Psychological side effects are a frequent reason for discontinuation of hormonal contraception (HC), yet women with pre-existing mental health (MH) conditions are often excluded from studies despite their prevalence and needs.
To examine the effects of HC used for pregnancy prevention on anxiety and mood (affective) symptoms in women with established MH disorders.
MEDLINE, Embase and Cochrane CENTRAL were systematically searched for English-language studies published between 2015 and 2025. Randomised controlled trials, cohort and cross-sectional studies evaluating any HC type in women with clinically diagnosed or self-reported anxiety or mood (affective) disorders were included. Studies assessing HC for therapeutic indications were excluded. Screening and data extraction followed Cochrane Rapid Review guidance. Due to heterogeneity in study designs and outcomes, findings were narratively synthesised by contraceptive type and population (adult, adolescent, postpartum).
Ten studies met inclusion criteria. HC use did not consistently worsen anxiety or mood symptoms in women with pre-existing MH disorders. Combined oral contraceptives (COCs) showed largely neutral effects, with some studies reporting increased mood symptoms, while progestogen-only methods and levonorgestrel intrauterine devices were associated with stable or improved symptoms. Negative associations were less pronounced in women with existing disorders than in those without prior MH conditions.
HC appears generally safe for women with established anxiety or mood (affective) disorders. Symptoms were largely stable or modestly improved, with adverse effects reported more often with COCs, particularly among adolescents and first-time users. Individualised contraceptive counselling is recommended.