The widespread use of hormonal contraceptives, including both combined and progestin-only pills, raises concerns regarding their impact on mental health and brain function. Hormonal therapies significantly affect neurotransmission, with estrogen promoting cognitive functions such as memory and arousal, while progesterone and its metabolites such as allopregnanolone (ALLO) modulate mood and anxiety. These neurosteroids fluctuate throughout a woman’s life, with ALLO levels varying throughout the menstrual cycle and contributing to mood stability, particularly during the luteal phase. However, by altering neurosteroid production, exogenous hormonal contraceptives can cause adverse mood changes, including depression, which is a common reason for discontinuation. Several studies have highlighted the association between hormonal contraceptive use and an increased risk of depression, with adolescents being particularly vulnerable. For example, the use of combined oral contraceptives and progestin-only pills has been associated with higher rates of antidepressant prescriptions and suicide attempts. In addition, progesterone receptors and their distribution in the brain have been implicated in mood disorders, and research suggests that certain progestins, such as chlormadinone acetate (CMA), may have mood-stabilizing effects by increasing ALLO levels and modulating the GABAergic and opioidergic systems. Furthermore, different synthetic progestins have different effects on mood regulation, with some, such as CMA, showing clinical benefits in relieving symptoms of premenstrual dysphoric disorder. This variability underscores the importance of considering the specific hormonal composition of contraceptives when prescribing them, as individual responses may differ. Personalized contraceptive counselling, taking into account pharmacological and psychological factors, is crucial for optimizing both reproductive and mental health outcomes in women. Further research is needed to better understand the neurobiological mechanisms involved and to ensure that women can make informed choices about their contraceptive options.