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. 2025 Aug;40(8):915-923.
doi: 10.1007/s10654-025-01267-0. Epub 2025 Jul 2.

Use of systemic hormonal contraception and risk of depression: a registry-based study from Finland

Elena Toffol  1 , Timo Partonen  2 , Oskari Heikinheimo  3 , Anna But  4 , Antti Latvala  5 , Jari Haukka  4
Affiliations

Use of systemic hormonal contraception and risk of depression: a registry-based study from Finland

Elena Toffol et al. Eur J Epidemiol. 2025 Aug.

Abstract

Earlier findings on the relationship between use of hormonal contraception (HC) and depressive symptoms and disorders are contradictory. Thus, we assessed the associations of use of different types of systemic hormonal contraceptives in the six preceding months with the risk of depression in women aged 15-49 years. Data were obtained from national registers in Finland. All cases of depression in the years 2018-2019 were identified in a population-based cohort of women. We used a nested case-control design with 1:4 ratio (n = 117,360 cases) and applied multivariable conditional logistic regression models. During the follow-up a total of 23,480 new cases with the diagnosis of depression were observed (incidence rate: 21.7, 95% confidence interval = 21.5-22.0 per 1000 person-years). Use of HC in the six preceding months, specifically that of combined hormonal contraceptives (containing gestodene and ethinylestradiol, drospirenone and ethinylestradiol, and nomegestrol and estradiol), was significantly associated with a lower risk of depression compared to non-use when controlling for marital status, socioeconomic status, education, recent delivery, recent psychiatric hospitalization, chronic diseases, use of psychiatric medications (excluding antidepressants) and former use of HC (odds ratio: 0.90, 95% confidence interval = 0.85-0.95; 0.86, 95% confidence interval = 0.81-0.91, respectively). Current use of progestogen-only preparations (norethisterone, levonorgestrel, desogestrel) was not associated with depression. This pattern was evident in all age groups, including adolescent girls. HC use appeared not associated with an increased risk of depression in fertile-aged women and across all age groups, including adolescent girls.

Keywords: Adolescents; Combined hormonal contraceptives; Contraceptive; Fertile-age; Girls; Women.

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Conflict of interest statement

Declarations. Conflict of Interest: O.H. serves occasionally on advisory boards for Bayer AG and Gedeon Richter and has designed and lectured at educational events of these companies. The other authors report no financial relationships with commercial interests. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. The study was reviewed by the Ethics Committee of the Faculty of Medicine, University of Helsinki (3/2018). Because this is a register-based study, no individual consent is needed.

Figures

Fig. 1
Fig. 1
Directed Acyclic Graph (DAG) utilized for model selection
Fig. 2
Fig. 2
Associations between depression and current use (in the previous 180 days) of hormonal contraceptives. Results are expressed as Odds Ratios with 95% Confidence Intervals. For each substance the reference category is no use of the same substance in the 180 days before the attempted suicide. Adjusted model is controlled for marital status, socioeconomic status, education, recent delivery, recent psychiatric hospitalization, chronic diseases, use of psychiatric medications (excluding antidepressants) and former use of HC. One substance in model a time. Care Register of Health Care and Register of Primary Health Care visits data together
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References

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