Hormonal Contraceptive Use and Acute Stress Reactivity: Examining Autonomic Responses and Affective States in Young Women

Emerging adulthood is marked by significant stressful events and life transitions that may increase vulnerability to distress. Young women in particular report higher stress levels compared to men, and sex hormones could be involved. Hormone level fluctuations at this critical age, may be especially sensitive to hormonal contraceptive (HC) manipulation, leading to altered stress reactivity. Thus, the current study examined stress, affective states and autonomic stress responses among naturally-cycling women, combined estrogen-progestin users and progestin-only users following an acute stressor. Young women (N=126) completed baseline questionnaires assessing mood and stress scores. Participants were randomly assigned to a stressor task (n=57) or a control task (n=69), after which mood dimensions were assessed. Heart rate was monitored via smartwatch at six timepoints across the study. Interestingly, interactions between time, HC type, and task condition for heart rate were trending towards significance (p=0.06), with HC users showing elevated heart rate during the stressor compared to naturally-cycling women over time. Progestin-only users in the stressor group displayed increased feelings of sadness (p=0.03), anger (p<0.001), and fear (p=0.008), compared to controls (an effect not found for combined users or naturally-cycling women), whereas feelings of shame (p<0.001) were elevated among all women in the stressor group compared to the control group. Together, HC use and type of contraceptive may be associated with exaggerated physiological stress reactivity and negative mood states. These findings provide insights into the effects of HCs on stress processes, supporting more evidence-based decision making in young women considering HCs.