Discontinuation of oral contraceptives (OCs) is the primary cause for the nearly 1 million annual unintended teen pregnancies in the United States. Despite substantial evidence documenting the low incidence of OC-related adverse effects, the perception among women of adverse effects is the most frequently cited reason for discontinuation of OCs. Women with psychological conditions appear to be at greater risk for perceived adverse effects and subsequent discontinuation. Some studies have suggested a relationship between discontinuation use of OCs and depression and stress as well as perceived weight gain. However, other studies reported no such relationship.
The aim of this prospective study was to determine whether depressed mood and psychological stress were risk factors for perceived OC-related mood or weight changes and OC discontinuation. The study was part of a larger randomized intervention trial comparing the impact of a 3-month versus 7-month supply of pills on OC continuation rates at 6 months, with questions on OC adverse effects and use at 6 months. Participants were a cohort of 354 minority women aged 13 to 35 years who completed a structured interview using standardized psychological instruments to assess symptoms of depression and stress. Multiple logistic regression analysis was used to assess the relationships between psychological conditions, perceived OC-related adverse effects, and the OC continuation rate, adjusting for covariates.
At baseline, depressed mood (21%) and stress (19%) were relatively common; at 6 months, 25% of the participants reported mood changes, and more than half (57%) reported weight changes. At 6 months, only 38% of participants still used OCs. The adjusted data showed that, at 6 months, young women with depressed mood (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.25–4.15; P = 0.007) and stress (OR, 2.07; 95% CI, 1.12–3.82; P = 0.02) were twice as likely to report perceived OC-related moodiness; those with depressed mood were nearly twice as likely to report perceived weight loss (OR, 1.89; 95% CI, 1.01–3.55; P = 0.05). In multivariate models, the likelihood of OC continuation was substantially lower in young women with depressed mood (OR, 0.54; 95% CI, 0.29–0.99; P = 0.04), stress (OR, 0.48; 95% CI, 0.25–0.91; P = 0.03), and perceived weight change (OR, 0.60; 95% CI, 0.38–0.94; P = 0.03).
These findings show that young women with depressed mood and stress are at risk for perceived adverse effects of OC and discontinuation.
Office of Population Research (K.S.H.), Center for Health and Wellbeing, Princeton University, Princeton, NJ; Department of Obstetrics and Gynecology (K.O’C.W.), Baystate Medical Center; Tufts University Medical School, Springfield, MA; Section of Adolescent Medicine (V.I.R.), Indiana University–Purdue University Indianapolis, Indianapolis, IN; School of Nursing (N.R.), Columbia University, New York, NY; and Department of Obstetrics and Gynecology (C.W.), School of Medicine, and Department of Epidemiology, School of Public Health, Columbia University, New York, NY.