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  Hormones, Depression and Libido

Depression is more common in women than men with the excess beginning at puberty and being no longer apparent five years after the menopause. There remains controversy whether this excess is due to environmental factors or hormonal factors but it is significant that depression occurs at times of hormonal flux such as adolescence, the post-natal period, the pre-menstrual days and the years around the time of the menopause. This climacteric depression is usually at its worst in the two or three years before the periods stop and is also affected by the cyclical depression of severe PMS.

This combination of post-natal depression, PMS and climacteric depression is known as the triad of hormone related mood disorders (HRMD) and often occur in the same vulnerable women. There is good evidence from randomised placebo-controlled trials that this depression is improved using moderately high dose oestrogens transdermally either by patches or hormone implant. This improvement occurs even in women who are not responsive to anti-depressants and in my view should be first-line therapy.

These patients respond well to oestrogens but are often progestogen-intolerant responding badly to the necessary cyclical oral progestogens needed if they still have a uterus. Such patients benefit from the insertion of a progestogen releasing (Mirena) intra-uterine system. Thus long-term therapy may be continuous oestradiol patches plus a Mirena coil producing the mental tonic effect of moderately high dose oestrogens without the bleeding or the cyclical changes that occur with progestogen tablets.

Loss of libido is a common, under-reported but complex issue in middle aged women. Hypoactive Sexual Desire Disorder (HSDD) or Female Sexual Arousal Disorder (FSAD) or Female Orgasmic Dysfunction (FOD) are the modern diagnostic distinctions. Marital or psycho sexual counselling are frequently employed with variable success. HRT helps with estrogens being less effective than testosterone.

Implantation is the only route licensed for women in the UK but it is possible to prescribe low dose gel or patches off license with the appropriate consultation.

Related Articles:

  • Studd, JWW. Panay, N (2004) Estrogens and depression. Climacteric

  • Gregoire, AJP, Henderson, AF, Kumar, R, Everitt B, Studd JW (1996).
        Transdermal oestrogen for treatment of severe postnatal depression.
        Lancet 347, 930 -33

  • Watson, NR, Studd, JWW, Savvas M, Garnett T, Baber RJ, (1989 Treatment of severe pre-menstrual syndrome with oestradiol patches and cyclical oral Norethisterone. Lancet ii, 730-34


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