University Department of Psychiatry, Warneford
Hospital, Oxford, UK.
SOURCE:
J Psychosom Res 1997 Feb;42(2):177-86
NLM CIT. ID:
97231250
ABSTRACT:
There is conflicting evidence regarding the
effects of hormone replacement therapy (HRT) with estrogens on psychological and
psychiatric symptoms of menopause. Forty women already attending a menopause clinic for
continuing HRT by estrogen implants were studied in a randomized, double-blind,
placebo-controlled study of estrogen reimplantation versus implantation of a placebo
preparation. Assessment included self rating with visual analog scales, standardized
psychological and menopause rating scales (Hospital Anxiety and Depression Scale,
Self-Concept Questionnaire, Cognitive Failures Questionnaire, Greene Menopause Index), and
interview with the Present State Examination. No difference in outcome with regard to
either psychological or psychiatric symptoms was found 2 months after entry to the study
between the women who received an active implant and those who received a placebo implant,
in spite of the former group having a significant rise in estradiol levels. The only
effect of HRT on physical symptoms was a nonsignificant reduction in flushes. Psychiatric
morbidity of the study population was high with nearly half being "psychiatric
cases" according to the Present State Examination at both initial assessment and
follow-up. At entry to the study nearly all the women had levels of estradiol in the
premenopausal range and four had supraphysiological levels. It appears likely that women
were returning requesting a new implant because of symptoms related to nonhormonal
factors. Women receiving continuing HRT for menopausal symptoms should be reassessed both
for hormonal status and current psychosocial factors when they present with recurrent
symptoms, especially those of a psychological or psychiatric nature.
MAIN MESH SUBJECTS:
Climacteric/DRUG EFFECTS/*PSYCHOLOGY
Estrogen Replacement Therapy/*PSYCHOLOGY
*Patient Acceptance of Health Care
ADDITIONAL MESH SUBJECTS:
Adult
Drug Implants
Estradiol/ADMINISTRATION & DOSAGE
Female
Human
Male
Middle Age
Support, Non-U.S. Gov't
When my office
lease expired at the end of 2004, I decided to turn it into a
"sabbatical" from my private practice. Many years ago, in my
grandfather's 89th year of life, he told me, "John, it is important
to smell the roses while you can still smell them." His life
gave living a very good reputation. It is also true that the
pursuit of that philosophy required my grandfather to to re-open his
assay office/ore market in Wickenburg, Arizona as a 75-year-old because
he had run a little short of retirement money. Thus, if blessed with his
luck and health, I'll be back.. --jjh
