Hormonal contraceptives linked to increased risk of postpartum depression

A team from Copenhagen University Hospital, Denmark, examined the link between hormonal contraception and the risk of postpartum depression in mothers after the birth of their first child. The population-based cohort study, published in JAMA Network Open, included 610,038 first-time mothers selected from a national Danish registry who gave birth between Jan. 1, 1997, and Dec. 31, 2022.Women were excluded if they had experienced depression in the 24 months prior to delivery, multiple births or stillbirths, or if they had been diagnosed with breast cancer or liver tumors. Of the 610,038 participants, 248,274 (40.7%) started taking oral contraceptives within 12 months of delivery. Hormonal contraceptive types were categorized into combined oral contraceptives (COCs), combined non-oral contraceptives (CNOCs), progestin-only pills (POPs), and progestin-only non-oral contraceptives (PNOCs).Among all participants, 23.6% used COCs, 0.9% CNOCs, 10.9% POPs and 5.3% PNOCs within one year of delivery. The mean follow-up duration was 11.7 months and 1.5% of mothers developed depression within 12 months of delivery. The earlier contraception started, the greater the risk of depressionInitiation of oral contraception after delivery was associated with a 1.49-fold higher risk of depression (95% CI, 1.42-1.56) than no oral contraception use, and the absolute risk of depression at 12 months postpartum increased from 1.36% to 1.54%. This was true regardless of the type of oral contraception, with the exception of progestin-only pills, for which the risk was initially reduced and then increased late after delivery.In detail, the adjusted hazard ratio for COCs was 1.72 (95% CI, 1.63-1.82); CNOC, 1.97 (95% CI, 1.64-2.36); and PNOC, 1.40 (95% CI, 1.25-1.56). "The earlier the use of combined oral contraceptives was initiated after delivery, the higher the associated rate of depression," regardless of age, the authors emphasize, adding that the risk was more pronounced among women without a history of mental disorders.A period of greater vulnerabilityThe association between the time of COC initiation and the risk of depression could, according to them, indicate that the early postpartum period is a period of greater vulnerability. Further, the interaction between sudden hormonal changes and psychological stressors could moderate the risk associated with oral contraceptive use."This finding raises the question of whether the incidence of postpartum depression is increased by the systematic initiation of hormonal contraceptives after delivery, an important piece of information to convey during postpartum contraceptive consultations," the Danish researchers concluded. The authors acknowledge that their research has several limitations, including its observational nature, the fact that depression is not always the primary reason for an antidepressant prescription, that the dispensing date of a prescription may not correspond to the prescription's onset date, and that the results may not apply to milder cases of depression.This article was translated from its original French and was first published in our sister publication Profession Santé.Reference:Larsen SV, Ozenne B, Mikkelsen AP, et al. Postpartum Hormonal Contraceptive Use and Risk of Depression. JAMA Netw Open. 2025;8(3):e252474. doi:10.1001/jamanetworkopen.2025.2474

Hormonal contraceptives linked to increased risk of postpartum depression

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