For most women, pill use has no impact on premenstrual mood symptoms, according to a community-based study of women from the Boston area.1 Roughly three-quarters of participants (71%) reported that premenstrual mood symptoms neither improved nor deteriorated when they started using the pill. However, women with a history of depression that preceded pill use were significantly more likely than other women to experience pill-related premenstrual mood deterioration (odds ratio, 2.0). The odds that premenstrual mood symptoms improved with pill use tripled among women who had had premenstrual mood disturbance within the first five years after menarche (3.1) and more than doubled among those who had experienced dysmenorrhea in the same time period (2.3).
To investigate the effects of pill use on premenstrual mood symptoms, and to identify predictors of pill-related premenstrual mood change, researchers used 1995-1997 data from a community-based sample of Boston-area women aged 36-44. Data were collected through screening questionnaires and structured psychiatric interviews that employed standardized clinical criteria to diagnose past and current depression. The analyses included 658 women who had ever taken the pill for at least three months. Participants were categorized according to whether they reported improvement, deterioration or no change in either of two types of premenstrual mood symptoms—tension and irritability, and moods swings and depression—after they started using the pill.
The researchers investigated a number of variables that preceded first pill use: one or more episodes of major depression; being overweight as a young adult; and characteristics of the menstrual cycle within the first five years after menarche (i.e., early-onset). They used chi-square and other appropriate tests to identify possible predictors of pill-related premenstrual mood change, which were then analyzed in logistic regression analyses that adjusted for clinical characteristics.
Seventy-one percent of respondents reported no difference in premenstrual mood symptoms before and after beginning pill use; 16% said that symptoms deteriorated, and 12% said they improved. In each group, virtually all participants were white; the majority (roughly 60-80%) were married, working, Catholic women who had had at least one child and were educated at the college level or higher. The women"s mean age was 40 years.
Three potential predictors of pill-related premenstrual mood change were identified through the univariate analyses. Among women who had experienced an episode of major depression prior to taking the pill, a significantly larger proportion reported that premenstrual moods worsened with pill use than reported they improved (25% vs. 14%). In addition, greater proportions reported pill-related premenstrual mood improvement than decline among respondents with early-onset premenstrual mood disturbance (23% vs. 18%) and early-onset dysmenorrhea (19% vs. 16%). Some 60-65% of women with each of these characteristics reported no change.
Results of the multivariate analyses indicated that women with a history of depression were significantly more likely than other women to report pill-related premenstrual mood deterioration (odds ratio, 2.0). Moreover, women with early-onset premenstrual mood disturbance had increased odds of premenstrual mood symptoms" improving with pill use (3.1), as did those with early-onset dysmenorrhea (2.3). No other clinical predictors were significantly associated with a greater likelihood of pill-related premenstrual mood improvement or decline.
While the researchers acknowledge the limitations of retrospectively reported data, they suggest that their findings have important implications for health care providers. For example, women with a history of depression may be more sensitive to the hormonal effects of pill use and should be informed of the potentially negative impact of the pill on premenstrual mood symptoms; however, these women need not be prevented from taking the pill, since most are unlikely to be affected. In addition, women with early-onset premenstrual mood disturbance who do not respond positively to the pill should be assessed for other, treatable conditions, such as clinical depression. The researchers conclude that "gynecologists can use information about previous depression, premenstrual mood disturbance, and dysmenorrhea to inform clinical decisions about the potential beneficial and deleterious impact of [the pill] on premenstrual mood."
1. Joffe H, Cohen LS and Harlow BL, Impact of oral contraceptive pills on premenstrual mood: predictors of improvement and deterioration, American Journal of Obstetrics and Gynecology, 2003, 189(6):1523-1530.