OC, depressive and insomnia symptoms in adult women with and without depression 45 1. Introduction Use of oral contraceptives (OC), commonly called “the pill”, is a method of birth control used by many women. It is currently the most popular form of contraception in Europe, North America and Australia with user rates in reproductive aged women between 35% and 63% (United Nations, 2019). OC works through administration of exogenous sex steroids, most commonly a combination of synthetic estradiol and progesterone (e.g. combined oral contraceptives), which suppress ovulation, thus preventing pregnancy and regulating the menstrual cycle. The potential deleterious effects of OC use have gained much attention. Among reported adverse mental health effects are depressive symptoms and, to a lesser extent, sleep problems (Bezerra et al., 2020; Hall et al., 2012). Although some women may experience negative mood symptoms while using OC (Skovlund et al., 2016), most women seem unaffected (Schaffir et al., 2016). Studies on the association between OC use and depression have shown mixed results. Skovlund et al. (2016) report that first use of OC is associated with a higher risk for a first clinical diagnosis of depression, as well as with a higher risk of first use of an antidepressant. However, most prospective studies have not shown a significant worsening in depressive symptoms in women using OC (as reviewed by Schaffir et al., 2016 and Worly et al., 2018). There are indications that variables such as young age (De Wit et al., 2020; Skovlund et al., 2016), composition of OC (Skovlund et al., 2016), but also previous experience of mood deterioration during OC use (Engman et al., 2018; Gingnell et al., 2013), may modify the risk of experiencing depressive symptoms during OC use. However, it is not yet clear whether a history of depression makes women more vulnerable for possible negative effects of current OC use such as depressive symptoms or insomnia. This information is important to enable well-informed choices on OC use. Up till now, few studies explored the relationship between OC use and adverse mood states in women with a previous or current depressive disorder. In a randomized controlled trial, women with previous or current psychiatric disorders (anxiety, depressive and eating disorders, n=59) were more likely to report adverse mood during use of combined OCs compared to placebo, although only six women in this sample had a current depressive disorder (Bengtsdotter et al., 2018). Further studies showed that women
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