I have been meaning to write something on this topic for a few weeks but have been putting it off because it is really complicated. I want to try to summarise all the evidence that I can, but it is definitely messy and conflicting. Here goes …
Hormones and mood changes
There is lots of evidence that changes in hormones are associated with changes in mood.
Menopause, pre-menstrual syndrome and post-natal depression are obvious examples - they are all associated with mood changes.
What is depression?
It is useful to be clear about what depression is. The International Classification of Diseases lists the following symptoms.
- depressed mood
- loss of interest or enjoyment
- increased fatiguability (you get tired easily).
- reduced concentration and attention
- reduced self esteem and self confidence
- ideas of guilt or unworthiness
- bleak or pessimistic views of the future
- ideas or acts of self-herm or suicide
- disturbed sleep
- diminished appetite.
To be diagnosed with depression you need to have at least two of the typical symptoms and at least two of the common symptoms.
Studies about hormonal contraception and depression
There was a large study from Denmark published in 2016 that looked at GP and hospital records of all Danish women born within a particular time period.
They found that all hormonal methods of contraception were associated with an increased risk of being prescribed medication for depression or having a hospital referral for depression.
It has been difficult to know exactly what this study means.
It could, for example, mean that women who are visiting their GPs for contraception are more likely to mention symptoms of depression and therefore get treatment than those who are suffering from depression and do not have another reason to see their GP. It does not necessarily mean that these contraceptive methods cause depression - although it also does not mean that they don’t.
A recent review of 26 studies that looked at the relationship between depression and progestogen only methods of contraception found no association except for the study mentioned above.
So, what I am trying to say is that the evidence remains unclear.
The Faculty of Sexual and Reproductive Health Care have issued a statement to say that they have no clear evidence of an association.
But what does that mean for people who are trying to find the right method of contraception for them?
I think, being aware of a possible association can be helpful - at least it means that you can look out for symptoms, keep an eye on them and switch contraception to see whether it makes any difference.
I also think that knowing that the association is not proven is useful - so that if you do experience depression on a hormonal method of contraception, you might think carefully about whether there are other causes, whether anything else has changed.
It is clear from this forum and from my own clinical practice that many women use hormonal contraception and have no problems with mood changes at all. It is also clear that some women experience significant mood changes on hormonal contraception and that they stop when they stop the contraception. I have also spoken to women who have had problems on one method sometimes and not others …
Some clinicians say that because there is no proven association that we should not mention these issues in contraceptive counselling. Some say we should …
There is clearly more research needed to unpick this issue and in the meantime the more we can do to share our experiences, support each other, stay aware of the evidence and be empowered to switch around our contraception according to our experiences - the better.
Look forward to hearing your thoughts.