Oral contraceptive (OC) intake has been linked to reduced emotion recognition, particularly for negative emotions, though cross-sectional findings are inconclusive. Differences in the androgenicity of OC formulations may partly explain these inconsistencies. This study examined the association of OC initiation or discontinuation on facial emotion recognition in women.

A total of 133 healthy young women completed the Vienna Emotion Recognition Test (VERT-K), which measures accuracy and response time of recognition of basic emotional expressions. Most participants (n = 115) completed the test twice and five groups were analyzed based on hormonal states: early follicular, peri-ovulatory, and active OC intake (control groups measured during the same hormonal phase twice), as well as OC discontinuation and initiation (before and after OC status transition).

Generalized linear mixed models revealed no significant changes in emotion recognition linked to OC initiation or discontinuation. Women in the early follicular phase and those discontinuing OCs were less accurate in recognizing neutral expressions compared to continuous OC users. Cross-sectional analysis showed no significant differences in emotion recognition between androgenic and antiandrogenic OC users. Exploratory correlation analyses suggest that changes in synthetic hormone levels may relate to emotion recognition performance, particularly improved anger recognition following OC discontinuation.

This first repeated-session study investigating OC status transitions could not replicate cross-sectional findings of impaired emotion recognition with OC use. However, given the importance of emotion recognition for social functioning and mental health, better powered longitudinal studies are essential to clarify mixed results and further investigate the potential associations between OCs and emotional processing.