Chapter 1 24 OC research to distinguish prospective from cross-sectional studies and to assess whether studies include new users or long-term users. It is not clear whether women who are known with previous depressions are more at risk for mood-related side effects during OC use, since most studies on OCs and mood have excluded participants with a history of psychiatric illnesses. In reproductive-age women, 24% to 32% have or have had a depressive disorder (Ten Have et al., 2023), but it is still largely unknown whether they are at increased risk of experiencing mood-related side effects during OC use. 3.2. Gender-affirming hormone therapy and depression Transgender persons show a high prevalence of depression, especially transgender persons who desire to use GAHT but who have not yet started GAHT use: estimates show between 42% and 48% of transgender persons reports clinically significant depressive symptoms at the start of GAHT use (Aldridge et al., 2021; Colizzi et al., 2014). Studies on GAHT and depression generally show improvements in depressive symptoms after GAHT use, although findings also differ between studies (Doyle et al., 2023). Despite significant work in this topic, knowledge of changes in specific depression symptomatology (e.g. prevalence of specific symptoms or groups of symptoms) after the start of GAHT use is still lacking. 3.3. Oral contraceptives and sleep Studies on OC use and sleep are scarce, and findings on the effects of oral contraceptives and sleep are mixed. In the domain of subjective sleep, Bezerra et al. (2020) found that OC users reported more insomnia symptoms and a prospective pre-post study reported that participants reported poorer sleep after starting OC use (Albuquerque et al., 2015), but a meta-analysis assessing sleep quality, summarizing four studies, did not find significant differences between OC users and non-users (Bezerra et al., 2023). Individual studies also found effects of oral contraceptive use on sleep architecture, but the aforementioned meta-analysis found no consistently significant differences in seven studies, most of which were cross-sectional (Bezerra et al., 2023). Only one study examined OCs and chronotype and found no associations between OCs and chronotype (Toffol et al., 2013).
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