From the Research
Estrogen Dose and Mood in COCP
- The relationship between estrogen dose in Combined Oral Contraceptive Pills (COCP) and mood is complex, with studies showing both positive and negative effects 1.
- A study published in 2017 found that COCP use was associated with small, but statistically significant, increases in mean anxiety, irritability, and mood swings scores during the intermenstrual phase, but a significant premenstrual improvement in depression 1.
- However, the study also found that the proportion of women who reported a clinically relevant mood deterioration did not differ between those allocated to COCP and those allocated to placebo 1.
Comparison of Estrogen Doses
- A review of 13 COC pairs found no differences in contraceptive effectiveness, but COCs containing 20 μg EE resulted in higher rates of early trial discontinuation and bleeding disturbances compared to higher-estrogen pills 2.
- Another study found that the risk of myocardial infarction or ischemic stroke seemed to increase with higher doses of estrogen, with the risk being highest for pills with > 50 microgram estrogen 3.
- A study published in 2015 recommended prescribing a pill with the lowest effective dose of oestrogen and progestogen, with pills containing levonorgestrel or norethisterone in combination with ethinyloestradiol 35 microgram or less considered first-line 4.
Adverse Effects and Risks
- The risks and adverse effects of COCPs are generally considered to be low, with the main effects being on the cardiovascular system, lipid and glucose metabolism, and cancer 5.
- Adverse effects such as nausea and breast tenderness can be managed by changing the estrogen dose or the type of progestogen 5.
- The clinical benefits of COCPs are thought to outweigh the risks and adverse effects, but individual women may experience different effects depending on their specific circumstances and health status 5.