SUMMARY Hormonal contraception is known to precipitate or perpetuate depression in some patients. The link between oral contraceptive pills and depression relates to the amount and type of progestogen contained in these pills. Many of the older oral contraceptive pills, which contain ethinylestradiol, are linked to severe mood problems. Newer oral contraceptive pills containing physiological forms of oestrogen may be better tolerated with a purported weaker link to mood problems. Clinicians should consider the temporal relationship between the use of hormonal contraception and development of new or worsened depression or mood changes.

Fluctuations of sex hormones across the menstrual cycle have been linked to exacerbation of symptoms of psychiatric disorders. Women diagnosed with trauma-related disorders such as post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD) have reported worsening of mood symptoms at various phases of their menstrual cycle. There is also considerable overlap between PTSD, BPD, and complex-PTSD (cPTSD) symptoms, suggesting similar biological underpinnings. This mini-review examines the influence of sex hormones and the menstrual cycle on PTSD, BPD, and cPTSD symptoms, and discusses the involvement of the hypothalamic-pituitary-adrenal (HPA) axis. We review literature showing that PTSD and BPD symptoms fluctuate with the menstrual cycle, though the effect of the menstrual cycle phase appears to be inconsistent, warranting future research. Based on the reported phasic vulnerability in individuals with PTSD and BPD, it is plausible to assume that women diagnosed with the newly introduced cPTSD may experience similar difficulties. However, no study to date has addressed this. This review highlights the importance of considering an individual's trauma history as it may influence symptom severity and diagnosis, and the phase of the menstrual cycle at the time of diagnosis. This review also highlights that additional work is needed to clarify the influence of estradiol and progesterone fluctuations on trauma-related symptoms, especially in cPTSD. Continued research on menstrual cycle vulnerability and trauma will lead to better informed management and treatment of PTSD, BPD, and cPTSD.

The magnocellular system has been implicated in the rapid processing of facial emotions, such as fear. Of the various anatomical possibilities, the retino-colliculo-pulvinar route to the amygdala is currently favored. However, it is not clear whether and when amygdala arousal activates the primary visual cortex (V1). Non-linear visual evoked potentials provide a well-accepted technique for examining temporal processing in the magnocellular and parvocellular pathways in the visual cortex. Here, we investigated the relationship between facial emotion processing and the separable magnocellular (K2.1) and parvocellular (K2.2) components of the second-order non-linear multifocal visual evoked potential responses recorded from the occipital scalp (O Z). Stimuli comprised pseudorandom brightening/darkening of fearful, happy, neutral faces (or no face) with surround patches decorrelated from the central face-bearing patch. For the central patch, the spatial contrast of the faces was 30% while the modulation of the per-pixel brightening/darkening was uniformly 10% or 70%. From 14 neurotypical young adults, we found a significant interaction between emotion and contrast in the magnocellularly driven K2.1 peak amplitudes, with greater K2.1 amplitudes for fearful (vs. happy) faces at 70% temporal contrast condition. Taken together, our findings suggest that facial emotional information is present in early V1 processing as conveyed by the M pathway, and more activated for fearful as opposed to happy and neutral faces. An explanation is offered in terms of the contest between feedback and response gain modulation models.