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

Menopause, mood, mental acuity, and hormone therapy
November 2015


They are common complaints as women go through menopause: “I’m depressed, anxious;” “I can’t remember a thing…how will I function at work?” While women’s hope that hormone therapy can help is high, the evidence is mixed. And just what if hormone therapy does help…do we really know about its safety in women at the younger end of the menopause spectrum?

As they go through the various phases of menopause, about 1 in 5 women will suffer depression.[1],[2],[3] The strongest predictor of who will experience depression with whether a woman has had a previous experience with depression. [4] Women who have not had clinical depression may be less affected by menopausal changes, but they too may experience mood swings of a lesser degree. Many women also complain about fuzzy thinking and a decreased verbal recall.[5],[6],[7] Studies have been mixed on whether hormone therapy helps with mood or cognition during menopausal phases. Most of the studies, moreover, have been observational, so a number of method limitations reduce the studies’ reliability.

The Kronos Early Estrogen Prevention Study is a randomized, double-blinded, placebo-controlled clinical trial[8] looking at, among other things, how oral and transdermal menopausal hormone therapy affects cognitive decline and mood. The study enrolled 693 women within 3 years of the onset of menopause who were wondering whether to use hormone therapy. All women were heart-healthy with intact uteri. Upon enrollment, researchers found that about 10% had some degree of depressive symptoms, ranging from mild to moderately severe, although none were diagnosed with clinical depression. The researchers randomized the study subjects into three groups: receiving oral conjugated estrogen (CEE) daily with micronized progesterone 12 days a month; applying a transdermal estradiol (E2) patch with micronized progesterone 12 days a month; or using a placebo. Each woman underwent detail in-clinic cognitive evaluations such as verbal learning and memory and the all-important executive function as well as measurements of affect and mood.

Over 48 months of treatment, women using the oral regimen had improvements in depression and anxiety symptoms when compared to the control group. The window for improvement occurred during the later stage of perimenopause through the early postmenopausal period. This window corresponds to the phases of menopause in which women are two to four times more likely to experience depression, according to the SWAN study.1

The transdermal E2 appeared to have no effect on mood. And neither transdermal nor oral menopausal hormone therapy appeared to effect cognitive performance. This supports the findings stated in the 2012 position statement issued by the North American Menopause Society.[9] In its statement, NAMS concluded that the negative effect of menopausal transition on cognition is transient, with negligible long-term effect.

The KEEPS study reported few adverse events among the subjects, who took the hormone therapy in the early, not the later, stages of menopause. Three women taking oral CEE, 2 using transdermal E2, and 1 taking placebo developed breast cancer. One women on oral therapy had a transient ischemic attack, 1 on transdermal reported a stroke that turned out not to be, and 1 women in each the transdermal and the placebo groups experienced venous thrombotic disease. No women developed a cognitive disorder during the study period.

As evidence has led to more limited indications for use of menopausal hormone therapy, the KEEPS trial suggests that in the transition to and early stages of menopause, clinicians may consider that oral hormone therapy may help with the concomitant mood swings. That said, the NAMS statement still stands: “Although HT might have a positive effect on mood and behavior, HT is not an antidepressant and should not be considered as such.”9


—Deborah Kowal, MA, PA, Executive editor of Contraceptive Technology


[1] Bromberger JT, Schott LL, Kravitz HM, Sowers M, Avis NE, Gold EB, et al. Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women’s Health Across the Nation (SWAN). Arch Gen Psychiatry. 2010 Jun. 67(6):598-607.

[2] Schmidt  PJHaq  NRubinow  DR A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry 2004;161:2238- 44.

Freeman  EWSammel  MDLiu  LGracia  CRNelson  DBHollander  L Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry2004;6162- 70.

[4] Soares CN, Joffe H, Steiner M. Menopause and mood. Clin Obstet Gynecol 2004;47:576-91.

[5] Henderson VW. Gonadal hormones and cognitive aging: a midlife perspective. Womens Health 2011; 7:81–93.

[6] Greendale GA, Huang MH, Wight RG, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology. 2009; 72:1850–1857.

[7] Epperson CN, Sammel MD, Freeman EW. Menopause effects on verbal memory: findings from a longitudinal community cohort. J Clin ENdocrin Metab 2013;98:3829-38.

[8] Wharton W, Gleason CE, Miller VM Asthana S. Rationale and design of the Kronos Early Estrogen Prevention study (KEEPS) and the KEEPS cognitive and affective stub study (KEEPS cog) Brain res 2013;1514;12-7.

[9] Schmidt P. The 2012 hormone therapy position statement of the North American Menopause society. Menopause 2012;19:257-71