In the July 2010 issue of Current Psychiatry, you will find a thorough review on the evaluation and treatment of insomnia in women across the life cycle. The bottom line is that many women experience insomnia during times of hormonal transition. The authors provide some useful guidelines for evaluating women who present with sleep problems (taken from Table 2):
In increasing numbers, women who are candidates for hormonal replacement therapy are requesting “bioidentical” rather than synthetic hormones. Although there is a tendency to think of bioidentical hormones as “all-natural”, they, like synthetic hormones, are manufactured in the laboratory. In contrast to synthetic hormones, they are chemically identical to the hormones produced by the human body; synthetic hormones are structurally different yet are designed to have similar biological effects as naturally produced hormones.
Although estrogen is highly effective for the treatment of hot flushes, many women are reluctant to use hormone therapy to manage these symptoms, given recent concerns that estrogen may carry certain risks. Several studies have demonstrated that gabapentin (Neurontin) and certain antidepressants, including paroxetine (Paxil) and venlafaxine (Effexor), may be useful non-hormonal treatments for the management of hot flashes. Data presented at the annual meeting of the American Society of Clinical Oncology indicate that pregabalin (Lyrica), an anticonvulsant drug similar to gabapentin, may also be helpful for alleviating hot flashes.
Hot flashes and depression are both common symptoms of the menopause transition. Several studies have found a relationship between depression and hot flashes: depressed women are more likely to experience hot flashes and women with hot flashes are more likely to have depression. Other studies have found no association between hot flashes and depression.
It is well established that women are at increased risk for developing depression compared to men. It has been hypothesized that this vulnerability to depression may be hormonally mediated, and several longitudinal studies have documented an increased risk of depressive symptoms during perimenopause or the menopausal transition. Based on the results of two prospective cohort studies, approximately one-third of women will develop their first episode of depression during the menopausal transition. (Cohen LS et al 2006, Freeman EW et al 2006).
Approximately seventy percent of all women experience hot flashes and/or night sweats (also called vasomotor symptoms) during the menopause transition (Stearns et al. 2002). Until recently, estrogen therapy was the treatment of choice for most women who sought treatment for hot flashes. Since the results of the Women's Health Initiative in 2002 noted risks of prolonged use of hormone therapy in older postmenopausal women (Roussouw et al. 2002), many women pursue other treatments for their hot flashes, including over-the-counter complementary and alternative medicines (CAMs), including soy isoflavones, black cohosh, and omega-3 fatty acids. However, there is limited evidence to support the use of these treatments for hot flashes to date.
The risk of depression after removal of both ovaries (also called bilateral oöphorectomy or surgical menopause) is a major factor for women to consider when they confront medical problems that require removal of the uterus (called a hysterectomy). Many women are advised to consider having their ovaries removed when they are having the uterus removed. Sometimes removal of the ovaries is required to fully treat the condition leading to surgery, but other times it is suggested as a precaution to reduce the risk of ovarian cancer. Removal of both ovaries in a premenopausal woman results in an abrupt withdrawal of estrogen, progesterone, and testosterone. Therefore removing both ovaries (rather than just one or neither ovary) may have significant effects on mood and well-being in women.
For decades, estrogen was used as a component of hormone replacement therapy to treat menopausal symptoms and for anticipated preventative health benefits in women with prostesterone, or as a monotherapy hormone treatment in women after hysterectomy, but after studies reported that long-term estrogen increase the prevalence of cardiovascular events and breast cancer, many patients and researchers have looked into alternative treatments such as food or products containing phytoestrogens. Phytoestrogens are weak plant-derived estrogens that are structurally similar to estrogen hormones produced by the body.
Sexual dysfunction is common among postmenopausal women and include a spectrum of problems, including low (or hypoactive) sexual desire, decreased satisfaction, and discomfort. Reports indicate that the prevalence of hypoactive sexual desire ranges from 9% in naturally postmenopausal women up to 26% in younger surgically postmenopausal women. A recent study published in the New England Journal of Medicine evaluates the effectiveness of the testosterone patch for postmenopausal women with low sexual desire.
Many women report vasomotor symptoms, including hot flushes and night sweats, during the menopausal transition. While estrogen is clearly one of the most effective treatments for vasomotor symptoms, recent concerns regarding the use of hormone replacement therapy (HRT) have made treaters much more reluctant to recommend HRT, even for short-term management of vasomotor symptoms.
