OBJECTIVE To determine the impact of oral contraceptive (OC) induced mood lability/depression on treatment maintenance in women with endometriosis. DESIGN Women with endometriosis were retrospectively identified through International Classification of Diseases-10 codes and then a comprehensive electronic medical record review was conducted, identifying mood lability/depression as a reason for treatment discontinuation with the use of combined or progestin-only oral contraceptives. SUBJECTS 2,682 women with endometriosis, between the ages of 18-45 treated in a university affiliated hospital between 2012-2024. EXPOSURE Use of combined or progestin-only oral contraceptives in patients with endometriosis. MAIN OUTCOME MEASURES The primary outcome was oral contraceptive discontinuation due to mood lability/depression in women with endometriosis. The secondary outcome assessed whether patients with a documented diagnosis of depression were more prone to discontinuing OC use due to mood lability. RESULTS Mood lability/depression as a side effect of OC use was more common in women with endometriosis and increased the likelihood of discontinuing OCs. Overall, 44.2% of women with endometriosis and treated with OCs discontinued their use. The depression prevalence in our study cohort was 33.6%. Among those who discontinued, 33.9% attributed their discontinuation to mood lability/depression. Of those who discontinued OC use due to mood lability, 52.7% had a diagnosis of depression, a higher rate than those who discontinued OC use for other reasons or did not stop using OCs. There was no difference in OC discontinuation due to side effects comparing combination oral contraceptives to progestin-only oral contraceptives. Similarly, the type of progestin prescribed did not influence the OC discontinuation among those who experienced mood lability/depression. CONCLUSION Women with endometriosis had an increased incidence of depression and a greater likelihood of discontinuing OCs when they experienced mood lability or depression. Mood lability played a significant role in OC discontinuation. The effect of oral contraceptive on mood lability/depression did not differ by the type of progestin. In patients with endometriosis at risk of depression, or who develop mood changes on oral contraceptives, other therapies that are typically considered second line should be considered early in the course of treatment.

中文翻译：

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情绪不稳定和抑郁限制了子宫内膜异位症的口服避孕药治疗。


目的 确定口服避孕药 （OC） 诱导的情绪不稳定/抑郁对子宫内膜异位症女性治疗维持的影响。设计 通过国际疾病分类 10 代码回顾性识别子宫内膜异位症女性，然后进行全面的电子病历审查，确定情绪不稳定/抑郁是停止使用复方或纯孕激素口服避孕药治疗的原因。对象 2,682 年至 2012 年间，18 年至 45 岁之间在大学附属医院接受治疗的 2024 名子宫内膜异位症女性。暴露 子宫内膜异位症患者使用复方或纯孕激素口服避孕药。主要结局指标 主要结局是子宫内膜异位症女性因情绪不稳定/抑郁而停药口服避孕药。次要结局评估了有抑郁症诊断的患者是否更容易因情绪不稳定而停止使用 OC。结果 情绪不稳定/抑郁作为 OC 使用的副作用在子宫内膜异位症女性中更为常见，并增加了停用 OCs 的可能性。总体而言，44.2% 的子宫内膜异位症和接受 OC 治疗的女性停止使用。我们研究队列中的抑郁症患病率为 33.6%。在停药者中，33.9% 将停药归因于情绪不稳定/抑郁。在因情绪不稳定而停止使用 OC 的人中，52.7% 的人被诊断为抑郁症，高于因其他原因停止使用 OC 或未停止使用 OC 的人。与复方口服避孕药与仅含孕激素的口服避孕药相比，因副作用而停用口服避孕药的情况没有差异。 同样，开具的孕激素类型不会影响那些经历过情绪不稳定/抑郁的人的 OC 停药。结论 子宫内膜异位症女性在经历情绪不稳定或抑郁时抑郁的发生率增加，停用 OCs 的可能性更大。情绪不稳定在 OC 停药中起重要作用。口服避孕药对情绪不稳定/抑郁的影响不因孕激素的类型而异。对于有抑郁风险的子宫内膜异位症患者，或口服避孕药后出现情绪变化的患者，应在治疗过程的早期考虑其他通常被认为是二线治疗的疗法。