By Rachel Chisausky, DO

Do hormonal contraceptives affect mood? Studies in a general population yield conflicting results, showing decreased, increased, or unchanged depression scores.¹ Limitations of current data include few randomized control trials, small sample sizes, the possible conflation of psychosocial factors associated with contraception initiation, the predominant focus on combined oral contraceptives (COCs), and limited inclusion of gender-diverse patients.

A 2016 systematic review examined the effects of hormonal contraception on mood among subjects with depression and bipolar disorder (either people with an established diagnosis or those who scored positive on a validated depression screening instrument).² This review found that COCs, injected progestin, and progestin-releasing intrauterine devices did not worsen depression measures. The US Medical Eligibility Criteria for Contraceptive Use (US MEC) gives all hormonal contraceptives a level “1” for patients with depressive disorders.³

COCs may improve the mood symptoms of premenstrual dysphoric disorder (PMDD). Yaz (Ethinyl estradiol 0.02 mg and drospirenone 3 mg) is currently the only COC that is FDA-approved for PMDD; however, this was based on comparison to placebo, and there are few head-to-head trials comparing different COCs.⁴

A 2023 survey suggests that mood changes often occur among people taking hormonal contraceptives, and that many patients would like to discuss mood with a clinician.⁵ Clinicians should ask patients whether or not they are happy with their contraceptive. For patients who experience bothersome side effects, a different COC formulation or another type of contraception may help. For example, progesterone is known to cause an increase in fatigue, which is a symptom associated with depression. Patients for whom this is the predominant side effect may benefit from switching to a COC with a lower dose of progesterone. ⁶