Practice Therapeutics

Newer non-oral hormonal contraception

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f341 (Published 14 February 2013) Cite this as: BMJ 2013;346:f341

Re: Newer non-oral hormonal contraception

Newer non oral hormonal contraceptives and depression

Deborah Bateson and colleagues1 seek to reassure about the safety of the newer hormonal contraceptives:-

Evra- norelgestromin and ethyinlestradiol

Nuva - etonogestrel and ethylestradiol

Intra Uterine System - levonorgestrel

Implanon or Nexplanon - etonogestrel

However, Lindeberg and colleagues reported the highest use of antidepressants in all age groups, particularly in the 16-19 years age group, related to use of medroxyprogesterone-only, followed by etonogestrel-only, levonorgestrel-only and ethinylestradiol/norelgestromin formulations.2

It is not reassuring that the commonest cause of death among current takers was violence (mostly suicide)at the start of the Royal College of General Practitioners oral contraceptive study (1968 – 1972).3 Their 2010 mortality study recorded three times more deaths in women under age 30 if they had ever taken hormonal contraceptives.4

Numerous studies, including previous RCGP Pill study publications, proved that hormone use increases the risk of cancers, vascular diseases and mental illnesses, which are all important causes of death in takers. Bateson quotes the RCGP finding of a lower mortality from cancers of the uterus, ovaries, and large bowel or rectum in users of the combined pill compared with never-users.4 This is clearly a dubious result because the authors did not know which women were currently using HRT hormones in the final decade when most study deaths occurred 30 to 40 years after enrollment. Progestins and estrogens, given as HRT, increase the risk of several cancers including ovarian cancer.5

In 1968 we reported that depressive mood changes with oral contraceptives related to progesterone potency, lower estrogen doses and high monoamine oxidase levels.6

The detrimental mental effects of progestin use continue to be overlooked.

1 Bateson D, McNamee K, Briggs P. Newer non-oral hormonal contraception. BMJ 2013; 346:f341

2 Lindberg M, Foldemo A, Josefsson A, Wiréhn AB. Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: a nationwide
population-based study with age-specific analyses.

3 Royal College of General Practitioners. Oral Contraceptives and Health. 1974 Pitman Medical , London p80.

4 Hannaford PC, Iversen L, Macfarlane TV, et al. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners’ Oral Contraception Study BMJ 2010; 340: c927

5 Grant EC. Ovarian cancer and oral contraceptives. Lancet 2008;371(9625):1662.

6 Grant ECG, Pryce-Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. BMJ 1968;3:777-80

Competing interests: No competing interests
17 February 2013
Ellen CG Grant
Physician and medical gynaecologist
Retired
Kingston-upon-Thames, KT2 7JU, UK
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