Photo Credit: Designer491

The following is a summary of “Real-world effectiveness of Menopausal Hormone Therapy in preventing relapse in women with Schizophrenia or Schizoaffective disorder,” published in the September 2024 issue of Psychiatry by Brand et al.

Antipsychotics tend to be less effective in preventing relapse in women with schizophrenia or schizoaffective disorder (SSD) as they approach menopause. It is unclear if menopausal hormone therapy (MHT) can help to prevent psychosis relapse.

Researchers conducted a retrospective study exploring whether systemic MHT can help prevent psychosis relapse in women with SSD during menopause. 

They conducted a within-subject study on Finnish women with SSD, aged 40-62, who used MHT between 1994 and 2017. Age and psychotropic drug use were adjusted to calculate hazard ratios for psychosis relapse (primary outcome) and psychiatric hospitalization (secondary outcome). 

The results showed that 3,488 women opted for MHT. It was shown that MHT use was linked to a 16% lower relapse risk (aHR=0.84, 95% CI: 0.78-0.90) compared to non-use. MHT reduced relapse risk between ages 40-49 (aHR=0.86, 95% CI=0.78–0.95) and 50-55 (aHR=0.74, 95% CI=0.66–0.83), but not between ages 56-62 (aHR=1.11, 95% CI=0.91–1.37). Estrogen alone or combined with progestogens, transdermal, and oral formulations showed similar effectiveness (aHRs 0.75-0.87), except tibolone (aHR=1.04, 95% CI=0.75–1.44) and formulations with dydrogesterone (aHR=1.05, 95% CI=0.85–1.30). Similar results were observed for any psychiatric hospitalization.

Investigators concluded that MHT may help prevent psychosis relapse in women with SSD during menopause. This real-world evidence supports the neuroprotective role of estrogens, especially for those whose current antipsychotic treatments may not be enough.

Source: psychiatryonline.org/doi/10.1176/appi.ajp.20230850