Estrogen, menstrual cycle phases, and psychopathology in women suffering from schizophrenia

Niels Bergemann, Peter Parzer, B. Runnebaum, Franz Resch, Christoph Mundt
In: Psychological Medicine · 2007 · vol. 37(10) , pp. 1427–1436 · doi:10.1017/s0033291707000578 · PMID:17451629 · W2085265643
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This study found that psychotic symptoms in women with schizophrenia improved during the luteal phase of the menstrual cycle, suggesting a potential antipsychotic effect of estradiol.

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This study evaluated whether menstrual cycle phase and/or estradiol levels were associated with psychotic symptom severity in 125 premenopausal women with schizophrenia and regular menses, measuring 17β-estradiol and other gonadal-axis hormones across follicular, peri-ovulatory, and luteal phases and analyzing symptom scores on PANSS and BPRS with regression models. The authors found significant improvement in psychotic symptoms during the luteal phase compared with other days, while depressive symptoms did not show the same pattern. A key caveat is that the findings are observational with cross-sectional comparisons across cycle phases rather than a randomized manipulation of estrogen or cycle timing. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

BACKGROUND: Estrogen has been hypothesized to have a protective and antipsychotic-like effect in women at risk for schizophrenia. The aim of the present study was to evaluate the association between menstrual cycle and/or estrogen levels and psychotic symptoms in a sample of women with schizophrenia. METHOD: One hundred and twenty-five premenopausal women with schizophrenia and regular menses were examined. The levels of 17beta-estradiol and other hormones of the gonadal axis were assessed in the follicular, peri-ovulatory, and luteal phases of the menstrual cycle. The effects of the menstrual cycle phase and/or the estradiol level on the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) scores were calculated by means of regression analyses. RESULTS: Significant improvement in psychotic, but not depressive, symptoms was observed during the luteal phase, compared with other days of the menstrual cycle. CONCLUSIONS: The present findings indicate that estradiol may have specific antipsychotic-like effects on the symptoms of schizophrenia. Thus further investigation into the therapeutic effect of estrogen may be worthwhile.
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Background

Estrogen has been hypothesized to have a protective and antipsychotic-like effect in women at risk for schizophrenia. The aim of the present study was to evaluate the association between menstrual cycle and/or estrogen levels and psychotic symptoms in a sample of women with schizophrenia.

Method

One hundred and twenty-five premenopausal women with schizophrenia and regular menses were examined. The levels of 17β-estradiol and other hormones of the gonadal axis were assessed in the follicular, peri-ovulatory, and luteal phases of the menstrual cycle. The effects of the menstrual cycle phase and/or the estradiol level on the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) scores were calculated by means of regression analyses.

Results

Significant improvement in psychotic, but not depressive, symptoms was observed during the luteal phase, compared with other days of the menstrual cycle.

Conclusions

The present findings indicate that estradiol may have specific antipsychotic-like effects on the symptoms of schizophrenia. Thus further investigation into the therapeutic effect of estrogen may be worthwhile. - Type - Original Article - Information - Copyright - Copyright © Cambridge University Press 2007 Abe, K. & Ohta, M. (1998). Recurrent brief episodes with psychotic features in adolescence: periodic psychosis of puberty revisited. Psychiatry and Clinical Neurosciences 52, 313–316.CrossRefGoogle ScholarPubMed Akhondzadeh, S., Nejatisafa, A. A., Amini, H., Mohammadi, M. R., Larijani, B. & Kashani, L. (2003). Adjunctive estrogen treatment in women with chronic schizophrenia: a double-blind, randomized, and placebo-controlled trial. Progress in Neuropsychopharmacology and Biological Psychiatry 27, 1007–1012.CrossRefGoogle ScholarPubMed Altschule, M. D. & Brem, J. (1963). Periodic psychosis of puberty. American Journal of Psychiatry 6, 1176–1178.CrossRefGoogle Scholar Ambelas, A. 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