Hormonal contraceptive (HC) use has been associated with an increased risk of depression, particularly concerning during the postpartum period when women face heightened risks of depression. A significant proportion of mothers in Denmark begin HC methods within the first year after childbirth, raising concerns about the potential impact on mental health. Recent study aimed to investigate whether postpartum initiation of HC contributes to the risk of depression, considering various types of contraceptives and maternal age.
Using comprehensive health data, the study analyzed 610,038 first-time mothers from Denmark who gave birth between 1997 and 2022. Women diagnosed with depression or those on antidepressants within 24 months prior to delivery were excluded. HC use was categorized as a time-varying exposure, accounting for different contraceptive types: combined oral contraceptives (COCs), combined nonoral contraceptives (CNOCs), progestogen-only pills (POPs), and progestogen-only nonoral contraceptives (PNOCs). The primary outcome was the incidence of depression, defined by the prescription of antidepressants or hospitalization for depression within 12 months postpartum. A total of 9,251 women (1.5%) developed depression within this timeframe. Crude incidence rates indicated a higher prevalence of depression among HC users compared to nonusers, with an adjusted hazard ratio (HR) of 1.49. Specific results showed increased risks associated with COCs (HR 1.72), CNOCs (HR 1.97), and PNOCs (HR 1.40), while the impact of POPs was more variable, showing lower risk early postpartum.
Age stratification revealed that postpartum HC use was linked to increased depression risk across all age groups, with the highest HR for women under 20. The findings demonstrated that HC initiation postpartum, particularly among women without prior mental health disorders, raised the likelihood of developing depression.
Further Analyses and Risks
Sensitivity analyses upheld these results, although the effect diminished in women with a history of mental disorders. The estimated average absolute risk of depression under observed HC use was 1.54%, with a risk difference of 0.18%. Exploratory analyses suggested that early initiation of COCs was associated with a sustained risk of depression throughout the first year postpartum.
Conclusions and Implications
The research concluded that postpartum initiation of HC is linked to increased depression risk, emphasizing its significance at contraceptive counseling post-childbirth. Although the study was well-designed using national health data, limitations include the observational nature of the study and potential misclassification biases related to medication prescriptions. Nonetheless, findings underscore the need for careful consideration of HC use during the postpartum period to mitigate depression risk.
Key Points
- Hormonal contraceptive (HC) use, especially postpartum, is associated with a higher risk of depression, with significant concern among new mothers who commonly initiate HC within the first year after childbirth.
- The study analyzed health data from 610,038 first-time mothers in Denmark, excluding those with prior depression diagnoses or antidepressant use in the 24 months before delivery. Different types of HC were categorized (COCs, CNOCs, POPs, PNOCs) to evaluate their respective risks.
- Among the study population, 9,251 women (1.5%) developed depression within 12 months postpartum, with HC users exhibiting a higher prevalence of depression compared to nonusers, indicated by an adjusted hazard ratio (HR) of 1.49.
- Specific HC types showed varying risk levels: COCs had an HR of 1.72, CNOCs an HR of 1.97, and PNOCs an HR of 1.40, while POPs exhibited a more variable risk profile, particularly early postpartum.
- Age stratification revealed that all age groups saw increased depression risk with postpartum HC use, with the highest risk ratio observed in women under 20, particularly for those without prior mental health issues.
- Results suggest the importance of contraceptive counseling for postpartum women to mitigate depression risk; however, limitations include the observational nature of the study and potential biases in medication classification.
Reference –
S. V. Larsen et al. (2025). Postpartum Hormonal Contraceptive Use And Risk Of Depression. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2025.2474.
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