Hormonal Effects on the Brain from Puberty to Menopause

Abstract: Fluctuations of endogenous and exogenous female sex hormones have been associated with a range of psychiatric symptoms from benign irritability to psychosis. Puberty, pregnancy, and menopause are all associated with increased rates of psychiatric symptoms including anxiety, depression, and psychosis. Additionally, sex hormone-related conditions such as catamenial migraines and polycystic ovary syndrome are prevalent throughout the reproductive lifecycle and can also impact mental health. Furthermore, fluctuations in sex hormone levels can affect the efficacy, pharmacokinetics, and tolerability of psychotropic agents (1,2).

Given the impact of sex hormones on mental health, it is important that CL psychiatrists have the skills to identify risks for certain sex hormone-related psychiatric illnesses by understanding patterns of hormonal fluctuations. Moreover, psychiatrists must consider both reproductive history and the interaction of hormones with medications when treating individuals exposed to female sex hormones. In this presentation, we will review normal and pathological hormonal fluctuations and their impact on mental health throughout the reproductive lifecycle. We will discuss psychiatric pathology related to hormonal variations that is important for CL psychiatrists to consider. We will also address opportunities for integrated care with other specialties to treat psychiatric illness, including hormonal therapies.

Dr. Bieber will discuss the roles of estrogen and progesterone, and their effects on psychiatric pathology during puberty and early adulthood (15 minutes). Dr. Nichols will use a case-based format to address sex hormones during adulthood, including the peri- and postpartum periods; consideration will also be given to newer hormonal treatments for postpartum depression (20 minutes). Dr. Reza will review the interplay between sex hormones and psychopathology during the perimenopausal and menopausal periods (15 minutes). Next, Dr. Davidowicz will highlight CL psychiatry’s role in the diagnosis and treatment of sex hormone-related psychopathology, with consideration of hormonal treatments as well as their potential impact on mood (15 minutes). We will spend the remainder of time engaging the audience in an interactive discussion regarding treatment methods, prior experiences (including collaborative efforts with other providers), and their comfort with prescribing hormonal treatments (10 minutes).

References:
(1) Schoretsanitis G, Deligiannidis KM, Paulzen M, Spina E, de Leon J. Drug-drug interactions between psychotropic medications and oral contraceptives. Expert Opin Drug Metab Toxicol. 2022;18(6):395-411. doi:10.1080/17425255.2022.2106214
(2) Wegner I, Edelbroek PM, Bulk S, Lindhout D. Lamotrigine kinetics within the menstrual cycle, after menopause, and with oral contraceptives. Neurology. 2009;73(17):1388-1393. doi:10.1212/WNL.0b013e3181bd8295

Content Contributors:

Diversity, Equity, and Inclusion: Sex is an important biological determinant of health. Provider biases in healthcare and research can directly impact patient care for women and lead to suboptimal treatment. This is further apparent in populations of women with minoritized backgrounds. Our session aims to equip CL psychiatrists with the skills to identify psychopathology throughout a woman’s reproductive life cycle. We will also explore opportunities for integrated care to improve diagnosis and treatment of women with sex hormone-related conditions. Our panel includes individuals from multiple backgrounds, training stages, institutions, and geographical regions, enabling a variety of unique perspectives for this topic.