(791) Perceived Stress in Hormonal Contraceptive Users: A Dissociation Between Emotional and Biological Stress Markers

Introduction Despite widespread use, the influence of hormonal contraceptives on non-reproductive dimensions of health remains poorly characterised. Research suggests that combined oral contraceptives (COCs) may attenuate cortisol responses compared to naturally cycling (NC) women, whereas evidence regarding hormonal intrauterine devices (IUDs) is minimal. Given potential associations between hormonal contraception, stress regulation, and emotional processing, it is important to assess both subjective and biological stress responses. This can inform future research into the sexual health and well-being of individuals using hormonal contraceptives. Objective To compare cortisol reactivity and perceived psychological stress in naturally cycling (NC) women, COC users, and IUD users. Methods Seventy-eight individuals assigned female at birth (aged 18–30 years) participated: NC (n = 39), IUD (n = 20), and COC (n = 19). A standardised stress protocol (a sound stressor and an emotional video) was administered. Serum cortisol levels were measured at baseline, immediately after the stressor, and during recovery. Participants completed the State-Trait Anxiety Inventory – State (STAI-S) pre- and post-stressor. Linear mixed-effects models were used to examine group differences, with significance set at p < 0.05. Results Cortisol levels changed significantly over time across the sample (p = .042), confirming successful stress induction. No significant group × time interaction was detected for cortisol (p = .240), although visual inspection suggested possible group trends. For STAI-S, a significant interaction between time and contraceptive group emerged (p = .025). Baseline STAI-S did not differ between groups, but IUD users reported a significant post-stressor increase (p = .012), and COC users showed a similar tendency (p = .062). Conclusions Hormonal contraceptive use, particularly of IUDs, was associated with increased perceived psychological stress following a stressor, despite no detectable differences in cortisol reactivity. These findings suggest a dissociation between subjective and biological stress responses and underscore the need for further investigation into stress-related health effects of hormonal contraception, including the potential impact on sexual health and wellbeing. Disclosure No