Contraception for women with psychiatric disorders

Leanne R. McCloskey, Katherine L. Wisner, Minaz Kolia Cattan, Hannah K. Betcher, Catherine S. Stika, Jessica W. Kiley

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

Objective: Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartumperiod. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations,Medical EligibilityCriteria for Contraceptive Use, provided the structurefor reviewof contraceptivechoices. Methods: A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives. Results: The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with lowfailure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions. Conclusions: Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.

Original languageEnglish (US)
Pages (from-to)247-255
Number of pages9
JournalAmerican Journal of Psychiatry
Volume178
Issue number3
DOIs
StatePublished - Mar 1 2021

Funding

received limited training about prescribing contraceptives for patients with severe and persistent mental illness (51). By specialty, 30.6% of the residents were from family medicine, 18.1% from obstetrics/gynecology, 10.8% from internal medicine, and from 10.4% psychiatry; 30.1% did not indicate a specialty. The majority of residents (60%) disagreed or strongly disagreed that they had received such training. A newly available resource, the National Curriculum in Reproductive Psychiatry, which is free and funded by the American Board of Psychiatry and Neurology (http://ncrptraining.org/), is available to address this information gap. Comprehensive training is also available through the Family Planning National Training Center (http://www.ctcfp.org/category/contraception/), funded by the Department of Health and Human Services Office of Population Affairs.

ASJC Scopus subject areas

  • Psychiatry and Mental health

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