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Contraception for Women With Psychiatric Disorders
Leanne R McCloskey1, Katherine L Wisner1, Minaz Kolia Cattan1
1Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan).
The American Journal of Psychiatry
|November 10, 2020
Summary
Women with mental illness can safely use various contraceptive methods, including hormonal contraceptives, which do not appear to increase depression risk. Long-acting reversible contraceptives are effective but underutilized.
Area of Science:
- Women's Health
- Psychiatry
- Reproductive Health
Background:
- Mental health care for women requires planning for major life events, including preconception care.
- Contraceptive choices, their effectiveness, side effects, and impact on psychiatric symptoms are crucial considerations.
- The Centers for Disease Control and Prevention's Medical Eligibility Criteria for Contraceptive Use guides contraceptive selection.
Purpose of the Study:
- To review contraceptive choices for women with mental illness.
- To provide evidence-based care recommendations for psychiatrists treating women desiring contraception.
- To inform decision support for preconception planning, pregnancy, and postpartum periods.
Main Methods:
- Literature search of PsycINFO, PubMed, Embase, and Scopus for publications on contraception for women with mental illness.
- Selection of publications providing data for evidence-based care.
- Review structured by the Centers for Disease Control and Prevention's Medical Eligibility Criteria for Contraceptive Use.
Main Results:
- Combined oral contraceptives are most commonly chosen, while long-acting reversible contraceptives (LARCs) are underutilized despite favorable profiles.
- All contraceptive methods are acceptable for women with depression; comorbidities may influence choice.
- Hormonal contraceptives generally show similar or lower rates of mood symptoms in women with psychiatric disorders compared to nonusers; interactions with psychotropic drugs are rare.
Conclusions:
- Proactive management of mental illness, contraception, and pregnancy enhances women's functioning and health.
- Optimizing reproductive health through informed contraceptive choices is vital for women with mental illness.
- Evidence supports the safety and efficacy of various contraceptive methods for women with mental health conditions.
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