The use of hormonal contraceptives following childbirth may be linked to a nearly 50% higher risk of postpartum depression, according to a recent study. 

Initiation of hormonal contraceptives during the postpartum period was associated with an increased risk of developing depression within 12 months of childbirth, according to a nationwide Danish cohort study published in JAMA Network Open. Lead study author Søren Vinther Larsen, PhD, of the Neurobiology Research Unit at Copenhagen University Hospital–Rigshospitalet in Copenhagen, and colleagues analyzed registry data from 610,038 first-time mothers in Denmark between 1997 and 2022 to assess the relationship between hormonal contraceptive initiation and postpartum depression risk.

The investigators excluded women with a diagnosis of depression or antidepressant use within 24 months prior to  delivery, those with multiple births or stillbirths, and those with contraindications to hormonal contraceptive use. Depression was defined as either filling a prescription for antidepressant medication or receiving a hospital diagnosis. Hormonal contraceptive use was treated as a time-varying exposure and categorized by method: combined oral contraceptives (COC), combined nonoral contraceptives (CNOC), progestogen-only pills (POP), and progestogen-only nonoral contraceptives (PNOC), including levonorgestrel-releasing intrauterine systems.

Among the total cohort, 40.7% (n = 248,274) of the mothers initiated hormonal contraceptive use within 12 months postpartum. The adjusted hazard ratio (HR) for depression among hormonal contraceptive users compared with nonusers was 1.49. Stratified by method, the adjusted HR was 1.72 for COCs, 1.97 for CNOCs, and 1.40 for PNOCs. For POPs, the risk varied over time, with a reduced risk early in the postpartum period that increased in later months.

The estimated average absolute risk of depression at 12 months postpartum was 1.54% under observed hormonal contraceptive use compared with 1.36% in a hypothetical scenario in which no hormonal contraceptives were initiated—an absolute risk difference of 0.18%. Among COC users, earlier initiation was associated with higher rates of depression, with a rate ratio per year of delayed initiation of 0.61.

The findings suggested that hormonal contraceptive use, particularly when initiated early postpartum, may contribute to an elevated risk of depression. The investigators highlighted the importance of considering timing and method selection during postpartum contraceptive counseling.

Full disclosures can be found in the published study.