Hormonal contraception and mental health: a narrative review of screening, monitoring, and patient-centered care for family physicians.

BACKGROUND

Hormonal contraceptives are widely used worldwide, yet the relationship between contraceptive use and mental health outcomes remains an area of active clinical inquiry, with mixed evidence regarding potential risks and benefits. Family physicians require clear guidance on screening, monitoring, and counseling.

OBJECTIVE

To provide a narrative review of current evidence on the association between hormonal contraceptive use and mental health outcomes, and to offer practical, expert-informed recommendations for family physicians.

METHODS

We conducted a narrative review of literature published between 2000 and 2025 in PubMed, Cochrane Library, EMBASE, and PsycINFO, examining studies on hormonal contraceptive methods and mental health outcomes (depression, anxiety, and mood disorders) in women of reproductive age. A narrative design was selected because of marked heterogeneity in study designs, formulations, populations, and outcome measures. Methodological quality was self-assessed using the Scale for the Assessment of Narrative Review Articles (SANRA), and the strength of the evidence underlying each conclusion is indicated throughout.

RESULTS

Evidence on hormonal contraception and mental health was mixed. Some studies reported associations with increased depression and anxiety; others reported neutral or even protective associations. Individual variability was notable, influenced by age, pre-existing psychiatric history, and formulation. Progestin-only methods and initiation during adolescence were more consistently associated with higher mood-related risks, whereas certain combined oral contraceptives, particularly those with anti-androgenic progestins, were associated with better outcomes or mood stabilization. Because most evidence is observational, these associations cannot establish causation and are susceptible to confounding by indication, reverse causation, and selection effects including the healthy-user phenomenon.

CONCLUSION

Given this variability, clinicians should prioritize individualized risk assessment, informed counseling, and close monitoring. Tailoring contraceptive choices to each woman's mental health history is likely to support both reproductive autonomy and emotional well-being. The screening, risk-stratification, and monitoring approaches proposed here represent expert-informed clinical guidance rather than formal practice standards, and their feasibility will vary across primary care settings. Future research should focus on longitudinal designs, standardized outcomes, and diverse populations.