Contraception: satisfaction with the method, effects on sleep and psychological well-being

Toffol, Elena; Partonen, Timo; Heikinheimo, Oskari; Suhonen, Satu

doi:10.1136/bmjsrh-2018-200107

Cited by 2 publications

(5 citation statements)

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“…They used a double-blind placebo-controlled setup and showed that the contraceptive pill, but not placebo, had significant negative effects on sleep and depression in the treatment group. Toffol et al (2019) showed that symptoms of insomnia are more likely after starting hormonal contraceptives (after controlling for whether the contraceptive method was short term, like the pill, or long term, like an IUD or implant). They also found an increase in odds for self-harm, with 6 out of 68 women (9%) reporting self-harm behavior after starting hormonal contraception, while none of the women in the other groups reported self-harm.…”

Section: Hormone Intervention Resultsmentioning

confidence: 99%

“…Two out of the three administration studies showed indications that not all women, but a subgroup of women may be vulnerable to these effects. Toffol et al (2019) found that women who showed self-harm behavior after starting hormonal contraceptives all reported negative psychological symptoms before starting the hormonal contraceptives. only included women who had previously experienced depressive symptoms while using hormonal contraceptives, and found that, even in a placebo-controlled setup, women who were provided hormonal contraceptives experienced significant depressive mood and disturbed sleep.…”

Section: Discussionmentioning

confidence: 99%

“…The quality of the included studies was reasonably good; five studies were deemed of fair quality and eight studies were deemed to be of good quality (National Institutes of Health, 2014, full quality assessment form available in Appendix 8.2). Three out of the thirteen studies assessed effects of a sex hormone intervention Toffol et al, 2019) and eleven out of thirteen studies assessed associations with endogenous sex hormone levels (Antonijevic et al, 2003;Baker et al, 2012;de Zambotti et al, 2015;Freeman et al, 2004;Kische et al, 2016;Kravitz et al, 2005;Lee et al, 2000;Li et al, 2015;Shechter et al, 2012). Three of the studies included a patient group next to the control group, this group being either a group of depressed patients or women suffering from premenstrual dysphoric disorder (PMDD).…”

Section: Designs and Quality Of The Included Studiesmentioning

confidence: 99%

“…Two studies assessed depressive symptoms with MDD diagnoses (Antonijevic et al, 2003;Freeman et al, 2004), while nine studies used validated questionnaires for depressive symptoms (Baker et al, 2012;Bartz et al, 2010;de Zambotti et al, 2015;Freeman et al, 2004;Lee et al, 2000;Shechter et al, 2012;Toffol et al, 2019) and six used non-validated question sets or questionnaires for depression Kische et al, 2016;Kravitz et al, 2005;Lee et al, 2000;Li et al, 2015). A number of studies also combined both daily ratings of mood and clinical depression questionnaires (Baker et al, 2012;Lee et al, 2000).…”

Section: Measurement Of Depression and Sleepmentioning

confidence: 99%

“…A number of studies also combined both daily ratings of mood and clinical depression questionnaires (Baker et al, 2012;Lee et al, 2000). Six studies assessed sleep with EEG/PSG (Antonijevic et al, 2003;Baker et al, 2012;de Zambotti et al, 2015;Kische et al, 2016;Shechter et al, 2012), one study used actigraphy (Lee et al, 2000), five studies used validated sleep questionnaires (Baker et al, 2012;de Zambotti et al, 2015;Freeman et al, 2004;Kische et al, 2016) and six studies used sleep items from other questionnaires Kravitz et al, 2005;Lee et al, 2000;Li et al, 2015;Toffol et al, 2019). A number of studies combined different methods of sleep assessment (Baker et al, 2012;de Zambotti et al, 2015;Kische et al, 2016;Lee et al, 2000).…”

Section: Measurement Of Depression and Sleepmentioning

confidence: 99%

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Waves of Change: Sex Hormones, Depression and Sleep

Morssinkhof

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Depression is twice as common in women compared to men, and the risk of insomnia is 1.5 times higher in women than in men during the reproductive age. It has been suggested that sex hormones, including estrogen, testosterone and progesterone, may partly explain this difference in prevalence. Changes in these hormones may possibly contribute to more depressive symptoms and more insomnia. One way to examine the effects of sex hormones on depression and sleep is to investigate situations where individuals start taking exogenous hormonal medications. Therefore, this study aimed to examine the effects of oral contraceptives (OCs) and the effects of gender-affirming hormone therapy (GAHT). We examined whether the use of OCs and GAHT affected depressive symptoms, sleep quality, sleep architecture and chronotype. The main research questions in this thesis were: 1. Are OC use and GAHT use associated with changes in depression? 2. Are OC use and GAHT use associated with changes in sleep? 3. What are the effects of sex hormones on the association between depression and sleep? 1. Sex hormones and depression Our findings show that OC use could be associated with increases in depressive symptoms and increased risk of depression, but that there might be strong individual differences in the effects of OCs on mood. Our findings in transgender people who start GAHT suggest that masculinizing and feminizing sex hormones have different effects on depressive symptoms, although it must be noted that we find only small to modest changes. 2. Sex hormones and sleep We find that use of OCs could possibly have very small effects on sleep, and that this could be related to the day-night rhythm of the hormone cortisol. In our studies on GAHT, we see that transgender people on masculinizing GAHT show no clinically significant changes in insomnia or sleep quality, but they show shorter slow wave (deep) sleep and slightly longer and earlier REM (dream) sleep after starting GAHT, as well as a later chronotype. After starting feminizing GAHT, transgender people show a shorter subjective sleep onset latency, no changes in sleep architecture and an earlier chronotype. 3. Sex hormones, depression and sleep Results from our systematic review and our studies on OCs and GAHT do not provide substantive support for the hypothesis that sex hormones affect the relationship between depression and sleep. The research results in this thesis show that changes in sex hormones can lead to small changes in depressive symptoms that are in line with prevalence differences in the population: feminizing hormones, including OAC and GAHT, can lead to modest increases in depressive symptoms and masculinizing GAHT can lead to modest decreases in depression symptoms. The effects of sex hormones on subjective sleep vary, and GAHT was found to have strongest effects on sleep architecture and chronotype. The hypothesis that sex hormones cause poor sleep, which would then lead to increases in depressive symptoms, was not supported by our findings. For future studies on mood, I emphasize the importance of examining short-term changes in mood, since changes in daily moods and mood variability have been described after sex hormone changes. For future studies on sleep, I recommend to further study the role of previous and current sex hormone status (i.e., OC use, menopause status) on sleep architecture and chronotype. Lastly, I advocate for the inclusion of sex and sex hormones in psychiatric research and in clinical practice, to provide knowledge and techniques for prevention, early detection and treatment of sex hormone-related problems in sleep and mood.

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Section: Hormone Intervention Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%