An estimated 80% of sexually active young women in the United States use hormonal or oral contraceptives (OCs). Clinically it is found that some women report depression or mood swings with oral contraceptives; however, many women seem to tolerate hormonal contraceptive without any effects on mood. Despite the prevalence of OC usage, few studies have explored the association between hormonal contraceptive use and mood disturbance.
We previously reported on studies suggesting estrogen may be helpful for the treatment of depression in peri- and post-menopausal women, either alone or in combination with an antidepressant. In addition, other studies have suggested that older, postmenopausal women may respond more poorly to antidepressants than premenopausal women. Two recent studies attempt to better understand the impact of reproductive hormones on clinical presentation and treatment response of depression in women.
For the treatment of menopausal vasomotor symptoms (VMS), such as hot flashes and night sweats, selective serotonin reuptake inhibitors (SSRIs) are effective and well-tolerated. Positive effects are observed within 4 weeks of the initiation of treatment. However, we do not know how long treatment with an SSRI must be continued in order to maintain control of VMS. Nor do we know if VMS will recur after discontinuation of SSRI or if recurrent VMS may be less frequent or less bothersome after receiving SSRI treatment. A recent report from Dr. Hadine Joffe and colleagues at the Center for Women’s Mental Health assessed the recurrence of vasomotor symptoms in women treated with SSRIs.
Aromatase inhibitors (AIs) are the preferred hormonal therapy for postmenopausal women with estrogen sensitive breast cancer. While the selective estrogen receptor modulators (SERMs), such as tamoxifen and raloxifene, are used in premenopausal women with estrogen sensitive breast cancer, the aromatase inhibitors (e.g., anastrozole, letrozole, and exemestane) have been shown to be more effective and safer than the SERMs in postmenopausal women.
Selective serotonin and serotonin-norepinephrine inhibitors (SSRIs and SNRIs) have been shown to be effective for the treatment of hot flashes. However, these agents may carry certain side effects, including sexual side effects and sleep disturbance. These two side effects may be particularly concerning to peri- and postmenopausal women who, in addition to having vasomotor symptoms, are more likely to experience sexual dysfunction and sleep disruption than premenopausal women.
Each year about 600,000 women in the United States undergo a hysterectomy. Somewhere between 55% and 80% of these women who also have their ovaries removed along with the uterus—a procedure known as oophorectomy. After the removal of the ovaries, menopause follows immediately and is associated with a constellation of symptoms including hot flashes and insomnia, as well as depression and anxiety.
The National Comorbidity Survey estimates that by the time women reach midlife, approximately 23% have experienced at least one episode of major depression and 30% have been diagnosed with an anxiety disorder. Depression and anxiety disorders are each associated with impaired functioning and lower quality of life (QOL). There is also some data to suggest that, even after a depressive episode resolves, those with a history of a affective illness have a lower quality of life than those without histories of depression, with impairment in social and interpersonal functioning.
Soy-based products have long been touted as a treatment for menopausal symptoms. However, many of the clinical studies measuring the effectiveness of dietary sources of soy isoflavones (e.g., soy beverages, soy powder) for the treatment of menopausal vasomotor symptoms (i.e., hot flushes, night sweats) have been negative. Less is known about the effects of soy on cognition. A large clinical trial suggests that soy may not have any positive effects on cognition in postmenopausal women.
In this study, half of women aged 45 to 60 years reported experiencing menopausal symptoms. 69% of these women reported that their symptoms have negatively affected their lives. Among the women who endorsed menopausal symptoms, 72% had not received any treatment for their symptoms and 77% reported that they had not discussed treatment options with their healthcare providers.
