Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

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


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 New and Improved

Combined pills’ effect on mood disorders
May 2018


While most patients with depression and related disorders will do well on most types of combined oral contraceptives, some have difficulty finding a satisfactory pill. For these patients, consider progestin type, phasic dosing, and extended or continuous regimens, say Kelli Stidham Hall and Julia R. Steinberg in the upcoming 21st edition of Contraceptive Technology, available September 2018.[1]

Family planning providers, who are often the sole source of healthcare for reproductive-aged women, are uniquely well-suited to address interrelated mental and reproductive health needs. In a brand new chapter on mental health and contraception, Hall and Steinberg write that contraception should be situated in the broader context of patients’ mental, physical, and reproductive health and wellbeing.

Most patients with depression and related disorders will do well on most types of combined oral contraceptives (COCs), and in fact research has suggested that the experi­ences of women with perceived side effects are generally similar across the many different available formulations of COCs (there are more than 90 different Food and Drug Administration (FDA)-approved COCs in the U.S. alone).[2],[3],[4] Contraceptive counseling should emphasize this point. However, several theoretical considerations may be useful in help­ing patients select the most suitable formulation, particularly for those patients who may have difficulty finding a satisfactory pill.

Progestin type, phasic dosing, and extended or continuous regimens are other considerations for COC selection among patients with de­pression and related conditions. A recent comprehensive review found that COCs containing less androgenic progestins may be less likely to contribute to mood symptoms compared to pills with higher androgenic properties.[5] Fourth-generation drospirenone-containing COCs have an FDA-approved indication for treatment of premenstrual dysphoric dis­order (PMDD)-related mood symptoms and thus may be beneficial for some patients with depression and anxiety disorders.4 Levonorgestrel- and norgestrel-containing COCs (second generation) are not known to contribute to mood symptoms, and given their widespread use, also offer suitable options.[6],[7],[8] Many of these progestins are available in various phasic dosages, which could have rel­evance for cyclic mood symptoms due to variable circulating estrogen levels during ovulation and menses. For patients with cyclic mood con­cerns, monophasic formulations offer a steady dose (versus triphasic or 4-phasic formulations) to better stabilize hormone levels and minimize the risk of mood symptoms.8,[9] Patients who report mood symptoms during their placebo week (i.e., estrogen withdrawal) may benefit from COCs with extended cycle regimens (e.g., 24/4) or continuous dosing (i.e. skipping inactive pills), which would reduce or eliminate the estro­gen withdrawal period.9

See Table 1 for strategies on counseling patients with mental health concerns.

Hall and Steinberg advise that, for the most part, a patient-provider shared deci­sion-making process should inform contraceptive method selection based upon the patient’s individual health circumstances, contraceptive preferences, and family planning needs, rather than a mental health diagnosis or treatment. Drug interactions between modern pharmaco­logic antidepressant agents and hormonal contraceptives are relatively rare, and the best available scientific evidence suggests selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) do not interact with hepatic metabolism of synthetic steroids in COCs or other locally acting hormonal contraceptives.[10],[11]

You can read more about contraception and mental health in the 21st edition of Contraceptive Technology, due out in September 2018. Click here for ordering information.


Table 1. Contraceptive counseling strategies in consideration of mental health
  • Employ universal mental health screening to identify patients with elevated symptoms who are potentially at risk of contraceptive nonuse, misuse, and discontinuation.
  • Assess for reduced reproductive autonomy.
  • Emphasize method efficacy and effectiveness in context of mental health symptoms.
  • Educate about the mood benefits of most available modern hormonal formulations.
    • Dispel myths about mood side effects.
    • Discuss benefits of long-acting methods.
  • Assess for non-adherence with antidepressants, which may raise a red flag for non-adherence with contraception.
  • Facilitate informed and shared patient-provider decision-making, tailoring method selection to patients’ preferences and needs.
  • Address dual protection and risk for sexually transmitted infections.

Hall KS, Steinberg JR. Mental Health and Contraception. Hatcher RA, Nelson A, Trussell J, et al. Contraceptive Technology, 21st edition. New York, NY: Ayer Company Publishers, Inc. In production.

[2] Moreau C, Trussell J, Gilbert F, Bajos N, Bouver J. Oral contraceptive tolerance: does the type of pill matter? Obstet Gynecol 2007;109:1277-85.

[3] Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception 2012:86:659-65.

[4] Hatcher RA, Trussell J, Stewart F, et al. Contraceptive technology, 20th revised edition. New York, Ardent Media, 2004.

[5] Schaffir J, Worly BL, Gur T. Combined hormonal contraception and its effects on mood: a critical review. Eur J Contraception Reprod Health Care 2016;21:347-355.

[6] Maitra NN, Kulier R, Bloemenkamp K, Helmerhorst FM, Gulmezogul AM. Progesto­gens in combined oral contraceptives for contraception. Cochrane Database Syst Rev 2004;3:CD004861.

[7] Lawrie TA, Helmerhorst FM, Maitra NN, Kulier R, Bloemenkamp K, Gulmezoglu AM. Types of progestogens in combined oral contraception: effectiveness and side-effects Cochrane Database Syst Rev 2011;5:CD004861.

[8] Van Vliet HAAM, Grimes DA, Lopez LM, Schulz KF, Helmerhorst FM. Triphasic ver­sus monophasic oral contraceptives for contraception. Cochrane Database Syst Rev 2011;11:CD003553.

[9] Edelman A, Gallo MF, Jensen JT, Nichols MD, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev 2014;7:CD004695.

[10] Koke SC, Brown EB, Miner CM. Safety and efficacy of fluoxetine in patients who receive oral contraceptive therapy. Am J Obstet Gynecol 2002;187:551-5.

[11] D’Arcy PF. Drug interactions with oral contraceptives. Drug Intell Clin Pharm 1986;20:353-62.