Mental health implications of contraceptive use in women

Hormonal contraceptives relieve depression in women with mental disorders but come with risks, urging healthcare providers to meticulously assess individual factors to improve contraceptive decisions and safeguard mental well-being.

This review aimed to explore how modern contraceptive methods like birth control pills, and long-acting reversible contraceptives (for instance, intrauterine devices, and implants), etc. affect mental health in females.

Database searching was done across different geographical boundaries from the beginning till February 2022. The randomized trials and observational studies underwent quality checks using the GRADE and the Downs and Black scoring system, respectively.

A meta-analysis was executed to analyse the data, followed by the computation of relative risk and mean variances. Forest plots were produced for each result when two or more data points were suitable for examination.

Forty-three studies were included. Among females with no prior mental conditions, both randomized trials (3 studies, high-quality evidence) and cohort studies (relative risk [RR] 1.04, 95% CI [1.03, 1.04]) identified a slight increase in the risk of developing depression.

In females with pre-existing mental disorders, both randomized trials (RCTs) (9 studies, high-quality) and cohort studies (standardized mean difference (SMD) - 0.26, 95% confidence interval (CI) [-0.37, -0.15]) found slight protective effects against the development of depression. Additionally, the use of hormonal contraceptives was associated with protective effects against anxiety in both groups (SMD - 0.20, 95% CI [-0.40, -0.01]). 

Hormonal contraceptives may ease depressive symptoms in women with a history of mental disorders, but carry potential risks, particularly with certain methods like hormonal intrauterine devices, implants, or patch/ring.