Hormonal changes are among a host of issues that can influence psychiatry and medical conditions in women, and being aware of the total picture can deeply impact these patient’s treatment, C. Neill Epperson, MD told attendees at the 2022 Psychiatric TimesTM World CME Conference being held in San Diego this week.1
Epperson, who is a professor and chair of the department of psychiatry at the University of Colorado in Aurora, Colorado, discussed the interaction between the endocrine system, early childhood influences, the brain, and the nervous system at the meeting.
Epperson noted that it is important for psychiatrists to consider the endocrine system when treating patients, particularly as it relates to women, since there are pronounced differences between genders in how hormones impact their mental health. The differences in how hormone treatments affect women begin in adolescence she said, with young girls twice as likely than male counterparts to be prescribed a steroid, often related to addressing unprotected sexual intercourse at sexual debut.
“Always think about what kind of steroid/contraception they are on, as they can profoundly affect the endocrine system,” Epperson explained. This is also true for women who are menopausal, as hormones have been shown to influence executive function, sexuality, cardiovascular disease, and mental health issues including major depressive disorder in women undergoing life transition. Postpartum, oxytocin has been shown to play a key role in milk letdown and uterine contraction, and it has a profound impact on maternal nurturing.
“I’m not saying it’s all about the hormones, but I am saying if you don’t think about it you’re missing a big piece of the puzzle,” Epperson said.
Shifting gears to another “piece of the puzzle,” Epperson addressed how early life experience can impact hormones, which in turn can have an influence on a patient’s mental health. She discussed the work ofIda Haahr-Pedersen, PhD, from Trinity Center for Global Health in Dublin, Ireland, and colleagues in a study that looked at 1839 US household survey participants and assessed self-reported rates of adverse childhood experiences (ACE). The investigators found that women were twice as likely as their male counterparts to report ACE as well as social and emotional difficulties in childhood. 2
In perimenopausal women, Epperson said, the most common ACEs associated with 4+ status for women included emotional abuse, domestic violence, emotional neglect, and physical neglect, and 15% of women in this age range are in the 4+ ACE group. There is also wide variability of ACE impact on women depending upon where they live, so taking that into account when considering how to interact with patients, and female patients in particular, is important as well, she said.
Looking at the total picture of the patient, including medication they may be taking, in addition to performing a thorough initial assessment that assesses past trauma, is key to helping address any mental health issues that may present, Epperson concluded.
1. Epperson N. Practical psychoneuroendocrinology: how the brain, nervous system, and endocrine system interact. Presented at: 2022 Annual Psychiatric TimesTM World CME Conference. Aug. 11-13, 2022. San Diego.
2. Haahr-Pedersen I, Perera C, Hyland P, et al. Females have more complex patterns of childhood adversity: Implications for mental, social, and emotional outcomes in childhood. Eur J Psychotraumatol. 2020; 11(1):1708618.