Editing Progestogen (medication) (section)

===Mood changes===

====Birth control====
The available evidence on the risk of [[mood (psychology)|mood]] changes and [[depression (mood)|depression]] with progestogens in [[hormonal birth control]] is limited.<ref name="pmid27636867">{{cite journal | vauthors = Schaffir J, Worly BL, Gur TL | title = Combined hormonal contraception and its effects on mood: a critical review | journal = Eur J Contracept Reprod Health Care | volume = 21 | issue = 5 | pages = 347–55 | date = October 2016 | pmid = 27636867 | doi = 10.1080/13625187.2016.1217327 | s2cid = 11959163}}</ref><ref name="pmid22467147">{{cite journal | vauthors = Böttcher B, Radenbach K, Wildt L, Hinney B | title = Hormonal contraception and depression: a survey of the present state of knowledge | journal = Arch. Gynecol. Obstet. | volume = 286 | issue = 1 | pages = 231–6 | date = July 2012 | pmid = 22467147 | doi = 10.1007/s00404-012-2298-2 | s2cid = 26204975}}</ref> As of 2019, there is no consistent evidence for adverse effects on mood of hormonal birth control, including [[progestogen-only birth control]] and [[combined birth control]], in the general population.<ref name="pmid31172309">{{cite journal | vauthors = Robakis T, Williams KE, Nutkiewicz L, Rasgon NL | title = Hormonal Contraceptives and Mood: Review of the Literature and Implications for Future Research | journal = Curr Psychiatry Rep | volume = 21 | issue = 7 | page = 57 | date = June 2019 | pmid = 31172309 | doi = 10.1007/s11920-019-1034-z | s2cid = 174818119}}</ref><ref name="pmid29496297" /> Most women taking [[combined birth control]] experience no influence or a beneficial effect on mood.<ref name="pmid27636867" /><ref name="pmid29496297" /><ref name="pmid22467147" /> Adverse effects on mood appear to be infrequent, occurring only in a small percentage of women.<ref name="pmid27636867" /><ref name="pmid29496297" /><ref name="pmid22467147" /> About 5 to 10% of women experience negative mood changes with combined birth control pills, and about 5% of women discontinue birth control pills due to such changes.<ref name="pmid22136510">{{cite journal | vauthors = Poromaa IS, Segebladh B | title = Adverse mood symptoms with oral contraceptives | journal = Acta Obstet Gynecol Scand | volume = 91 | issue = 4 | pages = 420–7 | date = April 2012 | pmid = 22136510 | doi = 10.1111/j.1600-0412.2011.01333.x | s2cid = 43671664| doi-access = free }}</ref><ref name="pmid27636867" /> A study of about 4,000&nbsp;women found that progestogen-only birth control with [[depot effect|depot]] [[medroxyprogesterone acetate]] had an incidence of depression of 1.5% and discontinuation due to depression of 0.5%.<ref name="pmid29496297" /><ref name="pmid18470526">{{cite journal | vauthors = Bakry S, Merhi ZO, Scalise TJ, Mahmoud MS, Fadiel A, Naftolin F | title = Depot-medroxyprogesterone acetate: an update | journal = Arch. Gynecol. Obstet. | volume = 278 | issue = 1 | pages = 1–12 | date = July 2008 | pmid = 18470526 | doi = 10.1007/s00404-007-0497-z | s2cid = 11340062}}</ref><ref name="pmid9649914">{{cite journal | vauthors = Westhoff C, Truman C, Kalmuss D, Cushman L, Davidson A, Rulin M, Heartwell S | title = Depressive symptoms and Depo-Provera | journal = Contraception | volume = 57 | issue = 4 | pages = 237–40 | date = April 1998 | pmid = 9649914 | doi = 10.1016/s0010-7824(98)00024-9| doi-access = free }}</ref> Beneficial effects of hormonal birth control such as decreased [[menstrual pain]] and [[menstrual bleeding|bleeding]] may positively influence mood.<ref name="pmid27636867" />

A 2018 [[systematic review]] of 26&nbsp;studies, including 5&nbsp;[[randomized controlled trial]]s and 21&nbsp;[[observational study|observational studies]], found that the overall evidence showed no association between [[progestogen-only birth control]] and depression.<ref name="pmid29496297">{{cite journal | vauthors = Worly BL, Gur TL, Schaffir J | title = The relationship between progestin hormonal contraception and depression: a systematic review | journal = Contraception | volume = 97 | issue = 6 | pages = 478–489 | date = June 2018 | pmid = 29496297 | doi = 10.1016/j.contraception.2018.01.010| s2cid = 3644828 }}</ref> The progestins assessed included depot [[medroxyprogesterone acetate]], [[levonorgestrel]]-containing [[contraceptive implant]]s and [[hormonal IUDs|intrauterine device]]s, and [[progestogen-only birth control pill]]s.<ref name="pmid29496297" /> Findings of large observational studies are mixed due to prominent [[confounding factor]]s, but overall show no association of hormonal birth control with depression.<ref name="pmid31172309" /><ref name="pmid29496297" /> Randomized controlled trials typically do not find clinically significant influences of hormonal birth control on mood.<ref name="pmid31172309" /><ref name="pmid29496297" /> [[Literature review|Reviews]] from before 1980 reported a high incidence of adverse mood effects with combined birth control pills.<ref name="pmid27636867" /> However, doses of estrogens and progestogens in birth control pills before 1980 were considerably higher than those used today, and these doses frequently caused unpleasant side effects that may have unfavorably influenced mood.<ref name="pmid27636867" /><ref name="pmid11585017">{{cite journal | vauthors = Kahn LS, Halbreich U | title = Oral contraceptives and mood | journal = Expert Opin Pharmacother | volume = 2 | issue = 9 | pages = 1367–82 | date = September 2001 | pmid = 11585017 | doi = 10.1517/14656566.2.9.1367 | s2cid = 45061663}}</ref>

Mood with birth control pills may be better with monophasic and continuous formulations than with triphasic and cyclic formulations.<ref name="pmid27636867" /><ref name="pmid22136510" /> Limited and inconsistent evidence supports differences in mood with hormonal birth control using different doses of ethinylestradiol or different [[route of administration|routes of administration]], such as birth control pills versus [[contraceptive vaginal ring]]s and [[contraceptive patch]]es.<ref name="pmid27636867" /><ref name="pmid22136510" /> Combined birth control with less [[androgenic]] or [[antiandrogen]]ic progestins like [[desogestrel]], [[gestodene]], and [[drospirenone]] may have a more favorable influence on mood than birth control with more androgenic progestins like [[levonorgestrel]].<ref name="pmid27636867" /><ref name="pmid22136510" /> However, [[androgen]] supplementation with hormonal birth control has also been reported to improve mood.<ref name="pmid27636867" />

Hormonal birth control that suppresses [[ovulation]] is effective in the treatment of [[premenstrual dysphoric disorder]] (PMDD).<ref name="pmid31172309" /><ref name="pmid31078196">{{cite journal | vauthors = Lanza di Scalea T, Pearlstein T | title = Premenstrual Dysphoric Disorder | journal = The Medical Clinics of North America | volume = 103 | issue = 4 | pages = 613–628 | date = July 2019 | pmid = 31078196 | doi = 10.1016/j.mcna.2019.02.007 | s2cid = 153307984 }}</ref> Combined birth control pills containing [[drospirenone]] are approved for the treatment of PMDD and may be particularly beneficial due to the [[antimineralocorticoid]] activity of drospirenone.<ref name="pmid31172309" /><ref>{{cite journal | vauthors = Ma S, Song SJ | title = Oral contraceptives containing drospirenone for premenstrual syndrome | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 6 | pages = CD006586 | date = June 2023 | pmid = 37365881 | pmc = 10289136 | doi = 10.1002/14651858.CD006586.pub5 }}</ref><ref name="pmid29137347">{{cite journal | vauthors = Regidor PA, Schindler AE | title = Antiandrogenic and antimineralocorticoid health benefits of COC containing newer progestogens: dienogest and drospirenone | journal = Oncotarget | volume = 8 | issue = 47 | pages = 83334–83342 | date = October 2017 | pmid = 29137347 | pmc = 5669973 | doi = 10.18632/oncotarget.19833 }}</ref> Studies on the influence of hormonal birth control on mood in women with existing [[mood disorder]]s or [[polycystic ovary syndrome]] are limited and mixed.<ref name="pmid31172309" /><ref name="pmid27636867" /> Women with underlying mood disorders may be more likely to experience mood changes with hormonal birth control.<ref name="pmid27636867" /><ref name="pmid31172309" /><ref name="pmid31701260">{{cite journal | vauthors = Lewis CA, Kimmig AS, Zsido RG, Jank A, Derntl B, Sacher J | title = Effects of Hormonal Contraceptives on Mood: A Focus on Emotion Recognition and Reactivity, Reward Processing, and Stress Response | journal = Current Psychiatry Reports | volume = 21 | issue = 11 | pages = 115 | date = November 2019 | pmid = 31701260 | pmc = 6838021 | doi = 10.1007/s11920-019-1095-z }}</ref> A 2016 systematic review found based on limited evidence from 6&nbsp;studies that hormonal birth control, including combined birth control pills, depot medroxyprogesterone acetate, and levonorgestrel-containing intrauterine devices, was not associated with worse outcomes compared to non-use in women with [[depressive disorder|depressive]] or [[bipolar disorder]]s.<ref name="pmid27364100">{{cite journal | vauthors = Pagano HP, Zapata LB, Berry-Bibee EN, Nanda K, Curtis KM | title = Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review | journal = Contraception | volume = 94 | issue = 6 | pages = 641–649 | date = December 2016 | pmid = 27364100 | doi = 10.1016/j.contraception.2016.06.012 | pmc = 10994544 }}</ref> A 2008 [[Cochrane (organization)|Cochrane]] review found a greater likelihood of [[postpartum depression]] in women given [[norethisterone enanthate]] as a form of [[progestogen-only injectable birth control]], and recommended caution on the use of progestogen-only birth control in the [[postpartum]] period.<ref name="pmid18843619">{{cite journal | vauthors = Dennis CL, Ross LE, Herxheimer A | title = Oestrogens and progestins for preventing and treating postpartum depression | journal = The Cochrane Database of Systematic Reviews | volume = 2008 | issue = 4 | pages = CD001690 | date = October 2008 | pmid = 18843619 | pmc = 7061327 | doi = 10.1002/14651858.CD001690.pub2 }}</ref>

Studies suggest a [[negativity bias]] in [[emotion recognition]] and [[emotionality|reactivity]] with hormonal birth control.<ref name="pmid31701260" /> Some data suggests blunted [[reward system|reward]] responses and potential dysregulation of the [[stress response]] with hormonal birth control in some women.<ref name="pmid31701260" /><ref name="pmid31172309" />

====Hormone therapy====
Estrogen therapy appears to have a beneficial influence on mood in [[depression (mood)|depressed]] and [[euthymia (medicine)|euthymic]] [[perimenopausal]] women.<ref name="pmid30182804">{{cite journal | vauthors = Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN | title = Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations | journal = J Womens Health (Larchmt) | volume = 28 | issue = 2 | pages = 117–134 | date = February 2019 | pmid = 30182804 | doi = 10.1089/jwh.2018.27099.mensocrec | doi-access = free}}</ref><ref name="pmid31740049">{{cite journal | vauthors = Stute P, Spyropoulou A, Karageorgiou V, Cano A, Bitzer J, Ceausu I, Chedraui P, Durmusoglu F, Erkkola R, Goulis DG, Lindén Hirschberg A, Kiesel L, Lopes P, Pines A, Rees M, van Trotsenburg M, Zervas I, Lambrinoudaki I | title = Management of depressive symptoms in peri- and postmenopausal women: EMAS position statement | journal = Maturitas | volume = 131 | pages = 91–101 | date = January 2020 | pmid = 31740049 | doi = 10.1016/j.maturitas.2019.11.002 | doi-access = free}}</ref><ref name="pmid31581598">{{cite journal | vauthors = Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, Meriggiola MC | title = Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy | journal =  Medicina| volume = 55 | issue = 10 | page = 668| date = October 2019 | pmid = 31581598 | pmc = 6843314 | doi = 10.3390/medicina55100668| doi-access = free }}</ref> Conversely, research on combined estrogen and progestogen therapy for depressive symptoms in menopausal women is scarce and inconclusive.<ref name="pmid30182804" /><ref name="pmid31740049" /> Some researchers contend that progestogens have an adverse influence on mood and reduce the benefits of estrogens on mood,<ref name="pmid25203891">{{cite journal | vauthors = Toffol E, Heikinheimo O, Partonen T | title = Hormone therapy and mood in perimenopausal and postmenopausal women: a narrative review | journal = Menopause | volume = 22 | issue = 5 | pages = 564–78 | date = May 2015 | pmid = 25203891 | doi = 10.1097/GME.0000000000000323 | s2cid = 5830652}}</ref><ref name="pmid9203229">{{cite journal | vauthors = Zweifel JE, O'Brien WH | title = A meta-analysis of the effect of hormone replacement therapy upon depressed mood | journal = Psychoneuroendocrinology | volume = 22 | issue = 3 | pages = 189–212 | date = April 1997 | pmid = 9203229 | doi = 10.1016/s0306-4530(96)00034-0 | s2cid = 44630030}}</ref><ref name="pmid15358281">{{cite journal | vauthors = Wiegratz I, Kuhl H | title = Progestogen therapies: differences in clinical effects? | journal = Trends Endocrinol. Metab. | volume = 15 | issue = 6 | pages = 277–85 | date = August 2004 | pmid = 15358281 | doi = 10.1016/j.tem.2004.06.006 | s2cid = 35891204}}</ref> whereas other researchers maintain that progestogens have no adverse influence on mood.<ref name="Lobo2007">{{cite book|author=Rogerio A. Lobo|title=Treatment of the Postmenopausal Woman: Basic and Clinical Aspects|url=https://books.google.com/books?id=gywV9hkcyOMC&pg=PA211|date=5 June 2007|publisher=Elsevier|isbn=978-0-08-055309-2|pages=211–}}</ref><ref name="pmid25308388">{{cite journal | vauthors = Gordon JL, Girdler SS | title = Hormone replacement therapy in the treatment of perimenopausal depression | journal = Curr Psychiatry Rep | volume = 16 | issue = 12 | page = 517 | date = December 2014 | pmid = 25308388 | doi = 10.1007/s11920-014-0517-1 | s2cid = 23794180}}</ref> Progesterone differs from progestins in terms of effects in the [[brain]] and might have different effects on mood in comparison.<ref name="pmid15358281" /><ref name="pmid24680649">{{cite journal | vauthors = Fischer B, Gleason C, Asthana S | title = Effects of hormone therapy on cognition and mood | journal = Fertil. Steril. | volume = 101 | issue = 4 | pages = 898–904 | date = April 2014 | pmid = 24680649 | pmc = 4330961 | doi = 10.1016/j.fertnstert.2014.02.025}}</ref><ref name="pmid16112947t" /> The available evidence, although limited, suggests no adverse influence of progesterone on mood when used in menopausal hormone therapy.<ref name="pmid29962247">{{cite journal | vauthors = Prior JC | title = Progesterone for treatment of symptomatic menopausal women | journal = Climacteric | volume = 21 | issue = 4 | pages = 358–365 | date = August 2018 | pmid = 29962247 | doi = 10.1080/13697137.2018.1472567 | doi-access = free}}</ref>