Menopause and the Link with Schizophrenia

woman painted blue to illustrate the link between menopause and schizophrenia

Did you know that the menopause can trigger schizophrenia?  Yes, it turns out that not only has Mother Nature contrived to make it possible for us to drown in our own sweat,  lose our memories, hair and sex appeal, but our falling oestrogen levels can also drive us mad!

While listening to the All in the Mind podcast from ABC Radio National I heard a fascinating interview with Professor Jayashri Kulkarni, Professor of Psychiatry and Director of the Monash Alfred Psychiatry Research Centre in Melbourne, Australia.

The programme, entitled Art, Science and Schizophrenia, explored how scientists, clinicians and artists are working together to improve the experience of those living with schizophrenia.

Menopause and Schizophrenia

When it came to exploring the causes and onset of schizophrenia, Professor Kulkarni made a point I’ve never come across before.  In the interview she said:

When we look at the age of first-time schizophrenia, there is a difference between men and women in that men present about almost eight years younger, so you tend to see first episode schizophrenia in young men—16 to 19 years of age. Whereas the first episode of schizophrenia in women tends to come on later, so they’re about 23 onwards to about 30, and then there’s a second blip if you like, or a second group of women who develop schizophrenia in their mid to late 40s for the first time in their lives. That doesn’t happen in men. And these are findings worldwide. And one of the things that suggests a difference is that perhaps there’s something that’s happening in the onset of puberty that is affecting the onset of psychosis in someone who’s perhaps got some family history or genetics of it, or there are other factors going on. In a lot of ways that epidemiological observation fits with the clinical observation that we’re seeing, and fits with some animal work which suggests that oestrogen is protective in the brain.

So of course after puberty women have massive rises of oestrogen and that is perhaps protecting them from becoming sick earlier in their lives. And at the menopause bump in the mid 40s to late 40s they lose that protection of oestrogen, so uncover this second if you like ‘at risk’ time for women. We’ve been using oestrogen as a treatment as well in combination with other treatments and found some really important results. And the interesting thing is that a number of women actually intuitively have also told us they observed their own mental state to be worse at low-oestrogen phases of their menstrual cycle and also in the women approaching menopause—that that’s another time when their mental state becomes affected. We also know that women who have had babies, in their post-natal period are at greater risk of both post-natal depression and post-natal psychosis…

Professor Kulkarni makes two very interesting points.  They are:

  • Some women may develop schizophrenia for the first time in their lives in their 40s when they are menopausal and
  • Oestrogen has been found to be an effective treatment in combination with other treatments.

Treatment of Schizophrenia with Synthetic Oestrogen

In trial results published in 2010 Professor Kulkarni and her team found that Raloxifene — a synthetic oestrogen currently used to treat osteoporosis – had beneficial effects on postmenopausal women with schizophrenia. In the trial a test group experienced a more rapid recovery from psychotic and other symptoms compared to control groups.

What to Make of it All?

On the one hand I find it alarming that being menopausal and experiencing falling levels of oestrogen could have such an extreme effect on women’s mental health.  On the other hand, it is reassuring to know that the cure could lie in replacing hormone levels rather than administering more anti-psychotic drugs.

Either way, the link between hormones and mental health is fascinating and one we still know so little about.

This is still an area that is not really talked about in the literature about menopause.  If you have any further knowledge or experience of this issue, I’d love to hear from you.  Please leave a comment below.

Further Reading:

Read the transcript from the All in the Mind ‘Art, Science and Schizophrenia’ podcast.  Click ‘Show’ next to ‘Transcript’.

You can read more about Professor Kulkarni’s research in this online article: Gender Differences in Schizophrenia and First-Episode Psychosis: A Comprehensive Literature Review.

Science Daily Article: Brain Estrogen Shows Promise as Schizophrenia Treatment

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10 Responses to Menopause and the Link with Schizophrenia

  1. Laila King January 5, 2017 at 9:03 pm #

    I had postnatal psychosis twice and one of my daughters was diagnosed with schizoaffective mood disorder bipolar type in her late teens; she has never been well since, her moods cycle rapidly with constant suicidal ideations. Her perimenstrual physical symptoms have led the doctors believe she has endometriosis widely dispersed, including her lungs. She just started daily Cerazette (progestin mini pill) but we remain concerned that her moods might drop to dangerous level. For years, her monthly cycle has manifested in fluctuating moods of mania and deep depression. I hope the phychiatry teams would learn more about the impact of endocrine hormones on the brain function.

    • Angie Macdonald January 10, 2017 at 7:28 pm #

      Hi Laila. I’m sorry to hear about your daughter’s struggle. I don’t know if you have read my posts on progesterone intolerance, but I think this is something worth bearing in mind if your daughter’s depression and suicidal ideations get worse with the progestin. Progesterone made me feel suicidal and very depressed. I hope for your daughter’s sake that her psychiatrists take her hormones into account. However with her endometriosis diagnosis I’m not sure oestrogen therapy will be an option.

  2. Jacqueline December 24, 2016 at 12:06 am #

    I was diagnosed in 1995. I told my drs then that my mental health got worse around my period. They told me it wouldn’t make any difference to my mental health at all. I’ve know all along that there’s a link because whenever I got a relapse it was around my period. I’m peri menopausal now and I can feel it messing with my mental health. My family have a history of blood clots and stroke so I doubt I’d be able to have hrt. I worry about it slot.

    • Angie Macdonald December 27, 2016 at 10:23 am #

      Hi Jackie. My family also has a history of blood clots. Before I started taking HRT my doctor did a blood test to determine how my blood clotted to see if it was safe for me to take HRT. You could ask your doctor to order such a test for you. This sounds like something you should persist with, especially as you have noticed the link with your period. Best of luck.

  3. Les September 11, 2016 at 2:14 pm #

    Thank you for this article , it resonates with the experience that I believe my partner experienced . She was a quiet shy child that seemed to only have any close relationship with her pets . Her relationship with her mother seemed distant . Her personality seemed to dramatically change with the onset of puberty . She became outgoing and with a great deal of drive. A high achiever ( MA) and extremely successful business executive with the ability to persuade fortune 100 companies CEOs to follow her recommendations . A totally quirky and individual person not afraid to take risks and with supreme confidence. This all changed in her early 50s she had a dramatic change of personality and over a 9 month period turned into a frightened psychotic she’ll. She could not comprehend why she felt as she did . Constantly uncertain of who I was , paranoid to the extreme of feeling helicopters were watching her it all ended in hospitalisation , and after discharge with suicide . I have raised the subject with the medical authority to be told she was suffering from depression , which no doubt she was , but as a symptom I feel now of the deeper problem of Schitzophrenia as a driving force . If only one asks , had any of the doctors that hart Gerhard kept abreast of this research as opposed to reaching for the neuroleptic ( nice recommended) solution that she did not follow .

    • Angie Macdonald October 11, 2016 at 11:06 am #

      Hi Les. I’m so sorry to hear what happened to your partner. From what you describe it certainly sounds like she is dealing with more than just depression. I hope you have managed to find the right psychiatric help for her.

  4. linda canavan April 25, 2016 at 4:47 pm #

    I work in mental health and carry out mental health act assessments. I am concerned that there are women who may be menopausal, but their long history of mental health over rides investigation or tests to confirm they are experiencing the menopause. is there more reading material I can access.

    • Angie Macdonald April 25, 2016 at 6:14 pm #

      Hi Linda. For diagnosis of menopause, you could begin with the new NICE guidelines: https://www.nice.org.uk/guidance/ng23. If your female patients are suffering from long-term depression and have also experienced severe PMS it’s worth considering that their depression may have a hormonal basis. Professor John Studd is a UK expert in this field – have a look at his very informative website: http://www.studd.co.uk/reproductivedepression.php. I’m not aware of any other specific reading material on mental health and menopause. If you search the menopause journal Maturitas, you may find some useful research articles there: http://www.maturitas.org/ I hope you’re able to find the information you’re looking for to help your patients.

  5. Cydniey Buffers January 11, 2016 at 11:36 pm #

    I’m a 40-something with schizophrenia who has been experiencing many symptoms of perimenopause, and worrying, fretting, obsessing, am I going to get worse, psychiatric-ally? Or are my medications going to stave the more severe symptoms off? This article gives me hope that something else can be tried for relief, if I do get worse as menopause progresses. Hormonal therapies are something I hadn’t even thought of. I had never made the connection. Thank you for writing this and sharing it with those like me so we don’t worry, and fret, and obsess, we instead have a solid possible solution to try.

    • Angie Macdonald January 14, 2016 at 3:21 pm #

      I’m so glad this helped Cydniey. Thanks for letting me know and I hope you get through menopause unscathed.

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