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The danger of misinformation is that it can deny complete contraception counseling to patients being treated for mental health issues.
Although the use of contraception in reproductive-aged patients with mental health concerns has been proven safe for the most part, there are still myths in circulation asserting its potential negative impact. The danger of this misinformation is that it can deny complete contraception counseling to patients treated for mental health issues who could have adverse events from an unintended pregnancy or would need comprehensive counseling before choosing to become pregnant.
To address these challenges to optimal care, Hayley Miller, MD, and colleagues developed a review that addressed the incidence of mental health conditions among reproductive-aged people. This included an examination of typical adverse reproductive outcomes, an overview of the hormonal profile of contraception and its relationship with psychiatric outcomes, and expanded information for practitioners providing contraceptive counseling for this population.
The researchers also examined the importance of considering polypharmacy when prescribing hormonal contraception, the considerations of potential patient adherence, and the patient’s postpartum status. Current Opinions in Obstetrics and Gynecology published the findings of this review and the resulting clinical guidance.
Dr. Miller spoke with Physician’s Weekly (PW) regarding applying the clinical guidance from this review.
PW: Why did you feel this topic needed exploration and the development of clinical guidance?
Dr. Miller: Mental health conditions are among the most common medical conditions affecting reproductive-aged people in the United States. It is important for healthcare providers who care for those with mental health conditions to understand contraceptive counseling and care to optimize mental health conditions prior to pregnancy or to avoid unintended pregnancies. There is a need for mental healthcare that is currently unmet in the United States, and clinicians need to understand the full scope of contraceptive options, effectiveness, and safety when caring for reproductive-aged women with mental health conditions.
What are the most important findings from your review?
This review serves to inform clinicians on the epidemiology of reproductive health outcomes among those with mental health conditions, review the effects of hormonal contraception on mental health, and provide contraceptive counseling considerations among specific mental health conditions. Overall, the available evidence demonstrates that hormonal contraceptives are safe to use among those with mental health conditions and those who are using specific antidepressants. Special considerations are needed for people who may be at risk of poor adherence; who use certain classes of antidepressants, antipsychotics, and antiepileptics; and who are less than 6 weeks postpartum.
How can providers incorporate these guidelines into practice?
I encourage clinicians who provide care to reproductive-age people to become familiar with the US Medical Eligibility Criteria. This is a document to guide providers on safe contraceptive use among those with medical comorbidities and those who use specific medications. I encourage clinicians to use available resources to provide full-scope reproductive health care and to understand that those with mental health conditions are particularly vulnerable to adverse reproductive health outcomes, and it is of utmost importance to prioritize full-scope care to these patients.
