A Summary of Two Publications on Mental Health and Hormonal Contraception

By Craig Turczynski, Ph.D.

Two articles on hormonal contraception and mental health, published out of Denmark, have resulted in much interest and discussion among BOMA board members and staff. The studies are somewhat confusing because the results are reported as relative risk rates. We wanted to make sure you are aware of these results and are armed with what the data means.  

The first article by Skovlund et al., was published in 2016 and evaluated over 1 million women for an average of 6.4 years. They measured the rate of first-time users of anti-depressants or first-time diagnosis of depression at a psychiatric hospital. They compared the rates between women using various forms of hormonal contraception against non-users, and concluded that the use of hormonal contraception was associated with subsequent use of antidepressants and first diagnosis of depression. The actual incidence was less than 1% difference between the groups (2.2% vs 1.7%) but because the number of women studied was large, the difference was statistically significant. This means that the result could be attributed to the use of hormonal contraception. Some of the other significant findings were:

1. Adolescent women, age 15-19, had the highest rates of depression.
2. Rates were higher for Progestin only and non-oral implants.
3. Rates were highest during the first 6 months and then started to decline.
4. When the category of non-users was broken out into “never users” the difference was even greater. This indicates that even after discontinuing hormonal contraception, it may still bring about negative consequences in some women.

Overall the study results were conclusive: the incidence of depression was 2-3-fold higher for women on some form of contraception. But perhaps the medical community is not overly concerned about this data because essentially the actual rate went from slightly less than 2% to 2-3%. What truly sprung from this study is the realization and need for a second study.

The second paper was published in 2018 by the same authors (Skovlund et al., 2018) and looked at the rates of suicide attempt and suicide in hormonal contraception users compared to never-users. There are a few reasons why this data is significant.
The number of study subjects were very significant (Nearly a half-million were followed for 8.3 years.)

Suicide or suicide attempt is a much more objective measure than depression. Either they did or did not attempt or commit suicide.
The results reached statistical significance and like the previous study, the highest risk was found among women 15-19 years of age who were using progestin only products, and non-oral implants.

Again, the paper is difficult to interpret because they report the results as relative risk rates. Using this measure, the rates averaged 97% higher for suicide attempt and over 200% higher for suicide. But if you look at the actual incidence, it is a small percentage even for the adolescent group at 2,196 suicide attempts for 786,497 person years or about 0.3%. The significance of this is that “hormonal contraception leads to 1,400 more suicide attempts and 12 more suicide deaths per 1 million people years”. Some may not think that number is significant, but I would like to point out that even one suicide death is substantial, especially when the medication is not being given for a life-threatening reason in the first place. As Hippocrates put it “abstain from whatever is deleterious and mischievous”. Also, suicide is the extreme manifestation of the side effect called “mood disorders.” If 12 women die from suicide and an additional 1,400 attempt suicide, many more may be experiencing a lack of wellbeing and mood alterations that go unreported. Those mood disorders lead to difficulties in relationships, family life, and work. How do you begin to measure that cost on society?
Once again, I would like to emphasize that the Billings Ovulation Method® is as effective as hormonal contraception when used according to the rules, and it has absolutely no harmful side effects. 

References

​Scovlund et al., (2018) Association of Hormonal Contraception with Suicide Attempts and Suicides. Am J Psychiatry. Vol 175, 4.
Skovlund et al., (2016) Association of Hormonal Contraception with Depression. JAMA Psychiatry. Vol 73, 11.