Oral contraceptive use among young women aged 15–22 is associated with an increased risk of suicidal behavior, particularly within the first year of use, according to a study published in Psychological Medicine. While the risk of suicide associated with hormonal contraceptives is relatively low, the findings indicate that the topic deserves additional attention and research.
(If you are experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255 or follow this link to their online chat.)
“I was interested in this topic because of the potential impact of oral contraceptive use on women’s health. Women use oral contraceptives for a range of reasons, yet relatively few studies have used longitudinal, population-based samples to examine associations with suicidal outcomes,” said study author Alexis C. Edwards, an associate professor at Virginia Commonwealth University.
“I think it’s important to be aware of potential risks and contextualize them relative to other predictors so that women and their medical providers can make informed decisions and select the health care options that work best for an individual.”
The researchers analyzed data from 216,702 women born between 1991 and 1995 who were included in Swedish national registries. Approximately 45% of these women used only combination pills during the observation period, 11% used only progestin-only pills, and 12% used both combination and progestin-only pills. The remaining 32% had no record of hormonal contraceptive use.
Edwards and her colleagues found that suicidal behavior was slightly more common among those using oral contraceptives relative to those who did not use oral contraceptives. The risk of suicidal behavior declined with increased duration of oral contraceptive use.
“Overall, the risks of suicidality associated with oral contraceptive use are relatively low: For women taking combination pills, the risk of suicidal behavior one year after onset of use barely differed from women not taking the pill. Importantly, risks associated with oral contraceptive use were dwarfed by those conferred by mood and anxiety disorders,” Edwards told PsyPost.
The use of the nationwide registers allowed the researchers to control for sociodemographic, familial, and psychiatric factors, such as parental history of suicide. But the study — like all research — includes some caveats.
“We were only able to follow women for a limited time frame, and it’s possible that the risks associated with oral contraceptive use declined further across time. We also weren’t able to compare women who took combination or progestin-only pills with those who used other types of birth control (condoms, IUDs, etc.),” Edwards explained.
“Important remaining questions include whether there are differences in risk as a function of sexual activity (not everyone taking the pill is sexually active), whether risks vary depending on the reason for oral contraceptive use, and how contraceptive use interacts with behavioral or interpersonal factors to impact risk of suicidal behavior.”
The findings are in line with a previous study, which examined similar data from Danish population registries.
“Studies such as ours, and those by Charlotte Skovlund and by Katherine Keyes to name just a couple, can be used to open up discussions between women and their health care providers about using oral contraceptives, always keeping in mind that reproductive health decisions and behavioral outcomes are complex issues – different decisions will work for different people,” Edwards said.
The study, “Oral contraceptive use and risk of suicidal behavior among young women“, was authored by Alexis C. Edwards, Sara Larsson Lönn, Casey Crump, Eve K. Mościcki, Jan Sundquist, Kenneth S. Kendler, and Kristina Sundquist.