To the Editor Skovlund and colleagues1 make a valuable contribution to the debate regarding the safety and adverse effects of hormonal contraceptives. However, their analysis did not include outcomes for patients who had received nonhormonal contraceptives such as the copper coil. Without including this method of contraception in their analysis, we cannot assume that the differences seen were due to exogenous hormones. Even with adjustment for multiple demographic and clinical factors, the differences seen may still be due to unidentified patient-related factors rather than treatment with hormonal contraception. A direct comparison between users of the levonorgestrel intrauterine system (which the authors suggested has systemic effects) and the nonhormonal intrauterine device would provide much-needed reassurance for clinicians and patients. Considering the potential influence of this research on the behavior of millions of women, can this oversight be ignored?
Chesney E. Hormonal Contraception and Its Association With Depression. JAMA Psychiatry. 2017;74(3):302. doi:10.1001/jamapsychiatry.2016.3703
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