Mood lability and depression limit oral contraceptive therapy in endometriosis.

Objective: To determine the impact of oral contraceptive (OC) induced mood lability/depression on treatment maintenance in women with endometriosis.

Design: Women with endometriosis were retrospectively identified through International Classification of Diseases-10 codes and then a comprehensive electronic medical record review was conducted, identifying mood lability/depression as a reason for treatment discontinuation with the use of combined or progestin-only oral contraceptives.

Subjects: 2,682 women with endometriosis, between the ages of 18-45 treated in a university affiliated hospital between 2012-2024.

Exposure: Use of combined or progestin-only oral contraceptives in patients with endometriosis.

Main outcome measures: The primary outcome was oral contraceptive discontinuation due to mood lability/depression in women with endometriosis. The secondary outcome assessed whether patients with a documented diagnosis of depression were more prone to discontinuing OC use due to mood lability.

Results: Mood lability/depression as a side effect of OC use was more common in women with endometriosis and increased the likelihood of discontinuing OCs. Overall, 44.2% of women with endometriosis and treated with OCs discontinued their use. The depression prevalence in our study cohort was 33.6%. Among those who discontinued, 33.9% attributed their discontinuation to mood lability/depression. Of those who discontinued OC use due to mood lability, 52.7% had a diagnosis of depression, a higher rate than those who discontinued OC use for other reasons or did not stop using OCs. There was no difference in OC discontinuation due to side effects comparing combination oral contraceptives to progestin-only oral contraceptives. Similarly, the type of progestin prescribed did not influence the OC discontinuation among those who experienced mood lability/depression.

Conclusion: Women with endometriosis had an increased incidence of depression and a greater likelihood of discontinuing OCs when they experienced mood lability or depression. Mood lability played a significant role in OC discontinuation. The effect of oral contraceptive on mood lability/depression did not differ by the type of progestin. In patients with endometriosis at risk of depression, or who develop mood changes on oral contraceptives, other therapies that are typically considered second line should be considered early in the course of treatment.