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To the Editor: Dr Stewart and colleagues¹ review and discuss recommendations for examining women at risk for health complications during the use of hormonal contraceptives. The list of eligibility for use of progestin-only contraceptives, adapted from the World Health Organization (WHO) as well as the authors' discussion of such contraceptives, fails to consider the presence of a mood disorder as a need for caution or special monitoring. However, progestin-only implants have been associated with an increased incidence of depressive symptoms in postpartum women.²

The omission of depression as a consideration in choosing a contraceptive method is potentially disastrous. Major depression is more common in women than in men, occurring in 10% to 20% of women during their lifetimes.³ The effects of depression may be severe, impairing a woman's social and occupational functioning. If a woman is a mother, her depression may have serious effects on her children, including long-term behavioral . . . [Full Text of this Article]

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RELATED ARTICLE

Clinical Breast and Pelvic Examination Requirements for Hormonal Contraception: Current Practice vs Evidence
Felicia H. Stewart, Cynthia C. Harper, Charlotte E. Ellertson, David A. Grimes, George F. Sawaya, and James Trussell
JAMA. 2001;285(17):2232-2239.
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