Näytönastekatsaukset

Use of contraceptives and the risk of psychiatric symptoms, disorders or psychotropic drug use among fertile-aged females

Näytönastekatsaukset

21.1.2025

Bianca Arrhenius

Level of evidence: D

Contraceptive use might not be associated with increased psychiatric symptoms, psychiatric disorders or psychotropic drug use, but the evidence is insufficient.

Description of the included studies

Reference	Study type	Population	Intervention and comparison	Outcomes	Risk of bias
«Kraft MZ, Rojczyk P, Weiss T, ym. Symptoms of mental disorders and oral contraception use: A systematic review and meta-analysis. Front Neuroendocrinol 2024;72():101111 »1	Systematic review and meta-analysis	Females over 12 years	Oral contraceptives use compared to naturally cycling women Other contraceptive methods excluded (IUD, injections)	1) Clinically relevant symptoms of mental disorders measured with a formal psychological instrument, including self-report OR 2) a diagnosis of a mental disorder OR 3) psychotropic drug use.	High
«Worly BL, Gur TL, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception 2018;97(6):478-489 »2	Systematic review	Women of all ages	Use of progestin-only contraceptives including pills, injections, intrauterine devices and subdermal implants	Depression, measured with externally validated depression scales.	Moderate

RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis, OC= oral contraceptives

Additional comments for included studies

Reference	Comments
«Kraft MZ, Rojczyk P, Weiss T, ym. Symptoms of mental disorders and oral contraception use: A systematic review and meta-analysis. Front Neuroendocrinol 2024;72():101111 »1	Varying outcomes: different psychiatric symptoms and diagnoses included. However, most studies (17/22) examined depression or depressive symptoms. High heterogeneity I²=99.8%, possibly due to differing outcomes. Risk of bias and level of evidence were only assessed by one author. Most included studies were observational, hindering the assessment of a causal relationship between OC use and psychiatric symptoms or disorders.

Reference

Comments

«Kraft MZ, Rojczyk P, Weiss T, ym. Symptoms of mental disorders and oral contraception use: A systematic review and meta-analysis. Front Neuroendocrinol 2024;72():101111 »1

Varying outcomes: different psychiatric symptoms and diagnoses included. However, most studies (17/22) examined depression or depressive symptoms.
High heterogeneity I²=99.8%, possibly due to differing outcomes.
Risk of bias and level of evidence were only assessed by one author.
Most included studies were observational, hindering the assessment of a causal relationship between OC use and psychiatric symptoms or disorders.

Results

Outcome: Clinically relevant symptoms or diagnoses of mental disorders

Reference	Number of studies and number of patients (I/C)	Follow-up time	Absolute number of events (%) I	Absolute number of events (%) C	Relative effect (95% CI)
Level of evidence: very low The quality of evidence is downgraded due to study limitations (high risk of bias) and inconsistency.
«Kraft MZ, Rojczyk P, Weiss T, ym. Symptoms of mental disorders and oral contraception use: A systematic review and meta-analysis. Front Neuroendocrinol 2024;72():101111 »1	16 studies included in meta-analysis. I n= 5,432229 C n= 5,210611	Varying in the studies: from 1 month to >10 years	121,945	109,944	Random effect model RR: 1.00 (0.82 to 1.22)
«Worly BL, Gur TL, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception 2018;97(6):478-489 »2	26 studies that met inclusion criteria, including 5 randomized controlled trials, 11 cohort studies and 10 cross-sectional studies.	Varying	no meta-analysis performed	no meta-analysis performed	No clear association between progestin-only methods and depression. No correlation with depression was found in five low-quality, high-risk-of-bias progestin subdermal implant studies and four out of five varying-quality and medium-risk-of-bias levonorgestrel intrauterine device studies. Two progestin-only contraceptive pill studies with varying levels of quality and bias indicate no increase in depression scores, while one good-quality, medium-bias study shows an association between progestin-only pills or intrauterine device and depression.

I= intervention; C=comparison; CI=confidence interval

References

Kraft MZ, Rojczyk P, Weiss T, ym. Symptoms of mental disorders and oral contraception use: A systematic review and meta-analysis. Front Neuroendocrinol 2024;72():101111 «PMID: 37967755»PubMed
Worly BL, Gur TL, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception 2018;97(6):478-489 «PMID: 29496297»PubMed