Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Drugs Aging. 2013 Sep;30(9):677-85. doi: 10.1007/s40266-013-0100-1.
Epidemiologic and clinic data have unequivocally supported the notion that women experience more psychiatric problems at some point in their lives compared with men, particularly mood and anxiety symptoms and sleep problems. It is also known that, for some women, such increased risk might be associated with reproductive cycle events such as the postpartum period or the menopausal transition. These periods are not only marked by substantial hormone variations but also quite often accompanied by stressful events and changes in personal, family and professional responsibilities. The complexity of these reproductive-related 'windows of vulnerability' poses a challenge to physicians and other professionals dedicated to women's health across the lifespan. The menopausal transition and early postmenopausal years constitute a characteristic example; during this period in life, dynamic changes in sex hormones and reproductive function co-occur with modifications in metabolism, sexuality, lifestyle behaviours and overall health, sometimes affecting a woman's quality of life and overall functioning. For most women, however, this transition has little or no significant impact on their mental wellness. A prior depressive episode--particularly if related to reproductive events--is the strongest predictor of mood symptoms or depression during menopausal years. Also, the presence and severity of vasomotor symptoms and other health-related issues appear to modulate the risk for depression in midlife women. Mechanistically, estrogen plays an important modulatory role in mood and cognitive regulation, hence the effects noted when midlife women are exposed to significant estrogen fluctuations or to estrogen-based therapies (use or withdrawal). Transdermal estradiol, as well as serotonergic and noradrenergic antidepressants, have shown efficacy in the management of depression in this population. Other evidence-based treatment options (hormonal, pharmacological, behavioural) are available to clinicians and health professionals who care for this population.
流行病学和临床数据明确支持这样一种观点，即与男性相比，女性在其一生中的某些时候会经历更多的精神健康问题，尤其是情绪和焦虑症状以及睡眠问题。众所周知，对于某些女性来说，这种风险增加可能与生殖周期事件有关，如产后或更年期过渡。这些时期不仅以大量的激素变化为特征，而且经常伴随着压力事件和个人、家庭和职业责任的变化。这些与生殖相关的“脆弱期”的复杂性给跨生命周期关注女性健康的医生和其他专业人员带来了挑战。更年期过渡和早期绝经后时期就是一个典型的例子；在这个生命阶段，性激素和生殖功能的动态变化与代谢、性、生活方式行为和整体健康的变化同时发生，有时会影响女性的生活质量和整体功能。然而，对于大多数女性来说，这种过渡对她们的心理健康几乎没有或没有显著影响。先前的抑郁发作——特别是如果与生殖事件有关——是预测绝经后女性情绪症状或抑郁的最强指标。此外，血管舒缩症状和其他与健康相关问题的存在和严重程度似乎也调节了中年女性患抑郁症的风险。从机制上讲，雌激素在情绪和认知调节中起着重要的调节作用，因此，当中年女性暴露于重大的雌激素波动或雌激素为基础的治疗（使用或停药）时，会出现上述效应。经皮雌二醇以及 5-羟色胺能和去甲肾上腺素能抗抑郁药已显示出在该人群中治疗抑郁症的疗效。为治疗这一人群，临床医生和健康专业人员还可使用其他基于证据的治疗选择（激素、药物、行为）。
