Bengtsdotter Hanna, Lundin Cecilia, Gemzell Danielsson Kristina, Bixo Marie, Baumgart Juliane, Marions Lena, Brynhildsen Jan, Malmborg Agota, Lindh Ingela, Sundström Poromaa Inger
a Department of Obstetrics and Gynaecology , Örebro University , Örebro , Sweden.
b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.
Eur J Contracept Reprod Health Care. 2018 Feb;23(1):45-51. doi: 10.1080/13625187.2017.1422239. Epub 2018 Jan 11.
Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders.
This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5 mg estradiol and 2.5 mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle.
Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP Δ-scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3-2.3). In contrast, among women without mental health problems, no difference in total DRSP Δ-scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP Δ-scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0-3.2).
Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.
既往研究强调，患有既往存在的情绪障碍的女性更倾向于停止使用激素避孕方法。然而，很少有研究探讨复方口服避孕药（COC）对既往或正在患精神障碍的女性情绪的影响。
这是一项由研究者发起的双盲随机临床试验的补充分析，在此试验中，202名女性在三个治疗周期中分别接受COC（1.5毫克雌二醇和2.5毫克诺孕酯）或安慰剂治疗。使用迷你国际神经精神访谈收集有关既往或正在患精神障碍的信息。主要结局指标是治疗周期月经间期问题严重程度每日记录（DRSP）量表上五种情绪症状的总变化得分。
与随机分配至安慰剂组的相应女性相比，分配至COC组的患有正在发作或既往发作的情绪、焦虑或饮食障碍的女性在治疗周期月经间期的DRSP总Δ得分更高，平均差值为1.3（95%CI 0.3 - 2.3）。相比之下，在没有心理健康问题的女性中，未观察到COC使用者和安慰剂使用者之间的DRSP总Δ得分有差异。随机分配至COC组的有酒精滥用风险的女性的DRSP总Δ得分高于随机分配至安慰剂组的女性，平均差值为2.1（95%CI 1.0 - 3.2）。
患有正在发作或既往发作的精神障碍或有酒精滥用风险的女性出现COC诱发情绪症状的风险更高。在计划生育和避孕咨询过程中，这一点可能值得注意。
