Tension and depression in women-the Role of hormone therapy

Tension and depression in women, there is no doubt that Tension and depression are common in women than in men. This is a widely accepted fact although the degree of difference is disputed. However, this may be due to a higher incidence of exogenous depression due to the difference in role between men and women but this does not appear to be a complete explanation.

Some of the differences may be associated with the actions of hormones that are peculiar to women, estrogen, and progesterone. In this article, we shall put in detail the perspective, tension, and depression associated with hormone changes.

Pubertal tensions

Few parents having the care of “teenage” will daughters will doubt that periodic “moodiness” occurring frequently which the cause of stress within the family. The puzzling changes of adolescence, difficulties, and examinations, problems of leaving school or home or taking up a job may all contribute to the tension about this time. The occurrence of pain with menstruation experienced by many young girls once ovulation is established may be another factor to take into account.

However, not all of the problem can be accounted for by these understandable, external pressures. Careful observation of mood changes will often show that the times of difficulty, often associated with poor performance at school or at work, coincide with the luteal phase of the cycle. These girls are suffering from a variant of the premenstrual syndrome but, because of the irregularity of the ovulation in early years of reproductive life,
this association goes often goes unnoticed.

Most girls and their families need little more than a sympathetic explanation of the natural hormone background to their changes of mood and the reassurance that with increasing maturity, that their problems will be resolved. In a few girls, the symptoms are severe enough to justify the treatment of the premenstrual syndrome. When severe dysmenorrhoea is an important component, the use of a conventional estrogen/progesterone “pill” may deal with the unpleasant premenstrual symptoms and the painful periods.

Depression in pregnancy and the puerperium

It is uncommon for a depressive psychosis to arise in pregnancy.
Indeed there is no consistent pattern seen in the response of patients with pre-psychiatric disorders during pregnancy. Some even improve and while some worsen, and most of them are scarely influenced by the hormonal changes.

Depression as a result of external pressures in unexpected or unwanted
pregnancy, and the unpleasantness that accompanies nausea and vomiting that is so common in early pregnancy, is easy to understand and usually resolves quickly once the problem id dealt with. Meanwhile, emotional liability during the first three months of pregnancy is common and a degree of ambivalence towards the pregnancy is frequently seen at this time, even in the absence of any obvious external stress. This resolves with time and the middle month of pregnancy is generally tranquil ones. Anxieties about labour and the wellbeing of the baby become more frequent as “term” approaches but the feelings are easily understood and usually, be dealt with by explanation and reassurance.

The puerperium often gives rise to more serious and perplexing problems. Neurotic reactions are common and understandable,
particularly in the anxious young mother, inexperienced and
fearful of her new responsibilities. A period of emotional liability often termed “fourth-day blues” occurs frequently at around the
time lactation is becoming established, usually this mild and
transient.

Manic-depressive illness is the commonest form of puerperal psychosis, the clinical picture is variable but the early signs are insomnia, delirium, hallucinations, and delusions. 

Depression may go on to total withdrawal occurs rapidly in most cases unless prompt treatment is given. The cause of this psychosis is idiopathic (unknown). In more than one-third of women there will be some personal or close family history of severe psychiatric disorder and in more than 25%of patients, it is a condition that will reoccur after any future pregnancy. In some cases, a physical element may be important to it is a more common disease in patients who have had prolonged labour, postpartum hemorrhage or puerperal infection.

The fact that puerperal depression sometimes occurs months after delivery makes it unlikely that hormonal changes are exclusive or even the main cause of the disease. Treatment of the condition on current lines, using chlorpromazine, tricyclic antidepressant and sometimes monoamine oxidase inhibitors gives excellent results if started early and employed vigorously, and early involvement of a psychiatrist is more important.

Problems associated with the contraceptive pill

Depression, loss of libido and headache are among the “premenstrual-like” problems reported to occur in some users of combined estrogen/progesterone contraceptive pill. In around 6% of pill users, the problems are sufficiently severe for the pill to be discontinued. Tension, sleep disturbance and loss of appetite are uncommon and in this respect, the pill syndrome differs from the menstrual syndrome.

Headaches are in fact more common during the one week in four that the woman is not taking her pill and this type of headache clearly needs to be considered as a separate entity. Where the depression occurs in the last week or so of taking the pill, the addition of weak progesterone-like dydrogesterone during this period often relieves the symptom. Where both of these approaches fail it may necessary to advise stopping the pill completely.

Postmenopausal depression

Tension and depression in women and other allied states after menopause are the sources of much current interest although it does appear that less than one-third of women in most countries of the world sufficiently suffers from this serious disorder. Some of the symptoms that are associated with this condition include hot flushes, sweats, and atrophic vaginitis causing bleeding, discharge and dyspareunia are examples.

These symptoms can be relieved by estrogen replacement therapy. Some psychological problems may have their origin in these physical disorders. Night sweats causing insomnia and hence depression and atrophic vaginitis causing dyspareunia, marital problems and hence depression.

The role of female steroid hormones in producing tension and depression in women is undoubted but poorly defined yet. Research into the direct effect of estrogen and progesterone on brain cells and upon other substances such as pyridoxine which in turn affects cerebral metabolism is taking and may soon indicate important advances in treatment.

Nevertheless, it is easy to fall into the trap of trying to explain away all problems in terms of hormonal imbalance. It is more acceptable to have abnormal hormones than a difficult husband, erring children or some psychiatric abnormality.

Also, careful assessment of the individual must precede all hormone therapy, at the same time, the depressive or the “psychogenic” may suffer from hormone upsets to the same degree as any other patient and can be considerably relieved by appropriate hormone treatment as an adjunct to conventional treatment of their disorders. There are clear and distinct guidelines for hormone therapy and should be employed in good practice.