Postpartum Hormonal Contraceptives Up Depression Risk by 50%: Daily Dose

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On April 25, 2025, we reported on findings from a study published in JAMA Network Open that was designed to determine whether hormonal contraceptive (HC) initiation post partum is associated with the development of depression within 12 months postpartum.

The study

Researchers conducted a population-based cohort study based on nationwide Danish register data including all primiparous women who gave birth from January 1, 1997, through December 31, 2022. They excluded women if they had depression within 24 months before delivery, multiple births or stillbirth, or a diagnosis of breast cancer or liver tumor.

The main outcome was depression within 12 months postpartum, defined as filling an antidepressant prescription or receiving a hospital diagnosis of depression. HC was stratified into combined oral contraceptives (COCs), combined nonoral contraceptives (CNOCs), progestogen-only pills (POPs), and progestogen-only nonoral contraceptives (PNOCs).

The findings

Among 610 038 first-time mothers, approximately 40.7% (248 274 women) started HC within 12 months after childbirth, with contraceptive users being younger on average (mean age 27.6 years) compared to nonusers (mean age 29.6 years). Initiation of HC was linked to a higher risk of postpartum depression, with an adjusted hazard ratio (AHR) of 1.49 (95% CI, 1.42-1.56), increasing the 12-month absolute risk from 1.36% to 1.54%. Specifically, the risk was higher for users of COC with an AHR of 1.72, CNOC at 1.97, and PNOC at 1.40.

Notably, POPs showed a transient decrease in depression risk early postpartum, but the risk increased later. Additionally, initiating COCs earlier postpartum was associated with a higher relative risk of depression.

Authors' comments

"These findings raise the issue of whether the incidence of depression post partum may be inflated by routine HC initiation, which is important information to convey at postpartum contraceptive counseling."

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