November 21, 2017
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Hormonal birth control may increase risk for suicide

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Recent findings indicated increased risk for suicide attempt and suicide among women who used hormonal contraception.

“In a nationwide prospective cohort study, we recently found an association between hormonal contraception and depression, and the association was most pronounced among adolescent women,” Charlotte Wessel Skovlund, PhD, of University of Copenhagen, Denmark, and colleagues wrote. “Adolescence is a period characterized by endogenous sex hormone changes and changing external cultural and social demands, which are likely to enhance the influence of any additional factor that might cause mood disturbances, such as use of hormonal contraception.”

To determine risk for suicide attempt and suicide in users of hormonal contraception, researchers analyzed a nationwide prospective cohort study of all women in Denmark with no psychiatric diagnoses, antidepressant use or hormonal contraceptive use before age 15 years. Study participants turned 15 during the study period, which occurred from 1996 through 2013. Hormonal contraception, suicide attempt, suicide and potential confounding variables were determined via nationwide registers. Participants were followed for a mean 8.3 years and had a mean age of 21 years.

Overall, there were 6,999 first suicide attempts and 71 suicides.

Current and recent hormonal contraceptive users had higher risk for suicide attempt (RR = 1.97; 95% CI, 1.85-2.1) and suicide (RR = 3.08; 95% CI, 1.34-7.08), compared with women who never used hormonal contraceptives.

Women who used the patch had an estimated risk of 3.28 (95% CI, 2.08-5.16), compared with 1.91 (95% CI, 1.79-2.03) for oral combined products, 2.29 (95% CI, 1.77-2.95) for oral progestin-only products and 2.58 (95% CI, 2.06-3.22) for vaginal ring.

The association between hormonal contraceptive use and first suicide attempt peaked at approximately 2 months of use.

“Assuming that the demonstrated associations are causal, the absolute increase in events due to use of hormonal contraception in our study population of previously mentally healthy women would be 1,400 additional first suicide attempts and 12 additional suicides per 1 million person-years,” the researchers wrote. “More awareness of possible mood implications from exogenous female sex hormones is warranted. Considering the severity of these little-recognized potential side effects of hormonal contraceptives, health professionals and women starting hormonal contraceptives should be informed about them.” – by Amanda Oldt

Disclosures: Wessel Skovlund reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.