RESEARCH WEEKLY: Exacerbation of symptoms during hormonal changes in women with psychosis
(June 11, 2019) Estrogen, a hormone that promotes the development of female characteristics, is hypothesized to be protective for psychotic symptoms. Conversely, reductions in estrogen have been shown to worsen or precipitate psychosis. These effects may help explain why women tend to see the onset of psychotic disorders later in life compared to men, due to the natural decrease in production of the hormone over time. A similar relationship may explain why some women develop psychosis after terminating a pregnancy or giving birth, when estrogen levels are also reduced.
A newly published systematic review and meta-analysis provides evidence to support this estrogen hypothesis, with results showing an increased rate of hospital admissions for psychotic disorders during the perimenstrual phase, or day 24–day 5 of the 28-day menstruation cycle when estrogen levels are at their lowest.
Thomas Reilly and colleagues from the King’s College London analyzed 19 published articles that represented more than 1,100 women with a psychotic disorder diagnosis. The authors included only papers that specifically studied women with psychotic disorders and that examined how symptoms were exacerbated during different phases of the menstrual cycle.
Through a statistical analysis of the combined results, the authors calculate that the rate of psychiatric hospital admission is 1.5 times higher during the perimenstrual phase. Based on the two studies examining symptom exacerbation during that period, the results indicate a 20–32.4% increase in psychotic symptoms when a woman’s estrogen levels are at their lowest in the menstrual cycle.
Although the findings provide further evidence for the role of estrogen in psychotic disorders in women, the authors conclude that more research is needed to fully characterize the effect of a woman’s menstrual cycle on psychosis. In addition, the authors suggest there could be a subgroup of women who have a uniquely strong correlation between their menstrual cycle and exacerbation of psychotic symptoms that may be improved with hormonal therapy.
References:
Reilly, T. J., et al. (2019) Exacerbation of psychosis during the perimenstrual phase of the menstrual cycle: A systematic review and meta-analysis. Schizophrenia Bulletin.
