMDD. Other combined monophasic, extended cycle hormonal contraceptive pills with less androgenic progestins may also be helpful, although not well studied. Copper intrauterine devices (IUDs) are recommended for those not seeking hormonal contraceptives. Progestin-only methods including the progestin-only pill (POP), levonorgestrel (LNG) IUD, etonorgestrel implant or depot medroxyprogesterone acetate (DMPA) have the potential to negatively affect mood symptoms for women with or without baseline mood disorders, including PMDD. Careful counseling and close follow-up is recommended for patients with PMDD seeking these contraceptive methods.
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Affiliation(s)
- Andrea J Rapkin
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yelena Korotkaya
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kathrine C Taylor
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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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; 214:20-25. [PMID: 30138841 DOI: 10.1016/j.socscimed.2018.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 08/02/2018] [Accepted: 08/12/2018] [Indexed: 12/24/2022]
Abstract
RATIONALE More thoroughly understanding the association between elevated depressive symptoms and effectiveness level of contraceptive method selected at a reproductive health visit could help women prevent unintended pregnancy. OBJECTIVE This study examined how the association between both current and past depressive symptoms and effectiveness level of contraceptive method selected at a clinic visit varies by type of reproductive health visit. METHODS Current and past depressive symptoms and contraceptive method selected were assessed among 1215 women aged 18-25 years seeking general reproductive health or abortion services at 40 community clinics throughout the United States. Using standard categories of effectiveness based on pregnancy rates during typical use, women's contraceptive method selected was coded as a low (e.g., no method, withdrawal, condoms), moderately (pill, patch, ring, or shot), or highly effective method (IUD, sterilization, implant). Depression status was divided into four categories: 1) no elevated depressive symptoms ever, 2) current elevated depressive symptoms only, 3) past elevated depressive symptoms only, and 4) past and current elevated depressive symptoms. Visit type, general reproductive health versus abortion care, was a moderator. The interaction effect between depressive symptoms and visit type on contraceptive method effectiveness level chosen was estimated with multinomial logistic regression analyses. RESULTS In general reproductive health visits, having both elevated current and past depressive symptoms increased women's likelihood of choosing low versus moderately effective methods (RRR = 5.63, 95% CI = 2.31 to 13.71, p < .0005). In contrast, among abortion patients, only current elevated depressive symptoms were associated with choosing high versus moderate effectiveness methods (RRR = 1.74, 95% CI = 1.06 to 2.86, p = .029). CONCLUSION Results suggest that considering both women's current and past elevated depressive symptoms and the type of reproductive health visit may assist providers in helping women prevent unintended pregnancy.
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Affiliation(s)
- Julia R Steinberg
- Department of Family Science, University of Maryland, College Park, United States.
| | - Nancy E Adler
- Department of Psychiatry, University of California, San Francisco, United States
| | - Kirsten M Thompson
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
| | | | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
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Zettermark S, Perez Vicente R, 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. [PMID: 29566064 PMCID: PMC5864056 DOI: 10.1371/journal.pone.0194773] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/11/2018] [Indexed: 12/18/2022] Open
Abstract
The burden of depression and anxiety disorders is greater in women, and female sex hormones have been shown to affect mood. Psychological side effects of hormonal contraception (HC) are also a common complaint in the clinic, but few previous studies have investigated this subject. We therefore wanted to investigate whether use of HC was associated with adverse psychological health outcomes, and whether this association was modified by age. All women aged 12–30 years on 31 December 2010, residing in Sweden for at least four years and with no previous psychiatric morbidity (n = 815 662), were included. We followed the women from their first HC use (or 31 December 2010, if they were non-users) at baseline, until a prescription fill of psychotropic drugs or the end of the one-year follow-up. We performed age-stratified logistic regression models and estimated odds ratios (OR) to measure the association between different HC methods and psychotropic drug use, as well as the area under the receiver operating curve to estimate discriminatory accuracy of HC in relation to psychotropic drugs. Overall, we found an association between HC and psychotropic drugs (adjusted OR 1.34, 95% confidence interval [CI] 1.30–1.37). In the age-stratified analysis, the strongest association was found in adolescent girls (adjusted OR 3.46, 95% CI 3.04–4.94 for age 12 to 14 years), while it was non-existent for adult women. We conclude that hormonal contraception is associated with psychotropic drug use among adolescent girls, suggesting an adverse effect of HC on psychological health in this population.
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Affiliation(s)
- Sofia Zettermark
- Unit of Social Epidemiology, Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden
- * E-mail:
| | - Raquel Perez Vicente
- Unit of Social Epidemiology, Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden
| | - Juan Merlo
- Unit of Social Epidemiology, Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden
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Vafai Y, Steinberg JR. The effects of preabortion depressive symptoms on postabortion contraceptive effectiveness level chosen among women seeking abortions. Contraception 2017; 97:335-340. [PMID: 29287671 DOI: 10.1016/j.contraception.2017.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/13/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We examined whether preabortion depressive symptoms were associated with contraceptive method effectiveness level chosen among women seeking abortions. STUDY DESIGN Three-hundred and forty-seven young, low-income women 18 years or older who were seeking abortions at 3 community reproductive health clinics in Northern California were recruited to participate in a study on contraceptive decision making. We classified women into choosing low-, moderate- or high-effectiveness contraceptive methods based on typical-use failure rates. We used the Center for Epidemiologic Studies Depression scale to assess depressive symptoms as a continuous and dichotomous variable. Using the standard cutoff of 20, women who scored at or above this were considered depressed for the dichotomous measure. We used multinomial logistic regression to examine the association between preabortion depressive symptoms and contraceptive effectiveness level chosen to use after an abortion, adjusting for sociodemographics, abortion characteristics, pregnancy history, future pregnancy desires, relationship characteristics and adverse experiences. RESULTS After adjusting for covariates, we found that a one-unit increase in depressive symptoms was associated with a higher likelihood of choosing low- versus moderate- [adjusted odd ratio (aOR)=1.05, 95% confidence interval (CI): 1.01-1.10, p<.02] and high-effectiveness methods (aOR=1.05, 95% CI: 1.002-1.10, p<.05). Furthermore, women scoring above the cutoff for depression were more likely to choose low- versus moderate-effectiveness methods (aOR=4.56, 95% CI: 1.27-16.32, p=.02). CONCLUSIONS More preabortion depressive symptoms were independently associated with choosing low- versus moderate- and high-effectiveness contraceptives. IMPLICATIONS These findings together with other findings show that preabortion depressive symptoms do not uniformly influence effectiveness level of contraceptive method selected to use after an abortion. Reproductive health care providers should consider the impact of women's psychological symptoms on their contraceptive decision making.
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Affiliation(s)
- Yassaman Vafai
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland College Park, College Park, MD, USA.
| | - Julia R Steinberg
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland College Park, College Park, MD, USA
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Moore M, Kwitowski M, Javier S. Examining the influence of mental health on dual contraceptive method use among college women in the United States. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 12:24-29. [DOI: 10.1016/j.srhc.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
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Abstract
The link between mood disorders and hormonal fluctuations has long been known, but the direction of this correlation has been questioned. New research suggests that initiation of hormonal contraception might lead to increased risk of first-time diagnosis of or treatment for depression over a short time frame, particularly for adolescents.
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Affiliation(s)
- Rachel A Ross
- Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215 and the Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Boston, Massachusetts 02114, USA
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, Massachusetts 02115, USA
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Schaffir J, Worly BL, Gur TL. Combined hormonal contraception and its effects on mood: a critical review. EUR J CONTRACEP REPR 2016; 21:347-55. [DOI: 10.1080/13625187.2016.1217327] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Jonathan Schaffir
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Brett L. Worly
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Tamar L. Gur
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
- Institute for Behavioral Medicine Research, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
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Field N, Prah P, Mercer CH, Rait G, King M, Cassell JA, Tanton C, Heath L, Mitchell KR, Clifton S, Datta J, Wellings K, Johnson AM, Sonnenberg P. Are depression and poor sexual health neglected comorbidities? Evidence from a population sample. BMJ Open 2016; 6:e010521. [PMID: 27009148 PMCID: PMC4809090 DOI: 10.1136/bmjopen-2015-010521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/10/2016] [Accepted: 02/29/2016] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine associations between sexual behaviour, sexual function and sexual health service use of individuals with depression in the British general population, to inform primary care and specialist services. SETTING British general population. PARTICIPANTS 15,162 men and women aged 16-74 years were interviewed for the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), undertaken in 2010-2012. Using age-adjusted ORs (aAOR), relative to a comparator group reporting no treatment or symptoms, we compared the sexual health of those reporting treatment for depression in the past year. OUTCOME MEASURES Sexual risk behaviour, sexual function, sexual satisfaction and sexual health service use. RESULTS 1331 participants reported treatment for depression (5.2% men; 11.8% women). Relative to the comparator group, treatment for depression was associated with reporting 2 or more sexual partners without condoms (men aAOR 2.07 (95% CI 1.38 to 3.10); women 2.22 (1.68 to 2.92)), and concurrent partnerships (men 1.80 (1.18 to 2.76); women 2.06 (1.48 to 2.88)), in the past year. Those reporting depression treatment were more likely to be dissatisfied with their sex lives (men 2.32 (1.74 to 3.11); women 2.30 (1.89 to 2.79)), and to score in the lowest quintile on the Natsal-sexual function measure. They were also more likely to report a recent chlamydia test (men 1.92 (1.15 to 3.20)); women (1.27 (1.01 to 1.60)), and to have sought help regarding their sex life from a healthcare professional (men 2.92 (1.98 to 4.30); women (2.36 (1.83 to 3.04)), most commonly from a family doctor. Women only were more likely to report attending a sexual health clinic (1.91 (1.42 to 2.58)) and use of emergency contraception (1.98 (1.23 to 3.19)). Associations were broadly similar for individuals with depressive symptoms but not reporting treatment. CONCLUSIONS Depression, measured by reported treatment, was strongly associated with sexual risk behaviours, reduced sexual function and increased use of sexual health services, with many people reporting help doing so from a family doctor. The sexual health of depressed people needs consideration in primary care, and mental health assessment might benefit people attending sexual health services.
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Affiliation(s)
- Nigel Field
- Research Department of Infection and Population Health, UCL, London, UK
| | - Philip Prah
- Research Department of Infection and Population Health, UCL, London, UK
| | | | - Greta Rait
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Michael King
- Division of Psychiatry (Faculty of Brain Sciences), UCL, London, UK
| | - Jackie A Cassell
- Division of Primary Care and Public Health, University of Brighton, Brighton, UK
| | - Clare Tanton
- Research Department of Infection and Population Health, UCL, London, UK
| | - Laura Heath
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kirstin R Mitchell
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Soazig Clifton
- Research Department of Infection and Population Health, UCL, London, UK
| | - Jessica Datta
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, UCL, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, UCL, London, UK
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