Menopausal hormone therapy prevents relapse in women with SSD

Use of menopausal hormone therapy (MHT) can avert psychosis relapse in women with schizophrenia or schizoaffective disorder (SSD) of menopausal age, suggests a recent study.

The authors employed a within-subject study design to assess the effectiveness of MHT in preventing relapse in a Finnish nationwide cohort of women with SSD between ages 40 and 62 years. These women used MHT during follow-up from 1994 to 2017.

Psychosis relapse (main outcome) and any psychiatric hospitalization (secondary outcome) were evaluated using hazard ratios (HRs) adjusted for age and psychotropic drug use.

A total of 3,488 women using MHT were included in the study. Use of MHT contributed to a 16-percent reduction in relapse risk when compared with nonuse (adjusted [a]HR, 0.84, 95 percent confidence interval [CI], 0.78–0.90).

When stratified by age, MHT use resulted in lower relapse risks between the age of 40 and 49 years (aHR, 0.86, 95 percent CI, 0.78–0.95) and between ages 50 and 55 years (aHR, 0.74, 95 percent CI, 0.66–0.83), but not between 56 and 62 years of age (aHR, 1.11, 95 percent CI, 0.91–1.37).

Similar effectiveness was seen for oestrogen alone or in combination with fixed or sequential progestogens (aHRs between 0.79 and 0.86), transdermal and oral formulations (aHRs, 0.75–0.87), and for most specific formulations (aHR, 0.75–0.85), except tibolone (aHR, 1.04, 95 percent CI, 0.75–1.44) and formulations containing dydrogesterone (aHR, 1.05, 95 percent CI, 0.85–1.30).

These results persisted for the secondary outcome of any psychiatric hospitalization.

“These findings translate clinical evidence on the neuroprotective effects of oestrogens to real-world settings, encompassing a group of women for whom current antipsychotic treatment options may be insufficient,” the authors said.