Hormonal contraceptive use and type matter: Distinct cortisol patterns and cortisol-mood relations

Hormonal contraceptives (HCs) are used by millions of people globally; however, the implications of HC use on mood and neuroendocrine processes are not fully understood. Thus, the main goal of the current investigation was to assess stress, mood, quality of life, and cortisol patterns in individuals who were naturally cycling or using HC. Another goal was to differentiate HC type, assessing relations in combined oral contraceptive (COC) versus progestin-only HC users. Young females (N = 191) in first- and second-year university (M_age = 19.02, SD = 1.04) completed online self-report stress and mood questionnaires and provided samples for diurnal cortisol determination. When comparing HC users to naturally cycling females, no differences were found for stress, mood or diurnal cortisol patterns. However, distinct correlations were found between cortisol profiles and mood outcomes. This may indicate that the linkages between elevated mood symptoms and cortisol are dysregulated among HC users. When considering HC type, quality of life was higher in COC users compared to naturally cycling females; however, this was not found in progestin-only users. Progestin-only users were more likely to self-report a mental health diagnosis, an effect also significant in an independent replication sample of young females (N = 411; M_age = 19.34, SD = 2.15). Moreover, in the replication sample, plasma cortisol levels were lower among progestin-only users compared to COC users. This study contributes to a growing body of evidence that highlights complex relationships between HC use, mood outcomes, and neuroendocrine functioning, and emphasizes that type of HC matters.