Evidence that cyproterone acetate improves psychological symptoms and enhances the activity of the dopaminergic system in postmenopause

The psychological symptoms assessed with a validated psychometric scale, SC L-90, were significantly higher in postmenopausal women (PMW; 60 subjects) than in premenopausal women (20 subjects). In the same PMW, the activity of the dopaminergic system, assessed with the PRL response to the dopamine-bl ocking agent sulpiride, was significantly lower than that in premenopausal women. During a period of 12 weeks the 60 PMW were randomly divided into 3 groups: no treatment (group A; n = 20), treatment with estradiol (E-2) alon e (patches with a E-2 release of 50 mug/24 h; group B; n = 20), and treatme nt with hormonal replacement therapy [estradiol valerate (EV) at a daily do se of 2 mg for 11 days and EV at the same daily doses plus cyproterone acet ate (CPA) at a daily dose of 1 mg/day for 10 days; group C; n = 20). At the 12th week of the observation, only in group C women were the psychological symptoms significantly decreased, and the indirect evaluation of the dopam inergic system activity through PRL response to sulpiride showed a signific ant increase. During the same period, no changes in testosterone levels wer e observed in any group of PMW, whereas a significant increase in E-2 level s was found in both groups B and C. Although it is likely that the improvem ent in psychological symptoms with EV and CPA was due to progestin, we cann ot rule out the possibility that greater estrogen exposure may have played a role.