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The Copenhagen University Hospital-Rigshospital and collaboration of Danish universities have carried out statistical research suggesting that the use of the starting hormonal postpartum is associated with a 49% higher risk of developing depression compared to non-users, although the difference in absolute risk modeled over 12 months has only been 0.18 percentage points. The associated risks have been evaluated to be higher, the previous use was initiated into postpartum.
The use of HC has already been linked to a high risk of depression in the general population, especially in adolescents and younger women. The impact that this has an impact on a postpartum context has remained uncertain.
Postpartum itself is linked to an increased vulnerability to mental health disorders, including depression. Women are generally offered HC for contraception during this period, but studies on the intersection of postpartum and HC are lacking.
In Denmark, up to 40% of mothers are launching HC methods during the first year after childbirth and in the past 20 years, they have started at an increasingly short interval after childbirth.
In the study, “use and risk of postpartum hormonal contraceptive and depression”, published in Jama Network OpenThe researchers conducted a cohort study based on the population based on national Danish health data to examine how the use of Post-Partum HC is associated with depression in relation to the lack of exposure to HC.
The researchers analyzed data between 1997 and 2022 on more than 610,000 mothers for the first time; 248,274 (40.7%) launched HC in the 12 months postpartum. The data has been linked using the personal identification numbers assigned to all Danish residents. The hormonal contraceptives have been classified as combined oral contraceptives, combined non -oral contraceptives, only progestin pills and progestin non -oral contraceptives only.
The use of combined oral contraceptives was initiated by 143,751 women (23.6%), combined non -oral contraceptives of 5,465 (0.9%), progestin pills only of 66,612 (10.9%) and progestulous non -oral contraceptives only by 32,446 (5.3%). A subgroup of 29,864 women (4.9%) used intrauterine systems releasing lettland.
The average exposure time for HC users was 7.7 months overall; 7.0 months for combined oral contraceptives, 7.4 months for combined non -oral contraceptives, 8.8 months for progestin pills only and 8.0 months for progestulous non -oral contraceptives only.
Depression developed in 9,251 women (1.5%) within 12 months after childbirth. The gross incidence rate was 21 per 1,000 years of people among users of HC and 14 per 1,000 years of people among non-users.
The estimated risk modeling of postpartum depression under different contraceptive use scenarios has shown a variation between HC types. The use of HC (combined) was associated with an instantaneous risk of depression of 49% higher compared to non-use (adjusted risk ratio (AHR), 1.49; 95% CI, 1.42–1.56).
In a hypothetical scenario where no woman had initiated hormonal contraception, the absolute means of depression of 12 months was estimated at 1.36% (95% CI, 1.32% at 1.39%).
Among the women recorded as initiating hormonal contraception (based on prescribing dates), the average risk estimated was 1.54%(95%CI, 1.50%to 1.57%), which resulted in an absolute risk difference of only 0.18 percentage points (95%CI, 0.16%to 0.20%).
Exploratory analysis examined whether the previous initiation of combined oral contraceptives was associated with a greater risk of depression. The depression rate was higher in women who started using earlier in the postpartum period and decreased regularly in the first seven months, while remaining high throughout the 12-month period compared to non-users.
The likelihood risk tests supported a negative linear association between time in initiation and the depression rate, with a rate ratio of 0.61 (95%CI, 0.48–0.79) per year after childbirth.
The start of the HC after childbirth was associated with an increased risk of developing depression in the first 12 postpartum months. The risk was high in all types of HC, with the exception of progestogy pills only, which showed a scheme varying over time with an early risk reduced and an increased risk later in the study.
No coherent tendency linked to age in the risk of depression was found after taking into account the covariables varying over time. The risk was higher in women with no history of mental disorders compared to those who had a prior diagnosis. The results increase the possibility that the initiation of short routine postpartum can contribute to high depression rates during this period.
As an observation study, these results do not establish causality. The authors noted that previous studies outside the postpartum period have reported stronger associations between the use of HC and depression in younger women.
No direct comparison was made with non-post-post populations initiating hormonal contraception, and no demographically adjusted comparison at the basic depression rates outside the postpartum context was included for the comparison.
Another aspect that could influence the correlation (perhaps for a future study) are the protocols of nurse and midwife for patients with symptoms of postpartum, anxiety, insomnia, excessive or depression stress.
Denmark has robust postpartum follow-up care, with regular home visits by trained professionals. The trends observed in the data could easily reflect the care practices of routine patients.
More information:
Søren Vinther Larsen et al, use of postpartum hormonal contraceptives and risk of depression, Jama Network Open (2025). DOI: 10.1001 / JamanetWorkopen.2025.2474
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