A study has found risk doubled until one year after initiation of contraceptives, with highest risk attached to the patch, vaginal ring and progestin-only products
A large cohort study of nearly half a million Danish women, conducted from 1996 to 2013, has found women using hormonal contraception between ages 15 and 33 had nearly two times the risk for a first suicide attempt and more than three times the risk for suicide compared with never-users.
Risk of suicide attempt was higher among adolescents (ages 15 to 19), according to the study published in the American Journal of Psychiatry.
Across the cohort and study period, which had a mean follow-up of 8.3 years, researchers identified 6,999 first suicide attempts and 71 suicides.
The relative risk of first suicide attempt was found to increase rapidly after initiation of hormonal contraceptive use, compared with never use, and remained at least doubled until one year after initiation.
Decrease in risk estimates for suicide attempt after one year of use was probably due to women who experienced adverse mood reactions dropping use, suggest the researchers.
Risk estimates for suicide attempt were 1.91 for oral combined products, 2.29 for oral progestin-only products, 2.58 for vaginal ring, and 3.28 for patch.
While this was the first study of its kind to look at the association between hormonal contraceptive use and risk of suicide attempt, another published study found oral contraceptive users were at 1.4 times the risk of suicide compared with never-users.
“Our data indicate that adolescent women are more sensitive than older women to the influence of hormonal contraceptive on risk of a first suicide attempt,” say the researchers from the University of Copenhagen’s Department.
“This finding could be influenced by attribution of susceptible women, but also adolescent women are particularly vulnerable to risk factors for suicide attempt.”
There are several potential biological mechanisms to explain how estrogen and progesterone are involved in the etiology of depressive symptoms, they say.
However the authors suggest it is possible that other risk factors for suicide or suicide attempt might be less common among the never users of hormonal contraception, thereby potentially causing an overestimation of the results—for example, certain personality traits or religious subgroups causing both never use of hormonal contraception and a lower risk of suicide attempt.
Assuming the demonstrated associations are causal, researchers say the absolute increase in events due to use of hormonal contraception in the study population of previously mentally health women is 1400 additional first suicide attempts and 12 additional suicides per 1 million person-years.
“Considering the severity of these little-recognised potential side effects of hormonal contraceptives, health professionals and women starting hormonal contraceptives should be informed about them,” they conclude.