Effects of Hormonal Contraceptives on Mood: A Focus on Emotion Recognition and Reactivity, Reward Processing, and Stress Response

Abstract

Purpose of review: We review recent research investigating the relationship of hormonal contraceptives and mood with a focus on relevant underlying mechanisms, such as emotion recognition and reactivity, reward processing, and stress response.

Recent findings: Adverse effects of hormonal contraceptives (HCs) on mood seem most consistent in women with a history of depressive symptoms and/or previous negative experience with HC-intake. Current evidence supports a negativity bias in emotion recognition and reactivity in HC-users, although inconsistent to some extent. Some data, however, do indicate a trend towards a blunted reward response and a potential dysregulation of the stress response in some HC-users. HC-effects on psychological and neurophysiological mechanisms underlying mood are likely context-dependent. We provide suggestions on how to address some of the contributing factors to this variability in future studies, such as HC-dose, timing, administration-mode, and individual risk. A better understanding of how and when HCs affect mood is critical to provide adequate contraceptive choices to women worldwide.

Keywords: Depression; Emotion; Hormonal contraceptives; Mood; Reward; Stress.

Fig. 1

Comparison of ovarian hormone profiles across the natural menstrual cycle (top row), and during intake of most common hormonal contraceptives, such as combined hormonal contraception (middle row), and progestin-only hormonal contraception (bottom row). The modes of action as well as intake characteristics of the most common hormonal contraceptives are described below.