Hormonal contraception and the brain: Examining cognition and psychiatric disorders

Background: The combined oral contraceptive pill (OC), containing synthetic estrogensand progestins, is used by millions of women worldwide, yet little is known about its effects oncognition or on psychiatric disorders. The progestin component of OCs determines their androgenicity,i.e. whether the OC has androgen binding components with masculinising effects or antiandrogeniccomponents with feminising effects.Objective: The present review discusses the literature surrounding OC use and cognition in healthywomen. Given the important role that sex hormones play in psychiatric disorders, we also considerthe influence of OCs on symptoms of schizophrenia, post-traumatic stress disorder, depression,bipolar disorder, anxiety disorders and indirectly, sleep quality.Results: Research has shown that while there are no differences between OC users and non-users,androgenic OCs enhance visuospatial ability and anti-androgenic OCs enhance verbal fluency. Littleis known about OCs effects on other cognitive domains, such as memory and executive function.There is little research examining OC use in schizophrenia, post-traumatic stress disorder, bipolardisorder and anxiety disorders. There is some evidence that OC use is associated with depression,however the exact causality of this association remains to be verified.Conclusion: We maintain that future studies need to address several methodological limitations,such as separating OCs based on androgenicity to avoid the masking effects that occur when variousOCs are considered as one group. As this review highlights several significant effects of OC use onthe brain, the implications of OC use needs to be considered in future research