Practical Approach to Hormone Replacement Therapy for (Peri) Menopausal Women With Schizophrenia Spectrum Disorders:...

Estrogens play a neuroprotective role in schizophrenia spectrum disorders (SSD), and evidence suggests that perimenopausal estrogen decline is associated with symptom exacerbation and increased relapse risk in women with SSD. Hormone replacement therapy (HRT) may mitigate these effects, but clinical and epidemiological data on its use in women with SSD remain limited.

We conducted a case series of 5 women (aged 47-53 years) with SSD in perimenopause or postmenopause, who were treated with individualized HRT regimens (transdermal or oral estradiol with oral, vaginal, or intrauterine progestogens) in a psychosis outpatient clinic. The women were monitored for 3 months for psychiatric stability, tolerability, side effects, and menopausal symptoms, using clinical observation and self-report.

All 5 women tolerated HRT well, with no serious adverse effects. Three women reported notable improvements in mood, energy, and social functioning. Negative symptoms improved in 4 women, and 1 woman with active positive symptoms experienced partial symptom reduction. Three women reported relief of menopausal symptoms (eg, sleep disturbance, vasomotor symptoms, and joint pain), which was perceived as beneficial to mental stability. All patients continued HRT beyond follow-up.

Hormone replacement therapy appears feasible and acceptable for women with SSD before and after the menopausal transition, with potential benefits for mood and functional improvement and high tolerability. Individualized approaches and safety considerations are essential. This approach may be integrated into routine psychiatric care, though larger studies with standardized outcomes are needed.