Ever since 2002 when several large-scale studies called into question the safety of long-term hormone replacement therapy (HRT), there has been confusion and conflicting opinions regarding the management of menopausal symptoms. Initially there was a movement to avoid HRT altogether; now it is becoming clearer that certain women may safely use and benefit from hormonal interventions.
More than half of all women initiating treatment with hormone therapy will stop within the first year of treatment, most often because of side effects. Mood disturbance is a relatively common side effect that occurs with hormone therapy, and previous studies have suggested that progestins in the combined hormone preparations are responsible for these negative mood effects.
While phytoestrogens have gained attention as possible alternatives to hormone therapy for the treatment of menopausal symptoms, placebo-controlled studies have yielded mixed results. Pomegranate seed oil is a very rich source of phytoestrogens. In this prospective randomized, placebo-controlled, double-blinded trial, 81 postmenopausal women received two daily doses of either 30 mg pomegranate seed oil (PGS) or placebo. The frequency of hot flashes decreased by 38.7% (P < 0.001) after 12 weeks of treatment with pomegranate seed oil and by 25.6% in the placebo group (P < 0.01). However, the difference between the two groups was not statistically significant (P = 0.17). The authors suggest that it may take a longer period of observation to demonstrate a difference between pomegranate seed oil and placebo.
The FDA will require Yaz, Yasmin and several other newer oral contraceptives to carry new warning labels that detail the potential risk of venous thromboembolism (VTE or blood clots). All oral contraceptives increase the risk of blood clots; however, recent studies have suggested that birth control pills containing drospirenone, a synthetic form of the hormone progesterone, may carry a slightly increased risk of VTE, compared with older birth control pills. The FDA estimates that over a one year period, 10 in 10,000 women taking an oral contraceptive with drospirenone would develop a blood clot , as compared to about 6 in 10,000 women taking older contraceptives.
Menstrual irregularity is a common side effect of antipsychotic treatment in women, occurring more commonly in those treated with risperidone and the older antipsychotic medications. New research presented at the APA earlier this month indicated that the addition of metformin at 500 mg bid resolved menstrual irregularities in most women treated with antipsychotic medications. (Metformin is a medication used alone or with other medications, including insulin, to treat type 2 diabetes.) In addition, women receiving metformin lost an average 2.4 kg of weight after 6 months of treatment.
Menstrual problems are common among premenopausal women and become more frequent with increasing reproductive age, especially just before and during perimenopause. In the Study of Women's Health Across the Nation, a multisite study of menopause and aging, information regarding menstrual history was collected in a total of 934 premenopausal and early perimenopausal women between the ages of 42 and 52. History of major depression was associated with an increased likelihood of heavy bleeding (odds ratio, 1.89), adjusting for recent major depression, menopause status, and other confounding factors. History of depression was not associated with other abnormal bleeding or premenstrual symptoms. Future longitudinal studies are needed to explore why past depression increases the likelihood of subsequent heavy menstrual bleeding in midlife women. One possibility is that irregular fluctuations in estrogen levels may be responsible for both abnormal menstrual bleeding, as well as the dysregulation of neurotransmitter systems that mediate depressive symptoms.
Escitalopram, when used in the treatment of menopausal vasomotor symptoms, did not worsen overall sexual function among non-depressed midlife women.
3,4-methylenedioxymethamphetamine (MDMA) or “Ecstasy” is one of the most widely used illicit recreational drugs among young adults. This report indicates that infants exposed to Ecstasy ad other recreational drugs may have delays in their motor development.
In this essay published in the Journal of the American Medical Association, Dr. Helen Kim (an alumna of the CWMH) discusses the challenges of treating women with severe psychiatric illness during pregnancy:
Antenatal exposure to Wellbutrin (bupropion) does not appear to be associated with an increased risk of malformations in the exposed infant; however, it is not known if exposure to Wellbutrin during pregnancy has any effect on the child’s neurobehavioral development. In a study from Figueroa and colleagues published in 2010, insurance claims data from 38,704 children and their families were analyzed, using information obtained from the beginning of pregnancy until age 5. Outcomes were assessed in mothers taking selective serotonin reuptake inhibitors (SSRIs) or Wellbutrin before, during or after the pregnancy. This study sought to determine the risk of ADHD in exposed infants. Children up to the age of 5 were identified as having ADHD if they had an outpatient or inpatient claim with a primary or secondary diagnosis of ADHD or a prescription claim for stimulants.
