PSYCHOLOGICAL EFFECTS OF CONTINUATION VERSUS DISCONTINUATION OF HORMONE REPLACEMENT THERAPY BY ESTROGEN IMPLANTS - A PLACEBO-CONTROLLED STUDY

There is conflicting evidence regarding the effects of hormone replace ment therapy (HRT) with estrogens on psychological and psychiatric sym ptoms of menopause. Forty women already attending a menopause clinic f or continuing HRT by estrogen implants were studied in a randomized, d ouble-blind, placebo-controlled study of estrogen reimplantation versu s implantation of a placebo preparation. Assessment included self rati ng with visual analog scales, standardized psychological and menopause rating scales (Hospital Anxiety and Depression Scale, Self-Concept Qu estionnaire, Cognitive Failures Questionnaire, Greene Menopause Index) , and interview with the Present State Examination. No difference in o utcome with regard to either psychological or psychiatric symptoms was found 2 months after entry to the study between the women who receive d an active implant and those who received a placebo implant, in spite of the former group having a significant rise in estradiol levels. Th e only effect of HRT on physical symptoms was a nonsignificant reducti on in flushes. Psychiatric morbidity of the study population was high with nearly half being ''psychiatric cases'' according to the Present State Examination at both initial assessment and follow-up. At entry t o the study nearly all the women had levels of estradiol in the premen opausal range and four had supraphysiological levels. It appears likel y that women were returning requesting a new implant because of sympto ms related to nonhormonal factors. Women receiving continuing HRT for menopausal symptoms should be reassessed both for hormonal status and current psychosocial factors when they present with recurrent symptoms , especially those of a psychological or psychiatric nature. Copyright (C) 1997 Elsevier Science Inc.