Hormonal Contraceptives Increase Post-Partum Depression Risk

Women who start taking hormonal contraceptives within a year of giving birth are at 49% higher risk of developing depression than those who do not.

Results from a large Danish study published in JAMA Network Open show that the earlier the women began to use contraceptives the higher their risk for developing depression.

“Hormonal contraceptive initiation has been associated with an increased risk of developing depression,” wrote lead author Vibe Gedsø Frokjaer, a researcher based at Copenhagen University Hospital–Rigshospitalet, and colleagues.

However, they added that “it is unclear whether this also applies in the postpartum period, when women are already at a heightened risk of developing depression… Only a few studies have previously addressed this and found conflicting results; however, they were limited by lack of generalizability, insufficient follow-up time, and insufficient accounting for potential confounders.”

To investigate this potential issue further, Frokjaer and colleagues analyzed data from a large study that included 610,038 first-time mothers in Denmark who gave birth between 1997 and 2022. Women were excluded from the study if they had a diagnosis of depression within 24 months of giving birth, had multiple births or a still birth, or had a breast or liver cancer diagnosis.

Of the mothers included in the study, 41% started hormonal contraception within 12 months of giving birth. The women in this subgroup were at increased risk for depression compared with women who did not start hormonal contraception within a year of giving birth.

The absolute risk of developing depression 12 months after giving birth was 1.36%, but this increased to 1.54% in those who started hormonal contraception during this time. Overall, this corresponded to a 49% increased risk of depression in this group compared with those who did not start hormonal contraception.

The researchers also looked at risks associated with different types of hormonal contraceptives and found that combined oral contraceptives increased the risk by 72%, combined nonoral contraceptives by 97%, and progestogen-only nonoral contraceptives by 40%. Early exposure to progesterone-only oral contraceptives was linked to an early drop in risk for depression, but this risk increased in the later post-partum period.

“These findings raise the issue of whether the incidence of depression post-partum may be inflated by routine hormonal contraception initiation, which is important information to convey at postpartum contraceptive counseling,” concluded the authors.