Acute Aggression After Progesterone Discontinuation in a Young Female

Background: Although cyclical changes in progesterone activity have been linked with various psychiatric symptoms, such as anxiety, mood, and premenstrual dysphoria, less is known about the effects of contraceptive use of progesterone and behavioral aggression. Case Presentation: We report a case of a 23-year old hospitalized African female diagnosed with complex post-traumatic stress disorder (PTSD), bipolarity and history of alcohol use disorder, who developed significant behavioral aggression within a short time of removing her progestin (progesterone) implant. The association between abrupt behavioral deterioration and discontinuation of the contraceptive implant was further supported by resolution of patient’s aggression after 3 days of starting a long-acting progesterone contraceptive, medroxyprogesterone acetate, instead of the progestin implant to prevent non-adherence. This, to our knowledge, is the first case to document relationship between discontinuation of a progesterone contraceptive and aggressive behavior in a patient with significant trauma and psychiatric history. Discussion: & Conclusion: This may be the first documented case of behavioral aggression in a young African female after removal of a progesterone implant followed by resolution of aggression after initiating a long acting progesterone injection. Although several studies, mostly in animals, have shown a link between progesterone levels and aggression, there are no reports of aggression concerning contraceptive use of progesterone. Such aggression may be rare in healthy subjects but may be more common in a psychiatrically vulnerable patient with significant trauma history.