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Combined oral contraceptives (COCs) are widely recommended for the treatment of women with PMOS, potentially reducing stress related to managing PMOS symptoms and improving body image. However, concerns exist regarding a potential association between COC use and depression. Given these conflicting effects, the present study aimed to evaluate the relationship of COCs on depression and its associated factors in Thai women with PMOS, compared with non-COC users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comparative cross-sectional study was conducted among 96 participants (48 COC users and 48 non-COC users) diagnosed with PMOS using the Rotterdam criteria. Depression was assessed using the Thai version of the Patient Health Questionnaire-9 (PHQ-9). Group comparisons of depression prevalence were analysed using the chi-square test. Predictive factors and interaction analyses were performed using multivariable and Firth\u2019s logistic regression, expressed as odds ratios (ORs) and 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of depression was 37.50% of COC users and 35.42% of non-COC users, with no statistically significant association observed (p-value\u2009=\u20090.832). COC use was not associated with depression. Low testosterone levels were the crucial variables associated with depression among women with PMOS (OR 4.38, 95% CI: 1.45\u201313.28;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009), remaining significant after adjustment for age (OR 5.98, 95% CI: 1.83\u201319.52;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). These associations did not affect the interaction of COC use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Depression is highly prevalent among women with PMOS, with prevalence similar between COC users and non-users. Routine screening is recommended for early detection and timely management, regardless of the treatment approach or COC use. Low testosterone levels may be associated with depression in women with PMOS. However, the findings should be interpreted with caution owing to limited statistical power. Larger prospective studies are required to clarify the association between COC use, androgen imbalance, and depression in women with PMOS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12905-026-04641-6","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T22:56:00Z","timestamp":1783032960000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between combined oral contraceptive pills and depression in women with polyendocrine metabolic ovarian syndrome (formerly polycystic ovary syndrome): a comparative cross-sectional study"],"prefix":"10.1186","volume":"26","author":[{"given":"Purikorn","family":"Prommani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areepan","family":"Sophonsritsuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratana","family":"Saipanish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makaramas","family":"Anantaburana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5456-6021","authenticated-orcid":false,"given":"Siriluk","family":"Tantanavipas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"issue":"10","key":"4641_CR1","doi-asserted-by":"publisher","first-page":"2447","DOI":"10.1210\/clinem\/dgad463","volume":"108","author":"HJ Teede","year":"2023","unstructured":"Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. 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