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Interface of women’s mental and reproductive health

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Abstract

The interface of women’s reproductive and mental health is an evolving area of psychiatric practice, necessitating familiarity with psychobiological factors unique to women. The role of estrogen in particular has profound implications for the etiology and treatment of women’s psychiatric illness, and has been reviewed along with the role of other hormones. Additionally, the stress of specific life events such as miscarriage, abortion, and menopause affects female mental health from a biological and psychosocial standpoint with the potential for secondary mood and anxiety disorders. Psychiatric issues during pregnancy and the postpartum period present special diagnostic and treatment challenges to the clinician. Biological and psychosocial treatments of these conditions have been reviewed. Management of psychiatric conditions during pregnancy and the postpartum period should include the obstetrician, pediatrician, and involved family members. Treatment decisions should involve careful assessment of the risks and benefits of any intervention including the risk of no treatment.

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References and Recommended Reading

  1. Stahl SM: Estrogen makes the brain a sex organ. J Clin Psychiatry 1997, 58:421–22.

    PubMed  CAS  Google Scholar 

  2. Craig M, Cutter W, Norbury R, et al.: Oestrogens, brain function and neuropsychiatric disorders. Curr Opin Psychiatry 2004, 17:209–214. This is a summary of recent findings related to the psychobiology of estrogen in various psychiatric disorders.

    Article  Google Scholar 

  3. Shors TJ, Leuner B: Estrogen-mediated effects on depression and memory formation in females. J Affect Disord 2003, 74:85–96.

    Article  PubMed  CAS  Google Scholar 

  4. Parker GB, Brotchie HL: From diathesis to dimorphism: The biology of gender differences in depression. J Nerv Ment Dis 2003, 192:210–216.

    Google Scholar 

  5. Stotland NL, Stewart DE, Munce SE, et al.: Obstetrics and gynecology. In APPI Textbook of Psychosomatic Medicine. Edited by Levenson JL. Washington, DC: 2004:733–760. This is a broad overview of biopsychosocial consultation-liaison psychiatric issues in obstetrics and gynecology.

  6. Stahl SM: Natural estrogen as an antidepressant for women. J Clin Psychiatry 2001, 62:6.

    Article  PubMed  CAS  Google Scholar 

  7. Payne JL: The role of estrogen in mood disorders in women. Int Rev Psychiatry 2003, 15:280–290.

    Article  PubMed  CAS  Google Scholar 

  8. Oinonen KA, Mazmanian D: To what extent do oral contraceptives influence mood and affect? J Affect Disord 2002, 70:229–240.

    Article  PubMed  CAS  Google Scholar 

  9. Parry BL, Haynes P: Mood disorders and the reproductive cycle. J Gend Specif Med 2000, 3:53–58.

    PubMed  CAS  Google Scholar 

  10. Kalantaridou SN, Makrigiannakis A, Zoumakis E, et al.: Stress and the female reproductive system. J Reprod Immunol 2004, 62:61–68.

    Article  PubMed  CAS  Google Scholar 

  11. Oretti RG, Harris B, Lazarus JH, et al.: Is there an association between life events, postnatal depression and thyroid dysfunction in thyroid antibody positive women? Int J Soc Psychiatry 2003, 49:70–76.

    Article  PubMed  Google Scholar 

  12. Ernst CL, Goldberg JF: The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics. J Clin Psychiatry 2002, 63(Suppl 4):42–55.

    PubMed  CAS  Google Scholar 

  13. Weiner CL, Primeau M, Ehrmann DA: Androgens and mood dysfunction in women: comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med 2004, 66:356–362.

    Article  PubMed  CAS  Google Scholar 

  14. Bjorn I, Bixo M, Nojd K, et al.: Negative mood changes during hormone replacement therapy: A comparison between two progestogens. Am J Obstet Gynecol 2000, 183:1419–1426.

    Article  PubMed  CAS  Google Scholar 

  15. Amba J, Chandra A, Mosher W, et al.: Fertility, family planning, and women’s health: New data from the 1995 National Survery of Family Growth. Vital and health statistics, National Survey of Family Growth 1997, Series 23:19.

  16. Burt VK, Hendrick VC: Women’s Mental Health, 2nd Edition. Washington DC: American Psychiatric Publishing Inc.; 2001.

    Google Scholar 

  17. Kainz K: The role of the psychologist in the evaluation of infertility. Women’s Health Issues 2001, 11:481–485.

    Article  PubMed  CAS  Google Scholar 

  18. King R: Subfecundity and anxiety in a nationally representative sample. Soc Sci Med 2003, 56:739–751.

    Article  PubMed  Google Scholar 

  19. Lukse M, Vacc N: Grief, depression and coping in women undergoing fertility treatment. Obstet Gynecol 1999, 93:245–251.

    Article  PubMed  CAS  Google Scholar 

  20. Friedman T, Gath D: The psychiatric consequences of spontaneous abortion. Br J Psychiatry 1989, 155:810–813.

    Article  PubMed  CAS  Google Scholar 

  21. Klier CM, Geller PA, Ritsher JB: Affective disorders in the aftermath of miscarriage: A comprehensive review. Arch Women’s Ment Health 2002, 5:129–149.

    Article  CAS  Google Scholar 

  22. Geller PA, Kerns D, Klier C: Anxiety following miscarriage and the subsequent pregnancy: A review of the literature and future directions. J Psychosom Res 2004, 56:35–45.

    Article  PubMed  Google Scholar 

  23. Stotland NL: Psychiatric issues in abortion, and the implications of recent legal changes for psychiatric practice. In Psychiatric Aspects of Abortion. Edited by Stotland NL. Washington DC: American Psychiatric Publishing Inc.; 1991:1–16.

    Google Scholar 

  24. Shusterman LR: The psychosocial factors of the abortion experience: A critical review. Psychol Women Q 1976, 1:79–102.

    Article  PubMed  CAS  Google Scholar 

  25. Bradshaw Z, Slade P: The effects of induced abortion on emotional experiences and relationships: A critical review of the literature. Clin Psychol Rev 2003, 23:929–958.

    Article  PubMed  Google Scholar 

  26. Blumenthal SJ: Psychiatric consequences of abortion: Overview of research findings. In Psychiatric Aspects of Abortion. Edited by Stotland NL. Washington DC: American Psychiatric Publishing Inc.; 1991:17–38.

    Google Scholar 

  27. Ashton JR: The psychosocial outcome of induced abortion. Br J Ob Gyn 1980, 87:1115–1122.

    CAS  Google Scholar 

  28. Dagg PKB: The psychological sequelae of therapeutic abortion-denied and completed. Am J Psychiatry 1991, 148:578–585.

    PubMed  CAS  Google Scholar 

  29. Misri S, Anderson E: Second-trimester abortion. In Psychiatric Aspects of Abortion. Edited by Stotland NL. Washington DC: American Psychiatric Publishing Inc.; 1991:159–170.

    Google Scholar 

  30. Koren G: Discontinuation syndrome following late pregnancy exposure to antidepressants. Arch Pediatr Adolesc Med 2004, 158:307–308.

    Article  PubMed  Google Scholar 

  31. Cott AD, Wisner KL: Psychiatric disorders during pregnancy. Int Rev Psychiatry 2003, 15:217–230. This is a detailed review and discussion that covers various psychiatric disorders during pregnancy.

    Article  PubMed  CAS  Google Scholar 

  32. Hendrick V, Altshuler L: Management of Major Depression During Pregnancy. Am J Psychiatry 2002, 159:1667–1673.

    Article  PubMed  Google Scholar 

  33. Altshuler LL, Cohen LS, Moline ML, et al.: Treatment of depression in women: a summary of the expert consensus guidelines. J Psychiatr Pract 2001, 7:185–208.

    Article  PubMed  CAS  Google Scholar 

  34. Stewart DE, Robinson GE: Psychotropic drugs and electroconvulsive therapy during pregnancy and lactation. In Psychological Aspects of Women’s Health Care: The Interface Between Psychiatry and Obstetrics and Gynecology, 2nd Edition. Edited by Stotland NL, Stewart DE. Washington, DC: American Psychiatric Press; 2001:67–93.

    Google Scholar 

  35. MacQueen G, Chokka P: Special issues in the management of depression in women. Can J Psychiatry 2004, 49(Suppl 1):27S-40S. This is an updated, concise, and well-written review on depression in women.

    PubMed  Google Scholar 

  36. Simon GE, Cunningham ML, Davis RL: Outcomes of prenatal antidepressant exposure. Am J Psychiatry 2002, 159:2055–2061.

    Article  PubMed  Google Scholar 

  37. Suri R, Altshuler L, Hendrick V, et al.: The impact of depression and fluoxetine treatment on obstetrical outcome. Arch Womens Ment Health 2004, 7:193–200.

    Article  PubMed  CAS  Google Scholar 

  38. Nulman I, Rovet J, Stewart DE, et al.: Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 2002, 159:1889–1895.

    Article  PubMed  Google Scholar 

  39. Epperson CN, Terman M, Terman JS, et al.: Randomized clinical trial of bright light therapy for antepartum depression: preliminary findings. J Clin Psychiatry 2004, 65:421–425.

    PubMed  Google Scholar 

  40. Spinelli MG, Endicott J: Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry 2003, 160:555–562.

    Article  PubMed  Google Scholar 

  41. Hendrick V: Treatment of postnatal depression. BMJ 2003, 327:1003–1004.

    Article  PubMed  Google Scholar 

  42. Wisner KL, Parry BL, Piontek CM: Clinical practice. Postpartum depression. N Engl J Med 2002, 347:194–199.

    Article  PubMed  Google Scholar 

  43. Seyfried LS, Marcus SM: Postpartum mood disorders. Int Rev Psychiatry 2003, 15:231–242.

    Article  PubMed  CAS  Google Scholar 

  44. Robertson E, Grace S, Wallington T, et al.: Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 2004, 26:289–295.

    Article  PubMed  Google Scholar 

  45. Wisner KL, Perel JM, Peindl KS, et al.: Timing of depression recurrence in the first ear after birth. J Affect Disord 2004, 78:249–252.

    Article  PubMed  Google Scholar 

  46. Chaudron LH, Szilagyi PG, Kitzman HJ, et al.: Detection of postpartum depressive symptoms by screening at well-child visits. Pediatrics 2004, 113:551–558.

    Article  PubMed  Google Scholar 

  47. Burke L: The impact of maternal depression on familial relationships. Int Rev Psychiatry 2003, 15:243–255.

    Article  PubMed  CAS  Google Scholar 

  48. Diego MA, Field T, Hernandez-Rief M, et al.: Prepartum, postpartum, and chronic depression effects on newborns. Psychiatry 2004, 67:63–80.

    PubMed  Google Scholar 

  49. Appleby L, Warner R, Whitton A, et al.: A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ 1997, 314:932–936. Although published in 1997, this is the only random controlled trial of antidepressants in treatment of postpartum depression.

    PubMed  CAS  Google Scholar 

  50. Sunder KR, Wisner SL, Hanusa BH, et al.: Postpartum depression recurrence versus discontinuation syndrome: observation from a randomized controlled trial. J Clin Psychiatry 2004, 65:1266–1268.

    PubMed  Google Scholar 

  51. Lawrie TA, Herxheimer A, Dalton K: Oestrogens and progestogens for preventing and treating postnatal depression (Cochrane Review). In The Cochrane Library, Issue 3, Chichester, UK: John Wiley & Sons, Ltd. 2004.

    Google Scholar 

  52. Dennis CE, Stewart DE: Treatment of postpartum depression, Part 1: A critical review of biological interventions. J Clin Psychiatry 2004, 65:1242–1251.

    Article  PubMed  CAS  Google Scholar 

  53. Brockington I: Postpartum psychiatric disorders. Lancet 2004, 363:303–310.

    Article  PubMed  Google Scholar 

  54. Burt VK, Suri R, Altshuler L, et al.: The use of psychotropic medications during breast feeding. Am J Psychiatry 2001, 158:1001–1009.

    Article  PubMed  CAS  Google Scholar 

  55. Weissman AM, Levy BT, Hartz AJ, et al.: Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry 2004, 161:1066–1078.

    Article  PubMed  Google Scholar 

  56. Levine RE, Oandasan AP, Primeau LA, et al.: Anxiety disorders during pregnancy and postpartum. Am J Perinatology 2003, 20:239–248.

    Article  Google Scholar 

  57. American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk. Pediatrics 2001, 108:776–789.

    Article  Google Scholar 

  58. Sharma V: Pharmacotherapy of postpartum psychosis. Expert Opin Pharmacother 2003, 4:1651–1658.

    Article  PubMed  CAS  Google Scholar 

  59. Chaudron LH, Pies RW: The relationship between postpartum psychosis and bipolar disorder: a review. J Clin Psychiatry 2003, 64:1284–1292.

    Article  PubMed  Google Scholar 

  60. Gentile S: Clinical utilization of atypical antipsychotics in pregnancy and lactation. Ann Pharmacother 2004, 38:1265–1271.

    Article  PubMed  CAS  Google Scholar 

  61. Yonkers KA, Wisner KL, Stowe Z, et al.: Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004, 161:608–620. This is an excellent review by an expert panel in management of bipolar disorder and the use of mood stabilizers during pregnancy. A consensus documented was generated.

    Article  PubMed  Google Scholar 

  62. Cohen LS, Sichel DA, Robertson LM, et al.: Postpartum prophylaxis for women with bipolar disorder. Am J Psychiatry 1995, 152:1641–1645.

    PubMed  CAS  Google Scholar 

  63. Viguera AC, Cohen LS, Baldessarini RJ, et al.: Managing bipolar disorder during pregnancy: weighing the risks and benefits. Can J Psychiatry 2002, 47:426–436.

    PubMed  Google Scholar 

  64. Matthey S, Barnett B, Howie P, et al.: Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 2003, 74:139–147.

    Article  PubMed  Google Scholar 

  65. Webb RT, Howard L, Abel KM: Antipsychotic drugs for nonaffective psychosis during pregnancy and postpartum (Cochrane Review). In The Cochrane Library, Issue 3, Chichester, UK: John Wiley&Sons, LTd. 2004.

    Google Scholar 

  66. Freeman EW, Sondheimer SJ: Premenstrual dysphoric disorder: recognition and treatment. Prim Care Companion J Clin Psychiatry 2003, 5:30–39.

    PubMed  Google Scholar 

  67. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Text Revision) 4th ed. Washington, DC: American Psychiatric Association, 2000.

    Google Scholar 

  68. Freeman EW, Rickels K, Sondheimer SJ, et al.: Continuous or intermittent dosing with sertraline for patients with severe premenstrual syndrome or premenstrual dysphoric disorder. Am J Psychiatry 2004, 161:343–351.

    Article  PubMed  Google Scholar 

  69. Yonkers KA, Pearlstein T, Rosenheck RA: Premenstrual disorders: bridging research and clinical reality. Arch Women Ment Health 2003, 6:287–292.

    Article  CAS  Google Scholar 

  70. Girman A, Lee R, Kligler B: An integrative medicine approach to premenstrual syndrome. Clin J Women’s Health 2002, 2:116–127.

    Article  Google Scholar 

  71. Kaufert PA, Gilbert P, Tate R: The Manitoba Project: A re-examination of the link between menopause and depression. Maturitas 1992, 14:143–155.

    Article  PubMed  CAS  Google Scholar 

  72. Dennerstein L: Summary: What World Health Organization experts say. In A Woman’s Guide to Menopause and Hormone Replacement Therapy. Edited by Dennerstein L, Shelley J. Washington DC: American Psychiatric Publishing Inc.; 1998:121–128.

    Google Scholar 

  73. Stewart DE, Boydell KM: Psychological distress during menopause: Associations across the reproductive life cycle. Int J Psychiatry Med 1993, 23:157–162.

    Article  PubMed  CAS  Google Scholar 

  74. Shelley J: Why hormone replacement therapy is a social issue. In A Woman’s Guide to Menopause and Hormone Replacement Therapy. Edited by Dennerstein L, Shelley J. Washington DC: American Psychiatric Publishing Inc.; 1998:57–70.

    Google Scholar 

  75. Avis NE: Depression during the menopausal transition. Psychol Women Q 2003, 27:91–100.

    Article  Google Scholar 

  76. Schmidt PJ, Nierman L, Danaceau MA, et al.: Estrogen replacement in perimenopausal-related depression: A preliminary report. Am J Obstet Gynecol 2000, 183:414–420.

    Article  PubMed  CAS  Google Scholar 

  77. Schneider LS, Small GW, Hamilton SH, et al.: Estrogen replacement and response to fluoxetine in a multicenter geriatric depression trial. Fluoxetine Collaborative Study Group. Am J Geriatr Psychiatry 1997, 5:97–106.

    PubMed  CAS  Google Scholar 

  78. Ditkoff EC, Crary WG, Cristo M, Lobo RA: Estrogen improves psychological function in asymptomatic postmenopausal women. Obstet Gynecol 1991, 78:991–995.

    PubMed  CAS  Google Scholar 

  79. Miller KJ: The other side of estrogen replacement therapy: Outcome study results of mood improvement in estrogen users and nonusers. Curr Psychiatry Rep 2003, 5:439–444.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, Inova Fairfax Hospital, 3300 Gallows Road, 22042, Falls Church, VA, USA

    Thomas N. Wise MD

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  1. Sermsak Lolak MD
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  2. Navid Rashid MD
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  3. Thomas N. Wise MD
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Lolak, S., Rashid, N. & Wise, T.N. Interface of women’s mental and reproductive health. Curr Psychiatry Rep 7, 220–227 (2005). https://doi.org/10.1007/s11920-005-0057-9

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