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Conference reporter
Hormonal changes are among the many factors that can affect psychological and medical conditions in women, and knowing the whole picture can have a profound effect on the treatment of these patients, said Neil Epper, MD to the participants in 2022. Psychiatry TimesTM The World CME Conference is taking place this week in San Diego.1
At the meeting, Epper, professor and chair of the Department of Psychiatry at the University of Colorado in Aurora, Colorado, discussed the interactions between the endocrine system, early childhood influences, and the brain and nervous system.
Eppen explained that it is important for psychiatrists to consider endocrine system When treating patients, there are clear differences between the sexes in how hormones affect their mental health, especially when it comes to women. The difference in hormone treatment for women begins at puberty, and young girls are twice as likely to be prescribed steroids as men, which is often associated with the resolution of unsafe sex at the beginning of sexual intercourse.
“Think about what steroids/birth control you’re on, because they can seriously damage your endocrine system,” Epperson says. This is also true for menopausal women, as hormones have been shown to affect executive function, sexuality, heart and mental health issues, including major depression in women going through the transition. After birth, oxytocin has been shown to play a key role in milk letdown and uterine contractions, and has a significant impact on maternal care.
“I’m not saying it’s all about hormones, but if you don’t think about it, you’re missing a big piece of the puzzle,” Epper said.
Shifting gears to another “piece of the puzzle,” Epperson talks about how past life experiences can affect hormones, which in turn can affect a patient’s mental health. The work of Ida Hahr-Pederson, Ph.D., from the Trinity Center for Global Health in Dublin, Ireland, and her colleagues examined self-reported rates of obesity in a study of 1839 American Family Survey participants. Adverse Childhood Experiences (ACE). The investigators found that women were twice as likely as their male counterparts to report ACEs, as well as social and emotional problems in childhood. 2
In perimenopausal women, according to Epperson, the most common ACEs associated with a 4+ level for women include emotional abuse, domestic violence, emotional neglect, and physical neglect, and 15% of women in this age group are in the 4+ ACE group. In addition, there is a wide variation in the effect of ACE on women depending on where they live, so it is important to consider how to interact with patients, and especially female patients.
Looking at a patient’s overall picture, including the medications they’re taking, in addition to an initial assessment that assesses past trauma, is key to addressing potential mental health issues, Epperson said.
References
1. Epperson N. Functional psychoneuroendocrinology: how the brain, nervous system, and endocrine system interact. Presented by: 2022 Annual Psychiatry Times TM World CME Conference. August 11-13, 2022 San Diego.
2. Haar-Pedersen I, Pereira C, Hyland P, et al. Women have more complex childhood problems: Implications for early childhood cognitive, social, and emotional outcomes. Euro J Psychotramatol. 2020; 11(1):1708618.
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