Abstract
Objective
We performed a systematic review to look for an association between progestin-only
contraception and depression.
Methods
We searched PubMed, Ovid and Web of Science for English-language articles including
progestin-only contraception and depression from database inception to September 2016.
We evaluated study quality with the procedures guiding reviews for the United States
Preventive Services Task Force and the Cochrane Risk of Bias Tools. We included studies
that evaluated progestin-only contraception and depression, focusing on externally
validated depression measures. We excluded case studies, review articles and other
psychiatric disorders.
Results
We identified 26 studies that met the inclusion criteria, including 5 randomized controlled
trials, 11 cohort studies and 10 cross-sectional studies. We found minimal 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. Three medroxyprogesterone acetate intramuscular injection trials with
varying levels of quality and bias show no difference in depression. 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, the intrauterine device and depression.
Conclusion
Despite perceptions in the community of increased depression following the initiation
of progestin contraceptives, the preponderance of evidence does not support an association
based on validated measures (mostly level II-1 evidence, moderate quality, low risk
of bias).
Keywords
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Article info
Publication history
Published online: February 26, 2018
Accepted:
January 22,
2018
Received in revised form:
January 18,
2018
Received:
May 23,
2017
Identification
Copyright
© 2018 Published by Elsevier Inc.
