Identifying psychiatric comorbidities that occur following the introduction of hormonal contraception: a scoping review

Introduction: Hormonal contraceptives are widely used by women of reproductive age, yet concerns persist regarding their potential effects on mental health. Although mood-related side effects are frequently reported, their prevalence, clinical significance, and variation across formulations remain unclear. This scoping review examined associations between hormonal contraception and psychiatric outcomes, focusing on depressive symptoms, anxiety, and other mental health disorders. Methods: A comprehensive search of four major databases identified peer-reviewed studies published between 2014 and 2024. Forty-six studies met inclusion criteria, encompassing observational cohorts, cross-sectional surveys, and clinical trials. Study quality was assessed using the Joanna Briggs Institute checklist. Random-effects meta-analysis and subgroup analyses were conducted by hormonal class and psychiatric outcome. Results: Pooled analyses indicated a small but statistically significant association between hormonal contraceptive use (particularly progestin-only methods) and increased depressive symptoms (RR = 1.24, 95% CI 1.08-1.42; I² = 97.7%). For suicidality, cohort studies reported estimates ranging from HR = 1.97 in younger users to OR = 1.57 with long-term progestin-only use, although the pooled estimate across four studies was imprecise (RR = 1.20, 95% CI 0.65-2.21; I² = 98%). Evidence for anxiety and other psychiatric outcomes was inconsistent; four anxiety-focused studies yielded a non-significant pooled effect (RR = 1.08, 95% CI 0.83-1.40; τ² = 0.13). Methodological heterogeneity, particularly in outcome measurement and control for confounding, was a frequent limitation. Discussion: These findings suggest that hormonal contraception may contribute to adverse psychiatric outcomes in a subset of users. Integrating mental health screening into contraceptive counseling and conducting well-designed prospective studies with standardized psychiatric measures are essential for guiding safer, more tailored contraceptive prescribing practices.