Postpartum Hormonal Contraceptive Use and Risk of Depression.

Area of Science:

• Reproductive Health
• Mental Health
• Clinical Epidemiology

Background:

• Hormonal contraceptive (HC) use is known to be associated with depression.
• The postpartum period presents a heightened risk for depression in women.
• The association between postpartum HC initiation and depression remains unclear.

Purpose of the Study:

• To investigate the association between hormonal contraceptive initiation in the postpartum period and the development of depression within 12 months.
• To analyze different types of hormonal contraceptives and their specific risks.

Main Methods:

• Population-based cohort study using Danish nationwide register data.
• Included primiparous women giving birth between 1997 and 2022.
• Time-varying exposure analysis of HC initiation (COCs, CNOCs, POPs, PNOCs) and depression diagnosis or antidepressant prescription within 12 months postpartum.

Main Results:

• Hormonal contraceptive initiation was associated with a 49% increased risk of depression (AHR 1.49).
• Absolute risk of depression increased from 1.36% to 1.54% within 12 months postpartum.
• Combined oral contraceptives (COCs) showed a higher associated risk (AHR 1.72), with earlier initiation linked to greater risk.

Conclusions:

• Postpartum hormonal contraceptive initiation is associated with an increased risk of depression.
• The risk appears to be higher with earlier initiation, especially for COCs.
• Findings question the routine initiation of hormonal contraceptives immediately postpartum due to potential depression incidence increase.