Warning: This article mentions attempted suicide and contains data that may be triggering for some readers.
Women using hormonal contraception have lower rates of attempted suicide compared to those who are not, according to new large-scale study.
It's now common knowledge that hormonal contraception, such as the oral contraceptive pill, the implant and the hormonal IUD, can lead to changes in women's moods, including the onset of or worsened depression and anxiety. Hormonal contraceptives, such as the pill, are among the most widely used pharmaceutical products.
A team of researchers from Finland's University of Helsinki have now set out to verify previous reports that the use of hormonal contraceptives can be associated with higher rates of suicide. Recent studies have suggested there is a link between hormonal contraceptives and a higher risk of attempted suicides, prompting concerns about their safety.
However, according to data obtained from more than half a million Finnish women, the study found that rates of attempted suicide are actually lower in women using hormonal contraceptives, compared to women who are not - going against previous fears about contraception increasing the risk due to its impact on mood and mental health.
The researchers also found that rates of attempted suicide between users of hormonal contraceptives and non-users are similarly high in females aged 15 to 19 - in general, suicide rates are higher in younger women and decrease with age. The rates decreased in older age groups, with a greater drop in hormonal contraceptive users relative to non-users in the 20 to 24 and 25 to 29 age brackets.
In total, the researchers saw 474 cases of attempted suicide in women who did not use hormonal contraceptives, and 344 attempts in women who did. The research also found that women not using hormonal contraceptives may be at a greater risk of attempting suicide compared to active users, with the risk increasing by 37 percent.
The research was presented at the 2022 European Congress of Psychiatry, a conference organised by the largest association of psychiatrists in Europe and held virtually between June 4 and June 7. Describing the study, lead researcher Dr Elena Toffol from the University of Helsinki said the findings are "good news" for users of hormonal contraceptives.
"We set out to verify previous data, so this is not what we expected, and it's good news for contraceptive users."
She continued: "Women, especially younger women, have higher rates of depression and attempted suicide than men of similar ages. Many women using hormonal contraceptives, especially contraceptive pills, report mood changes as a side effect.
"Initial reports from 2018 and 2020 had indicated that use of hormonal contraceptives was associated with a higher number/risk of suicides and suicide attempts. We set out to confirm this data."
The researchers used several Finnish national databases to compare the rates of attempted suicide among users of hormonal contraceptives and non-users, based on data from the 2017-2019 period. They took results from 587,823 women, which represents around 50 percent of the total number of women in the 15 to 49 age group in Finland. Half of these women had used hormonal contraceptives, including pills, implants, patches and rings.
Dr Toffol continued: "The strength of this study is the large size, and that we broke the data down according to suicide attempts, psychiatric history, age and contraceptive use. We included a wider age range than the other studies, and importantly, we used a 'nested' study design, where we were able to pair each attempted suicide to four control subjects, which allows us see if contraceptive use in the previous six months was a factor in the attempt.
"After doing this, we found that women with no psychiatric history and using hormonal contraceptives, specifically those containing ethinylestradiol had a significantly reduced risk of attempting suicide than women not using any hormonal contraception."
The researchers' next step is to use data from the same population to examine the risk of depression associated with use of hormonal contraception.
"This interesting study focused on the complex relationship between hormonal contraception exposure and suicidal behaviour. Previous studies found a relationship between hormonal contraceptives use and higher risk of attempted suicide," added Professor Andrea Fiorillo, the Treasurer of the European Psychiatric Association and editor in chief of the journal European Psychiatry. He was not involved in the study and provided his commentary independently.
"The study by Toffol disconfirms this finding, showing that the rates of suicide attempts are actually lower in women using hormonal contraception.
"Of course, this striking finding deserves a careful evaluation and needs to be replicated in different cohorts of women and controlled for the impact of several psychosocial stressors, such as economic upheavals, social insecurity and uncertainty due to the COVID-19 pandemic.
"The clinical implications of the study are obvious and may help to destigmatise the use of hormonal contraceptives."
As the findings have been presented at the European Congress of Psychiatry, there is no paper and the work has yet to be peer-reviewed.