Oral contraceptives in the central nervous system: Basic pharmacology, methodological considerations, and current state of the field

•The basic pharmacology of oral contraceptives (OCs) is reviewed.•Reviews early and recent findings on OCs and cognitive function.•Reviews early and recent findings on OCs and depressive affect.•Archival data suggest greater dysphoria among OCs containing recent progestins or low estrogen.•Avenues for future work on the CNS effects of OCs are suggested. Millions of women around the world use combined oral contraceptives (OCs), yet surprisingly little is known about their central nervous system (CNS) effects. This article provides a short overview of the basic pharmacology of OCs, emphasizing features that may be relevant to understanding their effects in the CNS. Historical and recent findings from studies of cognitive function, mood, and negative affect (depressive changes under OC use) are then reviewed. We also present data from an archival dataset from our own laboratory in which we explore dysphoric changes in women using four generations of contraceptive progestins. Current data in the field are consistent with a modest effect of OC use on CNS variables, but conclusions based on current findings must be made very cautiously because of multiple methodological issues in many published studies to date, and inconsistencies in the findings. Directions for future research over the next 10 years are suggested. (150 words)