Which contraceptives are suitable for women with mental illness?

Proactive management of a woman’s mental illness, contraception, and pregnancy results in improved capacity to function and in better mental and reproductive health, suggests a study.

The investigators searched the databases of PsycINFO, PubMed, Embase, and Scopus for publications on the management of contraception for women with a psychiatric disorder. Studies were eligible if they included, based on the authors’ consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives.

The Centers for Disease Control and Prevention’s recommendations, Medical Eligibility Criteria for Contraceptive Use, were used to provide the structure for review of contraceptive choices.

Most women chose combined oral contraceptives. Only 14 percent of women chose long-acting reversible contraceptives (eg, implants, intrauterine devices) despite their association with low failure rates, favourable safety profiles, rapid return to fertility after removal, and few contraindications.

Although all methods were acceptable for women with depression, certain medical comorbidities might determine a specific type.

The effect of hormonal contraceptives on the risk of depression remains debatable, but clinical studies and randomized placebo-controlled trials of women with mental illness have mostly reported similar or lower rates of mood symptoms in hormonal contraceptive users as compared to nonusers.

Of note, interactions between psychotropic medications and contraceptives were rare, but clozapine, anticonvulsants, and St. John’s Wort were exceptions.

“Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period,” the investigators said.