Does Seasonique Cause Depression and Lower FSH/LH Levels?
Seasonique (ethinyl estradiol/levonorgestrel) does suppress FSH and LH levels as its primary mechanism of action, but the evidence linking combined oral contraceptives to depression is insufficient to establish a clear causal relationship.
Suppression of FSH and LH
Combined oral contraceptives like Seasonique reliably suppress gonadotropin secretion—this is how they prevent pregnancy. 1, 2
Seasonique works by inhibiting gonadotropin-releasing hormone (GnRH), which subsequently suppresses both follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This prevents ovulation by blocking the normal hormonal cascade needed for follicular development and egg release. 1, 2
Multiple studies demonstrate that ethinyl estradiol/levonorgestrel combinations significantly depress serum FSH and LH levels, particularly by day 20 of the treatment cycle. 3, 4, 5
Research specifically on low-dose triphasic preparations containing ethinyl estradiol and levonorgestrel shows significant suppression of both gonadotropins, with LH and FSH levels markedly reduced during treatment. 3, 4
The suppression is intentional and therapeutic—it's the mechanism that prevents ovulation and provides contraceptive efficacy. 2, 6
Studies show that FSH and LH suppression is time-dependent and may vary individually, with some women showing considerable follicular activity despite treatment (36% in one study), though contraceptive efficacy remains high. 3
Important Clinical Context
This is NOT hypogonadism or pathologic hormone deficiency. While Seasonique suppresses endogenous estradiol production from the ovaries, it simultaneously provides exogenous synthetic estrogen (ethinyl estradiol) that maintains adequate estrogenic effects throughout the body. 2
The synthetic ethinyl estradiol is significantly more potent than natural estradiol and provides sufficient estrogenic activity to maintain bone health, cardiovascular function, and other estrogen-dependent processes despite lower serum estradiol levels. 2
After discontinuation, normal ovarian function typically resumes, with ovulatory patterns reestablished in most women within one cycle. 6
Depression and Combined Oral Contraceptives
The current evidence does NOT establish a clear causal link between combined oral contraceptives and depression, though this remains an area requiring further investigation.
No high-quality guidelines or studies in the provided evidence directly address depression as a side effect of Seasonique or similar combined oral contraceptives containing ethinyl estradiol and levonorgestrel.
The safety profile of extended-regimen oral contraceptives like Seasonique (which contains 30 mcg ethinyl estradiol/150 mcg levonorgestrel for 84 days followed by 10 mcg ethinyl estradiol for 7 days) shows the regimen is "safe and well tolerated," though specific psychiatric adverse effects were not detailed in the efficacy trials. 7
Clinical Considerations
If a patient reports new-onset or worsening depression while taking Seasonique, this warrants clinical attention and consideration of alternative contraceptive methods. Individual responses to hormonal contraceptives vary considerably.
Progestin-only contraceptives may have different effects than combined preparations, though the evidence provided does not specifically address depression risk with either formulation. 1
Women with pre-existing mood disorders or depression history should be monitored when initiating any hormonal contraceptive, though definitive evidence-based guidance on this specific scenario is lacking in the provided literature.