Riecher-Rössler Anita, de Geyter Christian
Psychiatric Department, University Hospital, Basel, Switzerland.
Swiss Med Wkly. 2007 Oct 20;137(41-42):565-72. doi: 10.4414/smw.2007.11925.
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.
概述绝经对女性心理健康的影响，特别强调雌激素的作用。突出了一些有争议的话题，尤其是含雌激素的激素替代疗法在精神障碍辅助治疗中的作用。
对文献进行选择性综述。
绝经时失去了雌激素产生的性腺来源。由于雌激素具有重要的神经保护和心理保护作用，这种丧失可能引发或加重易感女性的精神障碍。尽管如此，绝经对心理健康的影响仍存在争议，尤其是自绝经后雌激素替代疗法潜在益处的研究结果发表以来。然而，这些研究中有许多存在方法学上的局限性，随后的讨论往往未能明确区分围绝经期和绝经后期、绝经过渡和衰老、明确的精神障碍和幸福感的微小变化。而且，最重要的是，作者们常常没有区分雌激素的预防性和治疗性给药。
一部分易感女性可能会受到围绝经期自然发生的激素变化的影响，这些变化与这一生命阶段同时出现的多种社会心理变化相吻合。在这些情况下，雌激素替代疗法可能会有所帮助，但也存在一些风险。需要对精神障碍背景下激素替代疗法的适应证和禁忌证进行更多研究。
