Impact of oral contraceptive pill use on premenstrual mood: Predictors of improvement and deterioration

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Abstract

Objectives

The purpose of this study was to estimate risk factors for the deterioration and improvement of premenstrual mood disturbance with oral contraceptive pill use.

Study design

Predictors of the deleterious and beneficial effects of oral contraceptive pill use on premenstrual mood were analyzed with the use of logistic regression in a nested case-control study within a community-based cohort of 976 premenopausal women in Massachusetts.

Results

Of 658 women who were using oral contraceptive pills, 16.3% of the women reported oral contraceptive pill–related premenstrual mood deterioration, and 12.3% of the women reported premenstrual mood improvement. In adjusted models, previous depression was the only significant predictor of mood deterioration (odds ratio, 2.0; 95% CI, 1.1-3.8); early-onset premenstrual mood disturbance and dysmenorrhea were significant predictors of oral contraceptive pill–related mood improvement (odds ratio, 3.1 [95% CI, 1.9-5.2] and odds ratio, 2.3 [95% CI, 1.4-3.9], respectively).

Conclusion

Oral contraceptive pills do not influence premenstrual mood in most women. Premenstrual mood is most likely to deteriorate in women with a history of depression and to improve in women with early-onset premenstrual mood disturbance or dysmenorrhea.

Section snippets

Methods

This investigation is a nested case-control study within a cohort of 36- to 45-year-old premenopausal women from the greater metropolitan Boston area (Harvard Study of Moods and Cycles).11 Written informed consent was obtained from each subject, and the research study was approved by the Brigham and Women's Hospital Institutional Review Board. The primary goal of the Harvard Study of Moods and Cycles was to determine the association between a lifetime history of depression and an earlier

Results

Of the 658 women who had used an OCP, 107 women (16.3%) reported premenstrual mood deterioration, and 81 women (12.3%) reported premenstrual mood improvement with OCP use. OCP use therefore had no deleterious or advantageous impact on premenstrual mood in 470 of women (71.4%) who had used an OCP.

The mean age of the subjects was 40.4±2.5 years, and the study population was comprised predominately of white, educated, married, working, Catholic women with children (Table I). There were no

Comment

This analysis highlights clinical risk-benefit decisions about the potential impact of OCP use on premenstrual mood symptoms. Our findings suggest that most women do not have a change in premenstrual mood symptoms after starting an OCP. The population in whom premenstrual mood is most likely to worsen with OCP use appears to be restricted to those with a history of depression. In contrast, the women who are most likely to benefit from a positive influence of an OCP on premenstrual mood symptoms

Acknowledgements

We thank Jonathan Orav, PhD, for his biostatistical consultation and Ms Allison Vitonis for her assistance with database management.

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    Supported by National Institutes of Health grants No. T32 MH17119 (H. J.) and No. R01-MH50013 (B. L. H., L. S. C.).

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