In Reply In their letter, Karina and Sivakumaran express concern that menarche may confound the findings in our article published in JAMA Psychiatry.1 In Denmark, the average age of menarche is 12 to 13 years. As all the women who entered our study were 15 years or older, it is unlikely that age at menarche would have influenced our results. We made an additional analysis restricted to women entering the study at age 15 years and who had never used hormonal contraception; therefore, those with early menarche and subsequent use of hormonal contraception were excluded. The risk estimates were even stronger in this analysis.
Wessel Skovlund C, Mørch LS, Lidegaard Ø. Hormonal Contraception and Its Association With Depression—Reply. JAMA Psychiatry. 2017;74(3):302–303. doi:10.1001/jamapsychiatry.2016.3865
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