Menopausal Hormone Therapy May Prevent Psychosis Relapse

TOPLINE:

Menopausal hormone therapy (MHT) is associated with a 16% lower risk for psychosis relapse in women with schizophrenia or schizoaffective disorder (SSD), especially in women who initiated MHT between ages 40 and 55 years.

METHODOLOGY:

• Researchers conducted a nationwide register-based cohort study in Finland that included 3488 women diagnosed with SSD and hospitalized for psychosis between 1972 and 2014 who initiated MHT between the ages of 40 and 62 years.
• Follow-up ended at death or on December 31, 2017, whichever occurred first.
• MHT usage information was derived from the Finnish Prescription Register.
• The primary outcome was hospitalization due to psychosis, the secondary outcome was hospitalization for any psychiatric reason, and age and the use of antipsychotics and other psychotropic drugs were included as time-varying covariates in the analysis.

TAKEAWAY:

• The use of any MHT was associated with a 16% decreased risk for psychosis relapse (adjusted hazard ratio [aHR], 0.84; 95% CI, 0.78-0.90).
• MHT was most effective when initiated between 40 and 49 years (aHR, 0.86; 95% CI, 0.78-0.95) and 50 and 55 years (aHR, 0.75; 95% CI, 0.66-0.83) but not between 56 and 62 years (aHR, 1.11; 95% CI, 0.91-1.37).
• Estrogen-only formulations, fixed combined formulations, and sequential combined formulations were also associated with reductions in the risks for relapse, ranging from 14% to 21%.
• The effectiveness of transdermal estrogens (aHR, 0.87; 95% CI, 0.75-1.04) was less robust than that of oral estrogens (aHR, 0.84; 95% CI, 0.73-0.97).

IN PRACTICE:

“The findings underscore the potential value of MHT in preventing psychosis relapse among women with SSD of menopausal age. These findings translate clinical evidence on the neuroprotective effects of estrogens to real-world settings, encompassing a group of women for whom current antipsychotic treatment options may be insufficient,” study authors wrote.

SOURCE:

The study was led by Bodyl A. Brand, MSc, University Medical Center Groningen, Groningen, the Netherlands. It was published online on September 12 in AJP in Advance.

LIMITATIONS:

Study limitations included the use of age to estimate menopause and the lack of data on clinical measures other than hospitalization. The observational design, potential for residual confounding, and lack of differentiation between psychiatric diagnoses and actual symptoms have further limited the study.

DISCLOSURES:

Study funding was not disclosed. One author reported receiving grants from the Academy of Finland and the Sigrid Jusélius Foundation. Some authors received research funding, honoraria, consultancy fees, and speaker fees from various pharmaceutical companies. Detailed disclosures are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.