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Abstract
Objectives: Adverse mood changes are sometimes cited as a reason for discontinuing combined hormonal contraception (CHC). A systematic review of recent literature was undertaken to characterise the nature of these side effects and identify characteristics that might predispose women to such effects.
Methods: A MEDLINE review of studies from the past 30 years that focused on CHC and mood was performed. Database search was supplemented with studies found through citations and references.
Results: The research literature on this topic is limited by a lack of prospective studies, a variety of measurements of mood, and a consolidation of many disparate types of contraceptives studied together in a single cohort. Common themes that emerge from review of these papers include (1) most women using CHC demonstrate no effect or a beneficial effect on mood, with a low incidence of adverse effects; (2) contraceptives containing less androgenic progestins may have fewer adverse effects on mood; (3) continuous and perhaps non-oral dosing of CHC has the fewest mood effects; (4) women with underlying mood disorders may be predisposed to mood effects, but this may reflect factors related to choice of contraception rather than the mood disorder itself.
Conclusion: Inconsistent research methods and lack of uniform assessments make it difficult to make strong conclusions about which CHC users are at risk for adverse mood effects. Until more prospective data is available, clinicians should recognise that such effects are infrequent and CHC may be prescribed with confidence.
Chinese abstract
目的: 不良的情绪变化有时是患者停用复方性激素类避孕药(CHC)的理由之一, 该论文对最新研究进行系统综述及评估, 来判断CHC副作用的性质并总结易患体质的特点。
方法: 对过去30年来CHC对情绪相关影响的研究进行MEDLINE分析, 对于引文及参考文献进行数据库搜索加以补充。
结果: 有关该主题的研究文献缺乏前瞻性研究, 而且通过一个队列研究评估不同情绪量表的测定方法, 完全不具可比性的不同避孕药的研究文献也是限制该研究进行的因素之一。这些论文最常见的观点包括: (1)应用CHC的大多数妇女认为用药对情绪无明显影响或有积极影响, CHC副作用发生率很低; (2)具有雄激素样作用的孕激素含量更少的CHC对情绪的副作用发生率更低; (3)连续用药及非口服应用CHC发生副作用的几率最低; (4)潜在的具有情绪障碍的妇女应用CHC发生副作用的几率更高, 但这提示我们对于此类妇女, 应更慎重选择CHC的种类, 而非关注其情绪障碍本身。
结论: 由于研究方法的不统一以及评估方式的不一致性, 我们对于识别应用CHC可能发生情绪方面副作用的人群无法得出强有力的结论。直至更多前瞻性研究数据的诞生, 临床医生才会认为CHC对于情绪的负面作用是很少见的, 从而更有信心地为妇女开具此类药物。
Disclosure statement
The authors report no conflicts of interest.