Personal view: Hormones and depression in women.

Depression is more common in women, occurring at times of hormonal fluctuations as premenstrual depression, postnatal depression and perimenopausal depression. These are all related to changes in hormone levels and constitute the diagnosis of reproductive depression. There is a risk that severe premenstrual depression can be misdiagnosed as bipolar disorder and that women will be started on inappropriate antidepressants or mood-stabilizing therapy.

Severe premenstrual syndrome and bipolar disorder: a tragic confusion.

Bipolar disorder and severe premenstrual syndrome (PMS) have many symptoms in common, but it is important to establish the correct diagnosis between a severe psychiatric disorder and an endocrine disorder appropriately treatable with hormones. The measurement of hormone levels is not helpful in making this distinction, as they are all premenopausal women with normal follicle-stimulating hormone and estradiol levels. The diagnosis of PMS should come from the history relating the occurrence of cyclical mood and behaviour changes with menstruation, the improvement during pregnancy, postnatal depression and the presence of runs of many good days a month and the somatic symptoms of mastalgia, bloating and headaches.

Treatment of premenstrual disorders by suppression of ovulation by transdermal estrogens.

The understanding of the cause and treatment of premenstrual disorders is confused but it is essentially the result of cyclical ovarian activity, usually ovulation, and an effective treatment should be by suppressing ovulation. This can be done by an oral contraceptive but as these women are progestogen intolerant the symptoms may persist becoming constant rather than cyclical. Alternatively, transdermal estradiol by patch, gel or implant effectively removes the cyclical hormonal changes, which produce the cyclical symptoms.

Reproductive depression.

Reproductive depression is the depression in women that is related to the hormonal changes of the menstrual cycle, pregnancy and the menopause and is manifested clinically as premenstrual depression, postnatal depression and climacteric depression. These three components occur in the same vulnerable women in that a woman with depression in the menopausal transition will usually have a history of premenstrual syndrome (PMS; premenstrual dysphoric disorder [PMDD]), would have been in a good mood during pregnancy and then develop postnatal depression. When the periods return the depression becomes cyclical as PMS.

A guide to the treatment of depression in women by estrogens.

Premenstrual depression, postnatal depression and climacteric depression are related to changes in ovarian hormone levels and can be effectively treated by hormones. It is unfortunate that psychiatrists have not accepted this form of treatment and this paper is an attempt to simplify this treatment, which should include transdermal estrogens, possibly testosterone and, if the woman has a uterus, also progestogen. A balance is often necessary between these three hormones.

'PROFOX'--the post HRT nightmare.

The recent report of a two-fold increase in esophageal cancer in women taking oral bisphosphonates is yet another reason to question current relegation of hormone replacement therapy (HRT) to a minor role in the correction of many problems occurring in the younger postmenopausal woman. Women under the age of 60 years with low bone density, flushes, sweats, vaginal dryness, loss of libido and climacteric depression would be treated with estrogens by gynecologists and most general practitioners. It is regrettable that bone physicians use bisphosphonates as first-line therapy in this age group, in spite of the growing number of serious complications reported.

Variations on hormone replacement therapy: an answer to the 'one dose fits all' Women's Health Initiative study.

The Women's Health Initiative study worked on the assumption that one dose would fit all asymptomatic postmenopausal women. The investigators therefore often used the wrong dose, of the wrong hormones, on the wrong patients and therefore came to many wrong conclusions. Different combinations of different hormones are necessary for different symptoms and different age groups.