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Treating schizophrenia during menopause

Brzezinski, Amnon MD1; Brzezinski-Sinai, Noa A. BMSc2; Seeman, Mary V. OC, MD, DSc, FRCPC3

doi: 10.1097/GME.0000000000000772
Review Article

Objective: The aim of this review is to examine three questions: What are the risks and benefits of treating women with schizophrenia with hormone therapy (HT) at menopause? Should the antipsychotic regimen be changed at menopause? Do early- and late-onset women with schizophrenia respond differently to HT at menopause?

Methods: MEDLINE databases for the years 1990 to 2016 were searched using the following interactive terms: schizophrenia, gender, menopause, estrogen, and hormones. The selected articles (62 out of 800 abstracts) were chosen on the basis of their applicability to the objectives of this targeted narrative review.

Results: HT during the perimenopause in women with schizophrenia ameliorates psychotic and cognitive symptoms, and may also help affective symptoms. Vasomotor, genitourinary, and sleep symptoms are also reduced. Depending on the woman's age and personal risk factors and antipsychotic side effects, the risk of breast cancer and cardiovascular disease may be increased. Antipsychotic types and doses may need to be adjusted at menopause, as may be the mode of administration.

Conclusions: Both HT and changes in antipsychotic management should be considered for women with schizophrenia at menopause. The question about differences in response between early- and late-onset women cannot yet be answered.

1Department of Obstetrics and Gynecology, The Hebrew University-Hadasssah Medical Center, Jerusalem, Israel

2Ben-Gurion University Medical School, Beer-Sheba, Israel

3Department of Psychiatry, University of Toronto, Canada.

Address correspondence to: Amnon Brzezinski, MD, Department of Obstetrics and Gynecology, The Hebrew University-Hadasssah Medical Center, Jerusalem, Israel. E-mail:

Received 2 July, 2016

Revised 30 August, 2016

Accepted 30 August, 2016

Funding/support: None.

Financial disclosure/conflicts of interest: M.V.S. is a medical consultant for Clera Inc.

© 2017 by The North American Menopause Society.