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. Author manuscript; available in PMC: 2016 Jun 1.
Published in final edited form as: Am J Obstet Gynecol. 2014 Dec 12;212(6):740–746. doi: 10.1016/j.ajog.2014.12.010

Table 2.

Considerations for Contraceptive Method Options for Women with Depression and Anxiety

CONTRACEPTIVE METHODS
Long-acting reversible contraceptives
copper-containing intrauterine device (IUD), levonorgestrel IUD, subdermal implants		 Progestin-only contraceptives
Depot medroxyprogesterone acetate injectable (DMPA), progestin-only pills (POPs)		 Combined hormonal contraceptives
combined oral contraceptives (COCs), vaginal ring, transdermal patch
1. Adherence concerns ++ DMPA +
POPs +/−		 +/−
2. Mood side effect concerns ++ + +
3. Menstrual irregularity concerns Copper IUD ++
Levonorgestrel IUD +/−
Implant +/−		 DMPA+
POPs +/−		 ++
4. Postpartum depression and breast feedinga Copper IUD ++
Levonorgestrel IUD +
Implant +		 + +/−
5. Perimenopausal depression + + If no contraindications to estrogen:
COCs ++
Ring/Patch +
6. Premenstrual dysphoric disorder (PMDD) + + COCs with Drospirenone ++
Ring/Patch +
7. Medical comorbidities (cardiovascular risks, age >35 years and a smoker, other estrogen contraindications) Copper IUD ++
Levonorgestrel IUD +
Implant +		 DMPA +
POPs +		 −
8. Modern antidepressants use (SSRIs or SNRIs) + + +
9. Older generation antidepressant use (TCAs, MAOIs, St. John’s wort); mood stabilizer/ anti-epileptic use Copper IUD ++
Levonorgestrel +
Implant −		 DMPA +
POPs −		 −
10. Intimate partner violence ++ DMPA ++
POP +/−		 +/−

Adapted with permission from Hall, Steinberg and Marcus. In Cwiak and Allen (Eds), Contraception for the Medically Challenging Patient. Springer, 2014.

IUD = intrauterine device; DMPA = depot medroxyprogesterone acetate; POPs = progestin-only pills; COCs = combined oral contraceptives; TCAs = tricyclic antidepressants; MAOIs = monoamine oxidase inhibitors; SSRI = selective serotonin reuptake inhibitors; SNRI = serotonin norepinephrine reuptake inhibitors.

++ indicates highly acceptable; first line option; + indicates acceptable option; +/− indicates acceptable but not optimal option; − indicates unacceptable option.

a

Combined oral contraceptives are acceptable (CDC category 2) after the first postpartum month among women who are breastfeeding.