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Use of systemic hormonal contraception and risk of attempted suicide

Background. Evidence regarding the role of hormonal contraception (HC) as a risk factor for attempted suicide (AS) is inconclusive. The aim was to assess the associations of use of different types of systemic hormonal contraceptives with the risk of AS in women aged 15-49 years. Methods. Data were retrieved from national registers in Finland. The AS incidence in 2018-2019 was assessed in a population-based cohort of women (n=587,823) according to their HC use in 2017. To examine the risk of AS related to HC use in the six months preceding the suicide attempt (i.e. current use), we used a nested case-control design with 1:4 ratio (n=4090), and applied multivariable conditional logistic regression models. Results. During the follow-up 1.174,346 million person-years were cumulated and 818 AS cases observed (incidence rate=0.70, 95% CI=0.63-0.83 per 1000 person-years). The incidence rate ratio of HC (n=344 cases) vs. no-HC (n=474 cases) was 0.73 (95% CI=0.63-0.83). Use of HC, and specifically of combined hormonal contraceptives was associated with a lower AS risk compared to non-use when controlling for marital status, socioeconomic status, education, chronic diseases and recent delivery (OR=0.55, 95% CI=0.42-0.73), but not when further adjusting for recent psychiatric hospitalizations and current use of psychotropic medications (OR=0.68, 95% CI=0.45-1.02). Current use of progestogen-only preparations was not associated with AS. Conclusions. HC use appeared not associated with an increased AS risk in fertile-aged women. The choice of the best and safest contraceptive option should take individual mental health status, including assessment of suicidal risk, into account.