Postpartum Hormonal Contraceptive Use Linked to Increased Risk of Depression

Initiating hormonal contraceptive (HC) use within 12 months of childbirth is associated with an approximately 50% increased risk of postpartum depression, particularly in women with no prior mental health diagnoses, according to findings from a large cohort study published in JAMA Network Open.¹

Vibe Gedsø Frøkjær, MD, PhD

Courtesy of Copenhagen University Hospital

In a population-based cohort of 610,038 first-time mothers in Denmark, 40.7% initiated HC use postpartum. Among them, 9251 women (1.5%) developed depression within the year following delivery, corresponding to a crude incidence rate of 21 per 1000 person-years. In comparison, the rate among non-HC users was 14 per 1000 person-years.1

The adjusted hazard ratio (aHR) for depression following HC therapy was 1.49 (95% CI, 1.42-1.56) compared with no use, according to the study findings. This translates to an increase in 12-month absolute risk from 1.36% (95% CI, 1.32%-1.39%) to 1.54% (95% CI, 1.50%-1.57%), according to the findings.

The increased risk was evident across all age groups and most pronounced in users of combined oral contraceptives (COCs), combined nonoral contraceptives (CNOCs), and progestogen-only nonoral contraceptives (PNOCs). Importantly, progestogen-only pills (POPs) were not associated with an increased risk of postpartum depression. Regarding COCs, researchers noted that the earlier the initiation following birth, the higher the associated rate ratio of depression.1

Describing the increased risk of developing depression as "instantaneous," study authors, led by Vibe Gedsø Frøkjær, MD, PhD, clinical professor in neuropsychiatry in the department of clinical medicine at the University of Copenhagen wrote, “These findings raise the issue of whether the incidence of depression postpartum may be inflated by routine HC initiation, which is important information to convey at postpartum contraceptive counseling.”1

Frøkjær and colleagues used Danish national health registry data from 1997 to 2022 to examine whether postpartum HC initiation was associated with new cases of depression. Only first-time mothers who had resided in Denmark for at least 2 years before delivery were included. Depression was identified based on new prescriptions for antidepressant medications filled within 12 months postpartum was the main study outcome. Women with a diagnosis of depression within 24 months of delivery were excluded, according to the study.1

HC use was treated as a time-varying exposure: participants contributed to nonexposed person-time until they filled an HC prescription and then to exposed time afterward. Researchers stratified exposure by HC type1:

• Combined oral contraceptives (COCs): 143,751 users (23.6%)
• aHR 1.72 (95% CI, 1.63-1.82)
• Combined nonoral contraceptives (CNOCs): 5465 users (0.9%)
• aHR 1.97 (95% CI, 1.64-2.36)
• Progestogen-only pills (POPs): 66,612 users (10.9%)
• Progestogen-only nonoral contraceptives (PNOCs): 32,446 users (5.3%)
• aHR 1.40 (95% CI, 1.25-1.56)

The average maternal age was 27.6 years for HC users and 29.6 years for nonusers. Mean follow-up time was 11.7 months postpartum.1

The study builds on concerns surrounding mental health during the postpartum period, a time when approximately 14% of new mothers experience depression. Many cases, up to half, remain undiagnosed, often due to stigma or reluctance to report symptoms.2

That said, Frøkjær et al cite data from a previous study in Denmark suggesting increasing use of HC following childbirth. The research found that up to 40% of new mothers start HC within a year of giving birth, with trends showing earlier initiation over the past 2 decades.³

While previous research linked HC use to depression in the general population, this study uniquely examines the postpartum window—a time when women are already at increased risk for mood disorders. "The interplay between the abrupt hormonal changes and psychological stressors may moderate the risk related to HC use," they added.

The authors emphasize the need for individualized postpartum counseling, reiterating their finding that certain hormonal contraceptives may pose greater mental health risks than others.

Among the study's limitations, the research team note the observational design, which precludes establishing causality between HC use and postpartum depression. They acknowledged the potential for misclassification bias as antidepressant medications are prescribed for conditions other than depression and fill dates may not reflect actual use. Healthy user bias is also possible as is an underestimation of incidence give that milder cases of depression would to undetected using the study methods.

Further research is needed to inform practice guidelines, but the findings underscore the importance of balancing contraceptive needs with mental health considerations in postpartum care.

References

1. Larsen SV, Ozenne B, Mikkelsen AP, et al. Postpartum hormonal contraceptive use and risk of depression. JAMA Netw Open. 2025;8(3):e252474. doi:10.1001/jamanetworkopen.2025.2474

2. Khadka N, Fassett MJ, Oyelese Y, et al. Trends in postpartum depression by race, ethnicity, and prepregnancy body mass index. JAMA Netw Open. 2024;7(11):e2446486. doi:10.1001/jamanetworkopen.2024.46486

3. Larsen SV, Mikkelsen AP, Madsen KB, et al. Postpartum hormonal contraceptive use in Denmark during 1997–2021. Sex Reprod Healthc. 2025;43:101075. https://doi.org/10.1016/j.srhc.2025.101075