Rate of suicide attempts lower among women using hormonal contraception
Click Here to Manage Email Alerts
Women using hormonal contraceptives had a lower incidence rate of attempted suicides compared with women who did not use hormonal contraceptives, according to data presented at the European Congress of Psychiatry.
These data contradict findings from other studies that reported an increased risk for attempted or completed suicide in women using hormonal contraceptives, according to lead researcher Elena Toffol, MD, PhD, a postdoctoral researcher at the University of Helsinki Department of Public Health.
“Based on the results of our study, carried out in a large representative population and by using two different designs” — observational and nested case-control — “we are confident enough to reassure young women that using hormonal contraception does not increase the risk of attempted suicide,” Toffol told Healio.
Toffol and colleagues analyzed the hormonal contraceptive information of 587,823 women aged 15 to 49 years included in four Finnish databases in 2017. They then examined the incidence of suicide attempts from 2018 to 2019 and matched attempted suicide cases by age to controls.
Risk for attempted suicide
During 2018 and 2019, there were 818 attempted suicides (incidence rate [IR] = 0.7 per 1,000 person-years; 95% CI, 0.65-0.75), with suicide attempts being less common among hormonal contraceptive users vs. nonusers (IR ratio = 0.73; 95% CI, 0.63-0.83).
Adjusting for marital status, socioeconomic status, education, chronic diseases and recent delivery, women currently using hormonal contraceptives had lower odds of attempting suicide compared with women who had not used hormonal contraception in the last 6 months (OR = 0.71; 95% CI, 0.56-0.9). This association was not significant when further adjusting for recent psychiatric hospitalization and current psychotropic medication use, Toffol said.
Association between attempted suicide, psychiatric history
Women without a psychiatric history who were using hormonal contraceptives had lower odds of attempted suicide compared with women not using hormonal contraception (OR = 0.73; 95% CI, 0.58-0.91). Toffol emphasized that among women with a previous psychiatric history, hormonal contraception use was not associated with suicide attempts.
Additionally, in women with no psychiatric history, the researchers found that the risk for suicide attempts was lower in women currently using hormonal contraceptives containing ethinylestradiol compared with those not using hormonal contraceptives (OR = 0.54; 95% CI, 0.4-0.73). There was no association between estradiol-containing contraceptives and attempted suicide, according to Toffol.
Of note, Toffol said that the risk for attempted suicide with hormonal IUDs needs further study.
“However, because it acts mainly locally, and only minute concentrations of hormone are released in the bloodstream, we can assume that it does not have a large effect on mood and suicidal risk,” Toffol told Healio.
Other research is needed to “to clarify the relationship between hormonal contraception and mental health outcomes, and possible underlying mechanisms,” Toffol said. “Our group is currently working at examining the relationship between the use of hormonal contraception and other mental health outcomes (eg, depression, sleep disorders, etc).”
References:
- Toffol E, et al. Use of hormonal contraception and attempted suicide: A nested case-control study. Presented at: European Congress of Psychiatry; June 4-7, 2022 (virtual meeting).
- New study shows fewer suicide attempts in women using hormonal contraceptives. https://www.eurekalert.org/news-releases/954699. Published June 6, 2022. Accessed June 9, 2022.
Perspective
Back to Top
Dr. Toffol's study used Finnish databases to compare rates of suicide attempt in women aged 15 to 49 years using estrogen-containing hormonal contraception with those not using these methods. They defined "current use" broadly, as any prescription fill within 180 days of the suicide attempt. This study is interesting because it found a reduced risk for suicide attempt in this population, the opposite of prior studies. Like all large database studies — including the other studies we have on hormonal contraception and suicide attempt — associations can be calculated, but cause and effect cannot be determined. This shows us that we have more research to do in this field. I look forward to reading Dr. Toffol's full methods and to future studies conducted in other populations.
Collapse
Toffol E, et al. Use of hormonal contraception and attempted suicide: A nested case-control study. Presented at: European Congress of Psychiatry; June 4-7, 2022 (virtual meeting).
Read more about
Click Here to Manage Email Alerts