Prevalence of Depression among Women Using Hormonal Contraceptive Use: Insights from a Hospital-Based Cross-Sectional Study

Abstract

Background: Hormonal contraceptives (HC) serve as a key component in managing premenopausal symptoms and controlling birth rates. However, mood-related side effects, ranging from minor disturbances to severe clinical depression, are the primary reasons for discontinuation.

Objective: To assess the prevalence of depression among women who use hormonal contraceptive methods. Additionally, the study aims to explore the association between specific types of contraceptives—such as oral pills, implants, injectables—and the prevalence of depression.

Methods: From October 2023 to October 2024, a total of 1500 women between the ages of 21 and 45 who currently take hormonal contraception participated in this hospital-based cross-sectional study, which was carried out at the tertiary care hospital at King Fahd Central Hospital's outpatient gynecology clinic.

Results: The most frequent age categories were from 26 to 40 years (85.7%). The majority of the studied cases were non-lean (82.6%). Most of the cases had parity from 1 to 4 (97.1%). Women were mainly of a low social class (77.1%). Social problems were found in (21.8%). Hypertension and diabetes mellitus were in 4.9% and 3.2% respectively. The most frequent contraceptive method were OCPs (40.3%), followed by POPs (31.2%), then subdermal implants (16.3%), injectable (8.6%), hormonal IUD (2.2%) and patches (1.4%). Most of the studied women used such method from 3 to 6 years (88.2%). Prevalence of depression among the studied cases was (8.7%; CI: 7.3%–10.2%). Obese individuals demonstrated a significantly higher prevalence of depression (11.5%) compared to overweight (8.5%) and lean individuals (5.0%), with a statistically significant association (p=0.015). Additionally, obese participants were more likely to have diabetes mellitus (27.1%), face social issues (21.8%), and belong to a low socioeconomic class (77.1%). Regarding contraceptive types, depression was notably less common among women using combined oral contraceptives (COCs) and progesterone-only pills (POPs), with rates of 4.6% and 4.5%, respectively. In contrast, higher rates of depression were observed in users of subdermal implants (19.2%), injectables (18.6%), hormonal IUDs (18.2%), and hormonal patches (19.0%) (p<0.001). The duration of contraceptive use also played a significant role, with depression rates increasing progressively from 2.8% for women using contraceptives for 1–2 years to 3.7% for 3–4 years and 12.7% for 5–6 years. The highest rate of depression, 37.7%, was observed among women using hormonal contraceptives for seven or more years (p<0.001)

Conclusion: Given the observed associations between certain hormonal contraceptives, prolonged use, and elevated depression rates, clinicians should adopt a proactive approach in assessing patients’ mental well-being, especially for women with additional risk factors like high BMI, socioeconomic challenges, or chronic conditions such as diabetes. Screening tools like the PHQ-9 should be routinely used during consultations to monitor for early signs of depression, allowing for timely intervention if needed.