MOOD lability and depression are significant factors contributing to oral contraceptive (OC) discontinuation in women with endometriosis, especially among those with pre-existing depression. This study highlights the need for tailored treatment approaches for endometriosis in women at risk of mood disturbances.
Endometriosis is a chronic condition often treated with hormonal therapies, including combined or progestin-only OCs. However, mood lability and depression are known side effects of OC use, which may impact treatment adherence. This retrospective study reviewed 2,682 women aged 18–45 diagnosed with endometriosis at a university-affiliated hospital between 2012 and 2024. Mood lability and depression were evaluated as reasons for OC discontinuation, with additional analysis examining the influence of pre-existing depression on treatment outcomes.
Of the women prescribed OCs, 44.2% discontinued treatment, with 33.9% citing mood lability or depression as the reason. Pre-existing depression, present in 33.6% of the cohort, significantly increased the likelihood of discontinuation due to mood-related side effects; 52.7% of those who stopped OCs for mood lability had a documented diagnosis of depression. There was no difference in discontinuation rates between combined and progestin-only OCs, nor did the type of progestin influence the likelihood of mood-related side effects. These findings underscore the high prevalence of mood lability and its impact on OC adherence in this population.
The study suggests that women with endometriosis are particularly vulnerable to mood disturbances associated with OC use, especially those with pre-existing depression. Since discontinuation of OCs can compromise symptom management, clinicians should carefully evaluate the mental health of patients before initiating hormonal therapy. Early identification of mood changes and the use of alternative therapies, such as GnRH agonists, intrauterine devices, or non-hormonal options, may be more effective for patients at higher risk of depression. Integrating mental health support into endometriosis care could also improve treatment adherence and outcomes. Future research should explore personalised strategies for managing endometriosis in women with mood sensitivity to hormonal treatments.
Abigail Craig, EMJ
Reference
Cevik EC et al. Mood lability and depression limit oral contraceptive therapy in endometriosis. Fertil Steril. 2024; DOI:10.1016/j.fertnstert.2024.12.011.
