[Estrogen treatment caused acute attacks of porphyria]

Two female patients with acute intermittent porphyria, who received oestrogen skin pads as supplementary treatment for postmenopausal discomfort, developed severe psychiatric disorders with persistent confusion, aggression and paranoid reactions. Some decades earlier they had reacted with symptoms of acute porphyria following oral contraceptive usage. There is well documented evidence of the advisability of restrictiveness in the use of oestrogens in conjunction with acute porphyria, particularly in cases of patients with a history of hormone-related symptoms of acute porphyria. The putative mechanisms by means of which oestrogens may exert effects on neurotransmitters and peptides are discussed in the article. The authors would be grateful to hear from colleagues abroad who have treated patients with similar symptoms following postmenopausal treatment with oestrogens.