In a recent investigation published in JAMA Network Open, researchers delved into the potential connection between the short-term hormone withdrawal experience by users of combination oral contraceptive agents (COCs) during the monthly pill break and mood changes, as well as emotional identification among long-term COC users.
Background:
Existing research has suggested a complex relationship between hormonal contraception, particularly COCs, and women’s mental health. While long-term COC usage has been associated with a decreased risk of panic disorder, depression, and suicide, there are concerns about heightened risk of depression and suicidal thoughts linked to hormonal contraception, necessitating a closer examination of its mental health consequences. Lifestyle changes and socioeconomic factors may also play a role in influencing these outcomes.
About the Study:
The case-control study, conducted in Austria from April 2021 to June 2022, aimed to investigate the impact of short-term hormone withdrawal, commonly known as the pill break, on mental health symptoms among long-term COC users.
The study explored potential variations based on estrogen dosage, progestin type, and mental health symptoms at the initiation of the study.
Participants, aged 18 to 35, had been using COCs for at least six months, were fluent in German, and had no neurologic, psychiatric, or endocrinologic illnesses. A control group of women with regular menstrual cycles was also included. Evaluations occurred twice monthly during the active pill phase and the pill break or menses phase.
During each session, the researchers gauged anxiety, negative affect, and issues related to mental well-being as outcome measures. For users of combination oral contraceptives (COCs), the researchers specifically quantified the proportional increase in psychiatric symptomatology between the oral contraceptive pill break and the active consumption period.
In addition to evaluating COC users, the researchers undertook a comparison of mood changes during menstrual periods in women with regular menstrual cycles. To delve into individual characteristics, the researchers employed the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and Premenstrual Symptom Screening Tool (PSST).
Throughout each session, participants underwent a comprehensive assessment, which included the administration of the Positive and Negative Affect Schedule (PANAS), an emoticon scale designed to evaluate both negative and positive affect. The State-Trait Anxiety Inventory (STAI) and the Daily Rating of Severity of Problems (DRSP) were also administered.
Furthermore, participants underwent a thorough health check and engaged in three cognitive tests – verbal fluency, navigation, mental rotation, an emotion detection task – alongside mood surveys and the collection of three saliva samples. These assessments were conducted over a 90-minute duration at each session.
To categorize users of COCs, those containing progestins such as desogestrel, levonorgestrel, etonogestrel, norelgestromin, or gestodene were identified as androgenic-type COC users (COC-A). On the other hand, users of COCs comprising drospirenone, dienogest, cyproterone acetate, nomegestrol acetate, or chlormadinone acetate were classified as anti-andorgenic-type COC users (COC-AA). The analysis involved the application of linear mixed modeling to unravel patterns and associations within the collected data.
Results:
The study comprised 181 females, with the majority being nulliparous, heterosexual, nonsmokers, and having completed university admission examinations. COC users demonstrated increases of 13%, 7.4%, and 24% in negative affect, anxiety, and psychiatric symptoms, respectively, during the pill break phase compared to the active intake period.
This shift mood was similar to changes experienced during menstrual cycles among women with regular cycles, irrespective of progestin type or ethinylestradiol dosage. Notably, depressed COC users experienced a more severe increase of 18% in negative affect during the pill break phase.
This shift in mood was similar to changes experienced during menstrual cycles among women with regular cycles, irrespective of progestin type or ethinylestradiol dosage. Notably, depressed COC users experienced a more severe increase of 18% in negative affect during the pill break phase.
Despite these variations, emotional identification performance did not significantly differ between the luteal and pill break phases. Additionally, no significant disparities in psychiatric health aspects were observed between COC groups and women with natural cycles during the pill discontinuation.
Conclusions:
The study’s findings suggest that the pill break, characterized by hormonal withdrawal, is associated with adverse psychiatric symptoms among long-term COC users. The observed modd changes during this phase resemble those experienced during natural menstruation after withdrawing from endogenous-type steroids.
These findings imply that continuous COC use may offer mood-stabilizing benefits to long-terms consumers. The study highlights significantly increased anxiety, negative effects, and psychiatric symptoms during the pill break period, particularly influenced by depression scores. This deterioration in mood may be linked to brain structural alterations and connectivity during the resting state in the pill break phase.
The study’s insights into adverse mood symptoms during the pill break phase contribute to our understanding of the mixed findings regarding COC efficacy in managing premenstrual dysphoric disorders. While the worsening of psychiatric symptoms may not be directly attributed to hormonal withdrawal, it suggests a potential association with physical discomfort disorders. While the worsening of psychiatric symptoms may not be directly attributed to hormonal withdrawal, it suggests a potential association with physical discomfort during withdrawal bleeding. Further research is warranted to explore the intricacies of these relationships and to inform strategies for optimizing mental health outcomes for contraceptive users.
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