The forthcoming role of treatment with oestrogens in mental health

An overview of the influence of the menopause on women's mental health is provided, with special emphasis on the role of oestrogens. Some controversial topics are highlighted, in particular the role of oestrogencontaining hormone replacement therapy as adjuvant treatment in mental disorders.

Selective review of literature.

The gonadal source of oestrogen production is lost at the menopause. As oestrogens have important neuro- and psychoprotective activities, this loss may trigger or aggravate mental disorders in vulnerable women. Notwithstanding, the influence of menopause on mental health is still controverted, particularly since the publication of study results denying the potential benefits of oestrogen replacement therapy after the menopause. However, many of these studies suffer from methodological limitations and the ensuing discussion often fails to differentiate clearly between perimenopause and postmenopause, between menopausal transition and aging, between clear-cut mental disorders and minor changes in wellbeing. And, most importantly, authors often do not distinguish between prophylactic and therapeutic administration of oestrogens.

A subgroup of vulnerable women may suffer from the hormonal changes naturally occurring during the perimenopause and coinciding with the manifold psychosocial changes coming together during this phase of life. Oestrogen replacement therapy may be helpful in these cases but also carries some risks. More research is needed on the indications and contraindications for hormone replacement therapy in the context of mental disorders.