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Am Fam Physician. 2004;70(1):190

A significant number of women in the United States use oral contraceptives (OCs) during their reproductive years. However, there are concerns that OCs may cause mood disturbances in some patients. This concern is a common reason for the discontinuation of OC therapy. However, several studies have produced conflicting results regarding the impact of OCs on mood. Some risk factors have been shown to be associated with OC-related premenstrual mood deterioration. They include history of depression, dysmenorrhea, premenstrual depression, higher dosages of estrogen and progestin, and use of triphasic preparations, as well as a family history of OC-related mood changes and younger age at first OC use. Despite the fact that studies have assessed the negative impact of OCs on mood, only a few studies examined the potential benefit of OCs on mood in certain patients. Joffe and colleagues assessed the risk factors for the deterioration and improvement of premenstrual mood symptoms in women who use OCs.

The study was a nested case-control study of women 36 to 45 years of age who were pre-menopausal. The sample population came from a metropolitan community. Screening questionnaires were mailed to 6,228 women to determine their eligibility for the study. A structured psychiatric interview was conducted with 976 women who agreed to participate in this phase of the study. Diagnosis of current or previous major depressive disorder was established during the interview.

The original questionnaire included information concerning OC use, premenstrual symptoms before first OC use, and the impact of OCs on premenstrual mood symptoms in women who had used them for at least three months.

The 10 items that were examined during the study included (1) the presence of a depression episode before first OC use, (2) the occurrence of early-onset premenstrual mood symptoms, (3) the early onset of dysmenorrhea, (4) the early onset of hyper-menorrhea, (5) the early onset of heaviness of menstruation, (6) the regularity of menstrual cycle during adolescence, (7) the age of first OC use, (8) the young adult body mass index, (9) cigarette smoking status before first OC use, and (10) the occurrence of at least one pregnancy that ended in a live birth before first OC use. Mood response to OCs was grouped into three categories: deterioration, improvement, and absence of change.

The study involved 658 women who had used OCs for at least three months. Of these women, 16.3 percent reported mood deterioration with OC use while 12.3 percent reported mood improvement. No change in mood was reported by 71.4 percent of women during OC use. Women with a history of depression before the use of OCs were twice as likely to have premenstrual mood deterioration while taking OCs compared with women who did not have this history. Women who had a history of early-onset premenstrual mood disturbances and dysmenorrhea were more likely to have improved premenstrual mood when taking OCs. The remainder of the items did not predict improvement in or deterioration of mood.

The authors conclude that the majority of women will have no change in premenstrual mood when using OCs. They note that women who have a history of depression are at higher risk for premenstrual mood deterioration with the use of OCs. In addition, women who have a history of early-onset premenstrual mood disturbances and dysmenorrhea are more likely to experience an improvement in their premenstrual mood.

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