Hormonal Contraception May Increase Risk of Suicide, Study Suggests

Women who use hormonal birth control may be more likely to attempt or die by suicide than those who never use the medication, according to a study of women aged 15 to 33 in Denmark. The findings were published in AJP in Advance.

“Adolescent women experienced the highest relative risk,” wrote Charlotte Wessel Skovlund, Ph.D., and colleagues of the University of Copenhagen. “Patch, vaginal ring, and progestin-only products were associated with higher risks than oral combined [estrogen and progestin] products, and a similar association was suggested for suicide.”

To assess associations between their use of hormonal birth control and the risk of a first suicide attempt or suicide, Skovlund and colleagues followed a national cohort of Danish women who turned 15 during the study period, which extended from 1996 to 2013, and who had no history of hormonal contraceptive use. Women with prior suicide attempts, antidepressant use, and psychiatric diagnoses were excluded from the analysis.

The study included nearly half a million women followed on average for 8.3 years with a mean age of 21 years. A total of 6,999 first suicide attempts and 71 suicides were identified. The association between hormonal birth control and a first suicide attempt peaked after two months of use. 

Compared with women who never used hormonal birth control (“never users”), users of hormonal birth control aged 15 to 33 years had a relative risk of 1.97 for a first suicide attempt and 3.08 for suicide. The relative risk of a first suicide attempt increased rapidly after initiation of hormonal contraception use, compared with never use, and it remained at least doubled until one year after initial use. 

Following that, the risk estimates decreased, but remained higher compared with never users after more than seven years of use. The relative risk of suicide attempt with hormonal contraceptive use was for 2.06 for the 15-19 age group, 1.61 for the 20-24 age group, and 1.64 for the 25-33 age group.

“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,” the authors wrote. This age difference may be due to the fact “adolescent women are particularly vulnerable to risk factors for suicide attempt,” they noted.

They concluded, “Considering the severity of these little-recognized potential side effects of hormonal contraceptives, health professionals and women starting hormonal contraceptives should be informed about them.”

For related information, see the Psychiatric News article “Increased Risk of Depression Tied to Some Contraceptive Use.”

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