Factors predicting mood changes in oral contraceptive pill users

In order to promote women’s health universal access to reproductive health including using the correct methods of contraception is one of the Millennium Development Goals (MDGs) [1]. Oral contraceptive pills are one of the most common methods of contraception and over 100 million women are using oral contraceptives pills (OCP) worldwide [2]. Also there is evidence that more than 84% of women during their life use one of the hormonal methods in order to prevent pregnancy [3]. However, due to side effects almost 50% of new OCP users discontinue using the pills almost six to twelve months after the start. As such ‘mood changes’ and depression considered as being the primary reason for OCP discontinuation [4, 5].

Since the introduction of OCP in 1960, many studies have examined the extent to which oral contraceptive pills affected mood and depression. Nevertheless, the results of the research have been inconsistent and there has been little progress in identifying predictors or causes of OCP-related mood changes [6–8]. ‘Mood changes’ refer to one’s general emotional climate, and emotional state at a particular moment or at a particular day [9].

In Iran OCP is the most common method of pregnancy prevention and the prevalence of OCP use is estimated to be 25% [10]. Yet, ministry of health believes this should be increased or at least to be maintained at the current level [11]. Thus, at policy levels to recognize any barrier in using OCP is considered curtail. Ministry of health reports that almost 35% of users usually discontinue the pill after 12 months of start [12]. Perhaps similar to other societies Iranian women also discontinue using OCP due to side effects. The purpose of this study was to determine the prevalence of mood changes in pill users and identify factors that predict mood changes. It was hoped that the study might contribute to the existing literature and provide a framework for the future interventions.

The findings from this study indicated that the prevalence of reported mood changes due to OCP use among Iranian women appeared to be consistent with other studies. In addition the findings showed that receiving information on OCP side effects from health care workers and self-efficacy were important predicting factors for mood changes. The present study confirmed that most women who used oral pill faced several side effects. Women also reported that mood change was the most important side effects they have experienced during pill use. Unfortunately most warning notes on the pill packages do not address or acknowledge about mood changes adequately while this is an important issue for ensuring that women will continue to use pills in order to prevent at least unwanted pregnancies [16, 17]. In fact, discontinuity of oral contraceptive pills might jeopardize women’s health in general and reproductive health in particular [18, 19]. A study from the USA found that 33% of oral contraceptive pills users discontinued using pills 6 months after the start due its side effects and 33% of these side effects were emotional and behavioral [4]. Similarly a study from UK showed that the incidence of depression and mood changes among the pill users was about 30% [20]. Evidence from Iran suggest that barriers to use of OCP include health concerns, fear of side effects, misinformation, lack of confidence and sexual dissatisfaction [21, 22].

At least four explanations for OCP-related mood changes can be identified. A number of studies have explained some biochemical mechanisms for the effects of oral contraceptive pills on women’s mood changes. In fact they believed that the components of pills such as estrogen and progesterone might cause these behavioral changes [23–25]. A number of investigators believed that rumors and speech about side effects of the pills that generally is said by friends, neighbors and the warning notes on the pill packages would lead to this condition [26–28]. However, some researchers demonstrated that although oral contraceptive pills could cause mood changes, they believed that it will stabilize after while [9, 29, 30]. Finally, a group of investigators argue that oral contraceptive pills have no effects on mood change at all [31, 32].

Regardless of whatever the cause may be, the findings from the present study showed that there were significant association between mood changes and education on how to control side effects of pill, self-efficacy and place of living. Women who received education on how to control side effects of pill in family planning centers were more likely to report less mood changes compared to those who did not. In addition, women living in rural areas have reported lower mood changes in comparison with those who lived in urban environments. Perhaps since primary health care is more active in rural areas, women living in rural area receive more advice on oral pill use than women living in cities and metropolitans. Also women who had higher self-efficacy for using pill experienced less mood changes. Indeed women who had higher self-efficacy had more ability for controlling behavioral changes. Studies have suggested that identification of women who have low self-efficacy should be a priority and providers should promote self care ability and self-efficacy related to using OCP [15, 33, 34]. It is argued that people with low self-efficacy use avoidance coping strategies while people with high self efficacy use problem-focused coping strategies [35, 36].

The descriptive nature of this study might be considered as a limitation and the results should be interpreted with caution, although overall the findings from such studies might help to contribute to the topic. In addition, we relied on self-reported information while it seems that measuring mood changes need a valid and reliable instrument. Thus the findings should be interpreted with caution. Finally one should note that due to time constrain we chose a period of one month of OCP use as an inclusion criteria for this study and this may have been a limitation to our study results.