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Towards individualised contraceptive counselling: clinical and reproductive factors associated with self-reported hormonal contraceptive-induced adverse mood symptoms
  1. Cecilia Lundin1,
  2. Anna Wikman1,
  3. Marie Bixo2,
  4. Kristina Gemzell-Danielsson3,
  5. Inger Sundström Poromaa1
  1. 1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  2. 2Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
  3. 3Department of Women's and Children's Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Dr Cecilia Lundin, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, SE-75237, Uppsala, Sweden; cecilia.lundin{at}


Objective The study aim was to establish which demographic, clinical, reproductive and psychiatric factors are associated with self-reported hormonal contraceptive (HC)-induced adverse mood symptoms.

Study design We compiled baseline data from two Swedish studies: one cross-sectional study on combined oral contraceptive (COC)-induced adverse mood symptoms (n=118) and one randomised controlled trial on adverse mood symptoms on COC (n=184). Both included women eligible for COC use, aged over 18 years. All women answered a questionnaire on HC use and associated mood problems. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used to capture mood and anxiety disorders. Women who acknowledged HC-induced adverse mood symptoms, ongoing or previously (n=145), were compared with women without any such experience (n=157).

Results Compared with women without self-reported HC-induced adverse mood symptoms, women with these symptoms were younger at HC start (adjusted odds ratio (aOR) 0.83, 95% CI 0.72 to 0.95), had more often undergone induced abortion (OR 3.36, 95% CI 1.57 to 7.23), more often suffered from an ongoing minor depressive disorder (n=12 vs n=0) and had more often experienced any previous mental health problem (aOR 1.90, 95% CI 1.01 to 3.59).

Conclusions In line with previous research, this study suggests that women with previous or ongoing mental health problems and women who are younger at HC start are more likely to experience HC-induced adverse mood symptoms. Former and current mental health should be addressed at contraceptive counselling, and ongoing mental health disorders should be adequately treated.

Implications This study adds valuable knowledge for identification of women susceptible to HC-induced adverse mood symptoms. It should facilitate the assessment of whether or not a woman has an increased risk of such symptoms, and thus enable clinicians to adopt a more personalised approach to contraceptive counselling.

  • contraception behavior
  • hormonal contraception
  • counseling
  • reproductive health

Data availability statement

As far as is practicable, data will be available upon reasonable request from the corresponding author.

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Data availability statement

As far as is practicable, data will be available upon reasonable request from the corresponding author.

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  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors Study conception, planning, design and conduct: CL, ISP. Data interpretation: CL, AW, ISP. Statistical analysis: CL, ISP. Drafting of the manuscript: CL, ISP. Critical revision of the manuscript: CL, AW, MB, KGD, ISP.

  • Funding The Swedish Research Council (K2013-99X-22269-01-3) and the Family Planning Foundation supported this study.

  • Disclaimer No support was obtained from any pharmaceutical company. The funding source was not involved in the design of the study, the collection, analysis and interpretation of data, in the writing of the report or the decision to submit the article for publication.

  • Competing interests MB serves occasionally as medical advisor for Asarina Pharma. KGD reports honorarium for lectures from MSD/Merck, Bayer AG, Gedeon Richter, Exeltis, Azanta, HRA-Pharma, Mithra and Exelgyn, and her clinic has participated in clinical trials conducted by Exeltis, Mithra, Bayer, MSD, Removaid and Myovant. Over the past 5 years, ISP has served occasionally on advisory boards or acted as an invited speaker at scientific meetings for MSD, Bayer Health Care, Gedeon Richter, Peptonics, Shire/Takeda and Lundbeck A/S.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.