Adding menopausal hormone therapy (MHT) to antipsychotic medication can lower the risk of relapse or any psychiatric hospitalization in women between 40 and 62 years of age who have schizophrenia, according to a report in AJP in Advance.
“At menopausal age, antipsychotic effectiveness decreases and relapse risk increases,” wrote Bodyl A. Brand, M.Sc., of the University Medical Center Groningen, the Netherlands, and colleagues. “Higher dosages do not effectively prevent relapse, while they do increase the risk for side effects…. The current study provides evidence that, while accounting for antipsychotic use, augmentation with MHT may provide a better strategy for relapse prevention.”
The researchers analyzed data from 3,488 women in Finland diagnosed with schizophrenia or schizoaffective disorder (SSD) and hospitalized for psychosis who initiated systemic MHT between 1995 and 2017.
The researchers used a within-person study design that compared the rates of health outcomes during periods when the women were taking MHT and periods when they were not. The primary outcome was relapse, defined as hospitalization due to psychosis; the secondary outcome was hospitalization due to any psychiatric reason.
A total of 1,849 women (52.7%) had at least one hospitalization for psychosis during follow-up. Overall, women using MHT were 16% less likely to relapse than those not using MHT. Hospitalization for any psychiatric reason was also lower when MHT was used.
The reduced risk of relapse was greatest for women who started MHT between ages 50 and 55, followed by women who began between ages 40 and 49; there was no reduced risk for women who started between ages 56 and 62.
There were some slight differences in effectiveness among various hormonal formulations. Estradiol alone as well as estrogen plus levonorgestrel, medroxyprogesterone acetate, or norethisterone were associated with between 15% and 25% reduced relapse risk, while estriol, tibolone, and estrogen plus dydrogesterone were not associated with decreased relapse risk. Oral and transdermal formulations appeared to be similarly effective.
“To maximize benefits and minimize risks of MHT, treatment should be individualized using the best available evidence, with periodic reevaluation of continuation,” the authors concluded. “Women with SSD of menopausal age form an exceptional group which is susceptible to psychosis relapse, but also to side effects of antipsychotic medication…. Considering its potential and safety, continued efforts are needed to make MHT more accessible and acceptable in this vulnerable group of women.”
For related information, see the Psychiatric News article “Can Hormonal Treatments Help Your Patients?”
(Image: Getty Images/iStock/Daisy-Daisy)
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