FPIN's Clinical Inquiries

Is the Use of Hormonal Contraception Associated With Suicide and Suicide Attempts?

 

Am Fam Physician. 2022 Jan ;105(1):82-83.

Clinical Question

Is the use of hormonal contraception associated with suicide or suicide attempts?

Evidence-Based Answer

There may be an association between the use of hormonal contraception and suicide. Women using oral contraceptives had an increase in completed suicides and suicidal behaviors (i.e., suicidal thoughts and suicide attempts without success). Suicidal behavior decreased after one year of use. However, two older prospective cohort studies did not find an increased risk of suicide. Physicians should consider individual benefits and risks of hormonal contraception use in each patient and monitor closely for potential adverse mental health effects. (Strength of Recommendation: B; based on systematic reviews, meta-analyses, and cohort studies.)

Evidence Summary

A 2020 systematic review and meta-analysis of three cohort studies (N = 184,721) compared the use of oral contraception with the use of nonhormonal contraception or no contraception on the risk of suicide in women 25 to 59 years of age.1 Users (n = 95,901) were defined as women who were currently using or had ever used oral contraceptives. Nonusers (n = 88,171) were women who had never used hormonal contraception or a diaphragm or a nonhormonal intrauterine device for at least five months without previous oral contraceptive use. The follow-up period was study-dependent and ranged from 16 to 39 years. The primary outcome was completed suicides across the entire follow-up period, including during and after the use of oral contraceptives. A significantly increased risk of completed suicide was found in women using oral contraceptives compared with nonusers (relative risk [RR] = 1.36; 95% CI, 1.06 to 1.75). Study limitations included a lack of reported comorbid conditions known to be risk factors for suicide, and patients were taking higher doses of estrogen.

A 2020 retrospective cohort study from Sweden examined the association between combined and progestin-only oral contraceptive use and suicidal behavior.2 Women 15 to 22 years of age (n = 216,702) who had a filled prescription for oral contraceptives

Address correspondence to Jennifer Weakley, MD, at Jennifer-Weakley@ouhsc.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial relationships.


Copyright © Family Physicians Inquiries Network. Used with permission.

References

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1. Pérez-López FR, Pérez-Roncero GR, López-Baena MT, et al. Hormonal contraceptives and the risk of suicide: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;251:28–35....

2. Edwards AC, Lönn SL, Crump C, et al. Oral contraceptive use and risk of suicidal behavior among young women [published online October 21, 2020]. Psychol Med. Accessed September 22, 2021. https://www.cambridge.org/core/journals/psychological-medicine/article/abs/oral-contraceptive-use-and-risk-of-suicidal-behavior-among-young-women/3D482A155F8E26028DF03FAB875A9D6C

3. Skovlund CW, Mørch LS, Kessing LV, et al. Association of hormonal contraception with suicide attempts and suicides. Am J Psychiatry. 2018;175(4):336–342.

4. Jung SJ, Cho SMJ, Kim HC. Association of oral contraceptive use with suicidal behavior among representative Korean population: results from Korea National Health and Nutrition Examination Survey (2007–2016). J Affect Disord. 2019;243:8–15.

5. Keyes KM, Cheslack-Postava K, Westhoff C, et al. Association of hormonal contraceptive use with reduced levels of depressive symptoms: a national study of sexually active women in the United States. Am J Epidemiol. 2013;178(9):1378–1388.

6. Beral V, Hermon C, Kay C, et al. Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46,000 women from Royal College of General Practitioners' oral contraception study. BMJ. 1999;318(7176):96–100.

7. Colditz GA. Oral contraceptive use and mortality during 12 years of follow-up: the Nurses' Health Study. Ann Intern Med. 1994;120(10):821–826.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

 

 

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