Abstract
Background
Women with depressive or bipolar disorders are at an increased risk for unintended
pregnancy.
Objective
To examine the safety of hormonal contraception among women with depressive and bipolar
disorders.
Methods
We searched for articles published through January 2016 on the safety of using any
hormonal contraceptive method among women with depressive or bipolar disorders, including
those who had been diagnosed clinically or scored above threshold levels on a validated
screening instrument. Outcomes included changes in symptoms, hospitalization, suicide
and modifications in medication regimens such as increase or decrease in dosage or
changes in type of drug.
Results
Of 2376 articles, 6 met the inclusion criteria. Of three studies that examined women
clinically diagnosed with depressive or bipolar disorder, one found that oral contraceptives
(OCs) did not significantly change mood across the menstrual cycle among women with
bipolar disorder, whereas mood did significantly change across the menstrual cycle
among women not using OCs; one found no significant differences in the frequency of
psychiatric hospitalizations among women with bipolar disorder who used depot medroxyprogesterone
acetate (DMPA), intrauterine devices (IUDs) or sterilization; and one found no increase
in depression scale scores among women with depression using and not using OCs, for
both those treated with fluoxetine and those receiving placebo. Of three studies that
examined women who met a threshold for depression on a screening instrument, one found
that adolescent girls using combined OCs (COCs) had significantly improved depression
scores after 3 months compared with placebo, one found that OC users had similar odds
of no longer being depressed at follow-up compared with nonusers, and one found that
COC users were less frequently classified as depressed over 11 months than IUD users.
Conclusions
Limited evidence from six studies found that OC, levonorgestrel-releasing IUD and
DMPA use among women with depressive or bipolar disorders was not associated with
worse clinical course of disease compared with no hormonal method use.
Keywords
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Article info
Publication history
Published online: June 27, 2016
Accepted:
June 21,
2016
Received in revised form:
June 20,
2016
Received:
May 23,
2016
Footnotes
☆Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.
Identification
Copyright
Published by Elsevier Inc.
