Hormonal Contraceptives and the Brain - Implications for Women's Mental Health

Hormonal contraceptives have been introduced more than 60 years ago and have since been subject to one controversy after the other. Current debates center around the question of mental health implications of hormonal contraceptives with some studies suggesting adverse mood effects in 4-10% of women, while other studies highlight mood stabilizing effects in hormonal contraceptive users. Mood changes during hormonal contraceptive use are among the most common reasons for discontinuation of hormonal contraceptive treatment. Interestingly, subjective reports of mental health changes, both positive and negative, have been available since the beginnings of hormonal contraception, while research on the potential effects of hormonal contraception on the brain has only started a decade ago. Accordingly, little is known about the neurobiological underpinnings of hormonal contraceptive effects on mood. In this symposium we highlight this controversy from the perspective of women’s health research across various hormonal transition periods, like the menstrual cycle, the postpartum period and menopause, which have (i) all been associated with brain changes and (ii) have all demonstrated individual differences between women with higher and lower psychological sensitivity to hormonal fluctuations. The female brain is remarkably flexible in adapting to hormonal changes at a rapid timescale and hormonal contraceptives are no exception in this regard. However, it is of utmost importance to understand how different neuronal systems respond to different hormonal combinations in different populations of women. We here present the most current research findings on hormonal contraceptive actions on the brain and women’s mental health, ranging from alterations in resting state networks, over molecular signatures of hormone sensitivity to alterations in stress responsivity. The presented studies use different designs of contraceptive treatment/withdrawal and focus on different sub-populations of women, highlighting the importance of individualized approaches to hormonal contraception and mental health, thereby carving out a future perspective for the neuroscience of hormonal contraception. Going forward, the most pressing issue appears to be the identification of biomarkers for risk and protective factors predisposing women to develop adverse or beneficial mood symptoms during hormonal contraception.