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Psychological and Sexual Symptoms Associated with the Menopause and the Effects of Hormone Replacement Therapy

Published online by Cambridge University Press:  02 January 2018

Jane Pearce ,
Keith Hawton  and
Fiona Blake
Jane Pearce*
Affiliation:
Littlemore Hospital, Oxford
Keith Hawton
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford
Fiona Blake
Affiliation:
Department of Psychological Medicine, John Radcliffe Hospital, Oxford
*
Dr Jane Pearce, Littlemore Hospital, Oxford OX4 4XN. Fax: (0865) 223061
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Abstract

Background

There is considerable inconsistency in the results of studies of the psychological and sexual sequelae of the menopause and their treatment.

Method

A search of the literature on Medline was made of studies of psychological symptoms in women who were either naturally or surgically menopausal or who were receiving hormone replacement therapy for menopausal symptoms.

Results

There is evidence of a small increase in psychological morbidity (not usually amounting to psychiatric disorder) preceding the natural menopause and following the surgical menopause. Psychosocial as well as hormonal factors are relevant. While the response of psychosocial symptoms to hormone replacement therapy with oestrogens is variable and most marked in the surgical menopause, in some studies the effect is little greater than that for placebo. Where sexual symptoms are present, there is more consistent evidence that hormone replacement therapy is effective.

Conclusions

In the light of the available evidence, the current use of hormone replacement therapy to treat psychological symptoms detected at the time of (but not necessarily therefore due to) the natural menopause must be questioned. It does appear that oestrogen therapy ameliorates psychological symptoms after surgical menopause.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 167 , Issue 2 , August 1995 , pp. 163 - 173
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

Alder, E. M. (1992) The effect of hormone replacement therapy on psychological symptoms. In Reproductive Life (eds Wijma, K. & van Schoultz, B.). Carnforth: Parthenon.Google Scholar
Bachmann, G. A., Leiblum, S. R., Sandler, B., et al (1985) Correlates of sexual desire in post-menopausal women. Maturitas, 7, 211–216.Google Scholar
Ballinger, C. B. (1975) Psychiatric morbidity and the menopause: screening of general population sample. British Medical Journal, iii, 344–346.Google Scholar
Ballinger, C. B. (1990) Psychiatric aspects of the menopause. British Journal of Psychiatry, 156, 773–787.Google Scholar
Barlow, D. H., Abdalla, H. I., Roberts, A. D. G., et al (1986) Long-term hormone implant therapy – hormonal and clinical effects. Obstetrics and Gynaecology, 67, 321–325.Google Scholar
Brincat, M., Studd, J. W. W., O'Dowd, T., et al (1984) Subcutaneous hormone implants for the control of climacteric symptoms: a prospective study. Lancet, i, 16–18.Google Scholar
Bungay, G. T., Vessey, M. P. & McPherson, C. K. (1980) Study of symptoms in middle age with special reference to the menopause. British Medical Journal, 281, 181–183.Google Scholar
Burger, H. G., Hailes, J., Nelson, J., et al (1987) Effect of combined implants of oestradiol and testosterone on libido in postmenopausal women. British Medical Journal, 294, 936–937.Google Scholar
Campbell, S. (1976) Double blind psychometric studies on the effects of natural oestrogens on postmenopausal women. In The Management of the Menopause and Postmenopausal Years (ed. Campbell, S.). Lancaster: MTP Press.Google Scholar
Campbell, S. & Whitehead, M. (1977) Oestrogen therapy and the menopausal syndrome. Clinics in Obstetrics and Gynaecology, 4, 31–44.Google Scholar
Cardozo, L., Gibb, D. M. F., Tuck, S. M., et al (1984) The effects of subcutaneous hormone implants during the climacteric. Maturitas, 5, 177–174.Google Scholar
Chakravarti, S., Collins, W. P., Thom, M. H., et al (1979) Relation between plasma hormone profiles, symptoms, and response to oestrogen treatment in women approaching the menopause. British Medical Journal, i, 983–985.CrossRefGoogle Scholar
Cooke, D. J. (1985) Psychosocial vulnerability to life events during the climacteric. British Journal of Psychiatry, 147, 71–75.Google Scholar
Coope, J. (1976) Double blind cross-over study of estrogen replacement therapy. In The Management of the Menopause and Postmenopausal Years (ed. Campbell, S.). Lancaster: MTP Press.Google Scholar
Dennerstein, L., Burrows, G. D., Hyman, G. J., et al (1979) Hormone therapy and affect. Maturitas, 1, 247–259.Google Scholar
Dennerstein, L., Burrows, G. D., Wood, C., et al (1980) Hormones and sexuality: effects of oestrogen and progestogen. Obstetrics and Gynaecology, 51, 316–322.Google Scholar
Dow, M. G. T. & Hart, D. M. (1983) Hormonal treatments of sexual unresponsiveness in postmenopausal women: a comparative study. British Journal of Obstetrics and Gynaecology, 90, 361–366.Google Scholar
Fedor-Freybergh, P. (1977) The influence of oestrogens on the wellbeing and mental performance in climacteric and postmenopausal women. Acta Obstetrica et Gynecologica Scandinavica, (suppl. 64), 1–91.Google Scholar
Furuhjelm, M., Karlgren, E. & Carlstrom, K. (1984) The effect of estrogen therapy on somatic and psychical symptoms in postmenopausal women. Acta Obstet rica et Gynecologica Scandinavica, 63, 655–661.Google Scholar
Garnett, T., Studd, J. W. W., Henderson, A., et al (1990) Hormone implants and tachyphylaxis. British Journal of Obstetrics and Gynaecology, 97, 917–921.Google Scholar
Gath, D., Osborn, M., Bungay, G., et al (1987) Psychiatric disorder and gynaecological symptoms in middle aged women. British Medical Journal, 294, 213–218.CrossRefGoogle ScholarPubMed
Gath, D., & Iles, S. (1990) Depression and the menopause. British Medical Journal, 300, 1287–1288.Google Scholar
George, G. W. C., Utian, W. H., Beaumont, P. J. V., et al (1973) Effects of exogenous oestrogen on minor psychiatric symptoms in postmenopausal women. South African Medical Journal, 47, 2387–2388.Google Scholar
Gerdes, L. C., Sonnendecker, E. W. W. & Polakow, E. S. (1982) Psychological changes effected by estrogen–progestogen and clonidine treatment in climacteric women. American Journal of Obstetrics and Gynecology, 142, 98–104.Google Scholar
Green, J. G. (1984) The Social and Psychological Origins of the Climacteric Syndrome. Aldershot: Gower.Google Scholar
Green, J. G. & Cooke, D. J. (1980) Life stress and symptoms at the climacterium. British Journal of Psychiatry; 136, 486–491.Google Scholar
Hallstrom, T. (1977) Sexuality in the climacteric. Clinics in Obstetrics and Gynaecology, 4, 227–239.Google Scholar
Hallstrom, T. & Samuelsson, S. (1985) Mental health in the climacteric. The longitudinal study of women in Gothenberg. Acta Obstetrica et Gynecologica Scandinavica, (suppl. 130), 13–18.Google Scholar
Hawton, K., Gath, D. & Day, A. (1994) Sexual function in a community sample of middle-aged women with partners: effects of age, marital, socio-economic, psychiatric, gynaecological and menopausal factors. Archives of Sexual Behavior, 23, 375–395.Google Scholar
Hay, A. G., Bancroft, J. & Johnstone, E. C. (1994) Affective symptoms in women attending a menopause clinic. British Journal of Psychiatry, 164, 513–516.Google Scholar
Hunter, M. S. (1990a) Emotional well-being, sexual behaviour and hormone replacement therapy. Maturitas, 12, 299–314.Google Scholar
Hunter, M. S. (1990b) Somatic experience of the menopause: a prospective study. Psychosomatic Medicine, 52, 357–367.Google Scholar
Hunter, M. S., Battersby, R. & Whitehead, M. (1986) Relationships between psychological symptoms, somatic complaints and menopausal status. Maturitas, 8, 217–228.Google Scholar
Kaufert, P. A., Gilbert, P. & Hassaret, T. (1988) Researching the symptoms of menopause: an exercise in methodology. Maturitas, 10, 117–131.CrossRefGoogle ScholarPubMed
Kaufert, P. A., Gilbert, P. & Tate, R. (1992) The Manitoba Project: a reexamination of the link between menopause and depression. Maturitas, 14, 143–155.Google Scholar
Klaiber, E. L., Broverman, D. M., Vogel, W., et al (1979) Estrogen therapy for severe persistent depressions in women. Archives of General Psychiatry, 36, 550–554.Google Scholar
Kupperman, H. S., Wetchler, B. B. & Blatt, M. G. (1959) Contemporary therapy of the menopause syndrome. Journal of the American Medical Association, 171, 1627–1637.Google Scholar
Leiblum, S., Bachmann, G., Kemmenn, E., et al (1983) Vaginal atrophy in the post-menopausal women: the importance of sexual activity and hormones. Journal of the American Medical Association, 249, 2195–2198.Google Scholar
Magos, A. L., Brewster, E., Singh, R., et al (1986) The effects of norethisterone in postmenopausal women on oestrogen replacement therapy: a model for the premenstrual syndrome. British Journal of Obstetrics and Gynaecology, 93, 1290–1296.Google Scholar
Matthews, K. A., Wing, R. R., Kuller, L. H., et al (1990) Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women. Journal of Consulting and Clinical Psychology, 58, 345–351.Google Scholar
McCoy, N. L. & Davidson, J. M. (1985) A longitudinal study of the effects of menopause on sexuality. Maturitas, 7, 203–210.Google Scholar
McKinlay, J. B., McKinlay, S. J. & Brambilia, D. (1987) The relative contributions of endocrine changes and social circumstances to depression in mid-aged women. Journal of Health and Social Behaviour, 28, 345–363.Google Scholar
Montgomery, J. C., Appleby, L., Brincat, M., et al (1987) Effect of oestrogen and testosterone implants on psychological disorders in the climacteric. Lancet, i, 297–299.Google Scholar
Moore, B., Gustafson, R. & Studd, J. (1975) Experience of a national health service menopause clinic. Current Medical Research Opinion, 3 (suppl. 3), 42–55.Google Scholar
Nordin, B. E. C., Jones, M. M., Crilly, R. G., et al (1981) A placebo–controlled trial of ethinyl oestradiol and norethisterone in climacteric women. Maturitas, 2, 247–251.Google Scholar
Osborn, M., Hawton, K. & Gath, D. (1988) Sexual function among middle aged women in the community. British Medical Journal, 296, 959–962.Google Scholar
Paterson, M. E. L. (1982) A randomized double-blind cross-over trial into the effect of norethisterone on climacteric symptoms and biochemical profiles. British Journal of Obstetrics and Gynaecology, 89, 464–472.CrossRefGoogle ScholarPubMed
Pfeiffer, E., Verwoerdt, A. & Davies, C. I. C. (1972) Sexual behavior in middle life. American Journal of Psychiatry, 128, 1262–1267.CrossRefGoogle ScholarPubMed
Phillips, S. M. & Sherwin, B.B. (1992) Effects of oestrogen on memory function in surgically menopausal women. Psychoneuroendocrinology, 17, 485–495.Google Scholar
Sarrel, P. M. & Whitehead, M. I. (1985) Sex and menopause: defining the issues. Maturitas, 7, 217–224.Google Scholar
Sherwin, B. B. (1988) Affective changes with oestrogen and androgen replacement therapy in surgically menopausal women. Journal of Affective Disorders, 14, 177–187.CrossRefGoogle ScholarPubMed
Sherwin, B. B. (1990) Clinical consequences of endocrine changes at the menopause. In The Free Woman: Women's Health in the 1990s (eds van Hall, E. V. & Everaerd, W.). Carnforth: Parthenon.Google Scholar
Sherwin, B. B. (1991) The impact of different doses of estrogen and progestin on mood and sexual behavior in post-menopausal women. Journal of Clinical Endocrinology and Metabolism, 72, 336–343.Google Scholar
Sherwin, B. B. & Gelfand, M. M. (1985) Sex steroids and affect in the surgical menopause: a double-blind, cross-over study. Psychoneuroendocrinology, 10, 325–335.Google Scholar
Sherwin, B. B. & Gelfand, M. M. (1987) The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosomatic Medicine, 48, 397–409.CrossRefGoogle Scholar
Sherwin, B. B. Gelfand, M. M. & Brender, W. (1985) Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause. Psychosomatic Medicine, 47, 339–351.Google Scholar
Strickler, R. C., Borth, R., Cecutti, A., et al (1977) The role of oestrogen replacement in the climacteric syndrome. Psychological Medicine, 7, 631–639.Google Scholar
Studd, J., Watson, N. R. & Montgomery, J. (1990) Depression and the menopause. British Medical Journal, 300, 1653.Google Scholar
Thomson, J. & Oswald, I. (1977) Effect of oestrogen on the sleep, mood, and anxiety of menopausal women. British Medical Journal, ii, 1317–1319.Google Scholar
Utian, W. H. (1972) The true clinical features of post-menopause and oophorectomy and their response to oestrogen therapy. South African Medical Journal, 46, 732–737.Google Scholar
Walling, M., Andersen, B. L. & Johnson, S. R. (1990) Hormonal replacement therapy for postmenopausal women: a review of sexual outcomes and related gynecologic effects. Archives of Sexual Behavior, 19, 119–137.Google Scholar
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