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Viruses in semen potentially transmissible

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Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm

Ambivalence

Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception

Contraceptivetechnology.com New and Improved

Reassuring news on depression and OC use
May 2017

 

Oral contraceptive use was not associated with depression in a recent double-blind, randomized, placebo-controlled trial.[1] Out of 162 women randomized to using 150 micrograms levonorgestrel and 30 micrograms ethinyl estradiol and 167 randomized to placebo pills, 7% of women in each group were moderately to severely depressed after 3 months. This study, with a strong study design is a powerful response contradicting findings of an earlier and weaker study that had claimed a depression link[2] (see the December LateBreaker “Make Me Cry: Depression Link (Again).”

The study sample comprised women willing to start OCs. They were randomized to OC or placebo use and asked to fill out the Beck Depression Inventory at baseline and at the end of the study period. The researchers verified compliance with OC use by measuring serum hormone content. In contrast, the earlier study that reported a depression link identified women through Danish public registries, identifying women who obtained antidepressants and those who obtained oral contraceptives or received a depression diagnosis from January 2000 to December 2013. Participants were not randomized to OC use; instead they were self-selecting, so users and non-users less likely to be similar to one another in the factors that could contribute to depression risk. The researchers did not verify OC use compliance or use a standard instrument to measure and verify the depression diagnoses. As with most studies exploring the issue, there was no placebo control.

An interesting aspect to the new randomized, placebo-controlled study showing no depression link is that the researchers had actually hypothesized that they would find an OC link to depression. They had anticipated that the reduced free testosterone associated with OC use, as well as a progestin-induced central nervous system effect, would cause depression. What they did find was a null hypothesis: no association between depression and OC use.

Although the researchers found no link to depression, they found that OC users reported a decrease general well-being when compared with women in the study arm taking placebo pills. Six percent of the women taking OCs were more likely to report reduced sense of positive well-being, self-control, and vitality than were the women taking the placebo pills. The researchers did not indicate whether they had explored any connection between reduced feelings and well-being and adverse effects of OC use, but the question of a connection may be important. Only 4 women taking placebo pills reported adverse effects (including 2 pregnancies and 1 ovarian cyst). In comparison, 14 OC users reported bleeding disturbances, 5 reported acne, and 3 reported appetite changes. There were also 12 reports of anxiety and mood changes among OC users, and it would be interesting to know whether these mood changes were reported by the same women who reported another adverse effect as well, such as bleeding disturbances. It is likely, too, that women who reported adverse effects suspected they were taking OCs and therefore were not blinded to the study arm in which they were placed. Before concluding that OCs may be associated with reduced well-being, it would be important to examine whether adverse effects, such as unscheduled bleeding, may be at the root of the mood changes, rather than the hormonal effect alone on mood.

The researchers primarily focused their conclusions on whether the reports of reduced well-being may contribute to the high percentage of women who discontinue pill use. The study ended at 3 months, however, so the researchers’ speculation was not examined. Most clinicians do counsel patients about bleeding changes, in anticipation of confusion or worry over the changes that does contribute to discontinuation. Until the issue is further examined, it may be premature to advise that clinicians counsel all OC users about a potential reduction in well-being associated with their method. In any event, the finding that depression was not associated with pill use is good news, and that finding joins the findings from several other studies that have reported the same, including the few other placebo-control trials.

[1] Zethraeus N, Dreber A, Ranehill E, et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril doi.org/10.1016/j.fertnstert.2017.02.120

[2] Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiatry. 2016;73(11):1154-1162.