Östrogene und Schizophrenie - Patientinnen an der Schnittstelle zwischen Psychiatrie und Gynäkologie

Abstract

The meaning of estrogens and the gonadal axis in the treatment of women with schizophrenic psychoses is more and more realized. There is a growing body of evidence for a gonadal dysfunction and an estrogen-deficiency-syndrome in many women suffering from schizophrenia on the one hand and for protective, therapeutic properties of estrogen replacement and even adjunct estrogen therapy in this often chronic recurrent disorder on the other hand. This results in new demands on psychiatrists, but also gynaecologists and on their cooperation, which in future will get more and more important. Thus, the evaluation of the hormonal situation in women suffering from schizophrenia should be standard in our clinical practice. In young premenopausal women with proven estrogen-deficiency, the neuroleptic treatment should be changed to an atypical neuroleptic without hyperprolactinemia and secondary suppression of the gonadal axis or estrogens be replaced. A iatrogenic premature menopause with all its potential harmful consequences has to be avoided. When changing to such an atypical neuroleptic, contraception counselling is urgently needed, as these women can suddenly regain fertility after years and years of no need for contraception. The interactions of neuroleptics with oral contraceptives have to be regarded. When psychotic relapses mainly occur pre- and perimenstrually, taking a monophasic contraceptive pill continuously without a hormone-free interval could be helpful - especially if the woman wishes contraception at the same time. In other cases intrauterin-devices are often more reliable. Suffering from psychosis could be an additional argument for hormone replacement therapy in postmenopausal women, when pro's and con's are discussed with the woman individually.