Hormonal contraceptives increase the risk of postpartum depression

A new study looks at whether the use of conventional hormonal contraceptives after childbirth may be contributing to the rise in postpartum depression, and what that means for millions of mothers.

A recent study published in the journal JAMA Network Open examines whether the use of hormonal contraception (HC) increases the risk of postpartum depression.

Depression in the postpartum period

Hormonal contraceptives (HC) have previously been found to be a risk factor for depression. However, the impact of HC use on depression in the postpartum period, which already increases the risk of psychiatric disorders, remains unclear.

Over the past 20 years, the number of prescriptions for HCs in the postpartum period has increased, with the period between delivery and the initiation of these drugs becoming increasingly shorter. Current estimates are that about 40% of mothers in Denmark will start taking HCs within the first year after delivery.

This raises the question whether the habitual practice of prescribing HCs in the postpartum period increases the already increased risk of depression.

In the present study, data were obtained from the Danish national registries on all women who gave birth to their first-born child between January 1, 1997, and December 31, 2022. None of the women included in this analysis had depression in the 24 months preceding childbirth.

HCs were categorized into combined oral contraceptives (COCs), combined non-oral contraceptives (CNOCs), progestogen-only pills (POPs), and progestogen-only non-oral contraceptives (PONOCs).

The study cohort included 610,038 first-time mothers, 41% of whom started using one form of HC within 12 months of delivery. The mean age of women who took HCs was 27.6 years, compared with 29.6 years for those who did not.

Among women who were prescribed HCs in the postpartum period, 24% used OCs, 1% CNOCs, 11% POPs, and 5% PONOCs. Less than 1% of the study cohort was lost to follow-up.

Approximately 50% of women started HC between 7 and 10 weeks postpartum. Within 12 months postpartum, 1.5% of women developed depression, with an overall rate of 21 cases of depression per 1,000 person-years among mothers who took HC after delivery, compared with 14 cases per 1,000 person-years among those who did not.

The absolute risk of developing postpartum depression among those who were not taking contraceptives was about 36% higher than baseline. However, this risk increased to 54% with HC use, corresponding to an 18% increase in absolute risk.

Overall, the risk of developing postpartum depression within the first 12 months postpartum increased by 50% among users of HCs compared with non-users. This increased risk was observed when considering all types of HCs except progestogen-only pills. When POPs were studied, the initial decrease in risk of depression was followed by a later increase in depression eight months after delivery.

After adjusting for lifestyle, sociodemographic factors, and smoking, women prescribed oral contraceptives had a 72% increased risk of depression, while women prescribed other contraceptives such as vaginal rings and patches had a 97% increased risk of depression. In addition, women who were prescribed implants, depot injections, and levonorgestrel-releasing intrauterine systems had a 40% higher risk of developing depression.

Women without a history of mental illness were 63% more likely to develop postpartum depression compared with 32% of women with a history of mental illness.

The timing of HC initiation was also inversely related to the level of depression. Depression levels increased during the first seven months among those who started taking HCs early compared to those who did not.

Conclusions

The early postpartum period can be a particularly vulnerable time for depressive changes in women. This association is multifactorial, as the postpartum period is often accompanied by dramatic changes in hormonal background combined with various psychological stressors.

In this study, the risk of depression was observed for all types of HCs except POP. Women breastfeeding in the postpartum period are often recommended to take only progestogenic contraceptives because combined hormonal contraceptives may have a negative effect on lactation. Thus, more research is needed to determine whether selection bias affects the results of the current study and to clarify the role of breastfeeding in the risk of depression in the postpartum period.

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Published: 07.04.2025

Updated: 06.04.2025

Medical author, Medical editor:

Stepan Yuk

Medical expert:

PhD. Olexandr Voznyak