"Recently, researchers have documented negative effects on mood and psychological well-being as a consequence of HC use in women (Bancroft, Sanders, Warner, and Loudon, 1987; Herzberg and Coppen, 1970; Kahn and Halbreich, 2001; Kurshan and Epperson, 2006; Oinonen and Mazmanian, 2002). DeSoto, Geary, Hoard, Sheldon, and Cooper (2003) found that women using HCs exhibited more symptoms of borderline personality disorder (BPD), a disorder characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image (Lieb, Zanarini, Schmahl, Linehan, and Bohus, 2004), and that women with high pre-existing levels of BPD symptoms became significantly worse after starting HC use (DeSoto et al., 2003). Sanders, Graham, Bass, and Bancroft (2001) found that negative changes in emotional and sexual well-being were important predictors of discontinuation of oral contraceptives (see also Graham, Ramos, Bancroft, Maglaya, and Farley, 1995; Rosenberg and Waugh, 1998; Rosenberg, Waugh, and Meehan, 1995), although HC users report experiencing less variability in affect across the menstrual cycle and less negative affect during menstruation (Oinonen and Mazmanian, 2002). While women low in social anxiety are more likely to use oral contraceptives (Leary and Dobbins, 1983), HC users describe higher rates of depression (e.g., Kulkarni, 2007) than normally cycling women. On the other hand, pair-bonded (but not single) women report lower levels of intrasexual competition when using HCs as compared to when they are regularly cycling (Cobey, Klipping, and Buunk, 2013). Oral contraceptive-using women also showed significantly attenuated cortisol responses to stressors compared to controls (Roche, King, Cohoon, and Lovallo, 2013), with peak cortisol levels only slightly elevated above baseline levels (Kirschbaum, Pirke, and Hellhammer, 1995). Therefore, HC use appears to interfere with the adrenocortical response to psychological stress by influencing the amount of bioavailable unbound cortiso l (see also Kirschbaum, Kudielka, Gaab, Schommer, and Hellhammer, 1999), although reports of affective responses to identical stressor tasks do not differ as a function of HC use (Marinari, Leshner, and Doyle, 1976). Furthermore, Egarter, Topcuoglu, Imhof, and Huber (1999) found that a low-dose oral contraceptive actually improved patients’ perceptions of their own quality of life (see also Caruso et al., 2011; Ernst, Baumgartner, Bauer, and Janssen, 2002), highlighting the need for further research."