Hormonal Treatments and Women's Mental Health

One day during the holy month of Ramadan, a young unmarried woman in the prime of her life came to me complaining of headaches, irritability, low mood, and difficulty with sleep for two weeks. A comprehensive assessment revealed that she was taking contraceptive pills to postpone her menstrual period and complete the entire holy month's fast, as many women in our country do. In this article, we will explore how hormonal treatments such as these contraceptive pills, as well as fertility treatments that some women must undergo when natural conception is difficult, affect women's mental health.

Do contraceptive pills really cause symptoms of depression?

• Contraceptive pills are notorious for causing weight gain, but research suggests that this is not the only reason many women replace them with other contraceptive methods. Evidence shows that both estrogen and progesterone—the hormones contained in these pills—affect the brain, which may explain the negative mood changes or increase in symptoms of depression commonly reported by women who take contraceptive pills, although the underlying mechanism has not been clearly established.
• In 2002, a review of 13 studies examining the relationship between mood and contraceptive pill use was published. Twelve of the studies found differences in mood between women who used contraceptive pills and those who did not. Another experimental study in Australia, which included 58 women, found that new users of contraceptive pills had higher rates of depression than non-users. A large study conducted in Denmark involving more than one million women also showed an increase in first-time depression diagnoses and antidepressant use among users of different types of contraceptive pills.
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What is the role of doctors and healthcare professionals regarding contraceptive pills?

• Because there are clear links between depression and the use of some contraceptive methods, caution is warranted for women with a personal or family history of depressive disorder. Doctors should also discuss women's mental health thoroughly and carefully, noting any previous history of premenstrual dysphoria or earlier mood changes associated with contraceptive methods.
• It is important to pay attention when women report a clear temporal relationship between starting hormonal contraception and the development of new mood disturbances or the worsening of existing ones. In such cases, discussing the different types of contraception is important for protecting the patient's mental health.
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What is the psychological impact of assisted reproductive technologies?

• Women experiencing fertility problems have been found to carry an extremely stressful psychological burden. Assisted reproductive technologies may increase psychological distress among women undergoing these treatment options. The mental health consequences may be explained partly by the stress arising from the desire for motherhood and the social pressure associated with delayed childbearing, as well as by biological factors related to ovulation stimulants and medications used to support pregnancy. These treatments have several distressing psychological effects, the most common of which are mood disorders.
• The hormonal changes and estrogen withdrawal used in these fertilization techniques may increase women's vulnerability to depression, exacerbate psychotic symptoms, increase the risk of relapse, and increase the antipsychotic dose requirements of patients with previous conditions.
• Many studies have examined the prevalence of psychological disorders among women undergoing fertility treatments. Researchers found that the prevalence of mood disorders reaches 26% among women and confirmed that major depression is the most common diagnosis.
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What support can be provided to women undergoing these treatments?

Based on the above, we emphasize the importance of providing psychological supportfor women undergoing fertility and reproductive treatment, including marital and family support. When necessary, specialized psychological treatment and follow-up should be provided to women affected by hormonal fertility treatment.