Comparison of Dermatologic and Neuropsychological Side Effects of Oral Contraceptives, 2016-2020

Many patients seek a contraceptive medication that lessens symptom burden of comorbid conditions. To date, there have been limited studies investigating how oral contraceptives compare in rates of skin and mood-related side effects. The goal of this study was to compare rates of dermatological and neuropsychological side effects with various oral contraceptive formulations.

We utilized FDA Adverse Event Reporting System (FAERS) and Medical Expenditure Panel Survey (MEPS) data to compare rates of reported subjective side effects for oral contraception pills from 2016 to 2020, including acne, migraine, anxiety, and depression. Ethinyl estradiol/Norethindrone was used as the reference pill, as it is the oldest and the most prescribed combination oral contraceptive.

Pills with drospirenone had higher rates of acne, migraine, depression, and anxiety. Acne was also greater with levonorgestrel and norgestimate pills, and anxiety was greater with levonorgestrel combination pills and norethindrone alone.

Oral contraceptive formulation may affect dermatologic and neuropsychological symptoms. Multiple progestins may impact rates of acne and anxiety, with fewer effects on depression and migraine headaches. This knowledge may allow for the personalization of medication selection based on the patients' other co-morbid conditions.