Menopausal hormone therapy helps prevent relapse in women with schizophrenia

The use of menopausal hormone therapy (MHT) can provide protection against psychosis relapse among women of menopausal age with schizophrenia or schizoaffective disorder (SSD), a study has shown. 

This study employed a within-subject design to examine the effectiveness of MHT in preventing relapse in a Finnish nationwide cohort of women with SSD between 40 and 62 years of age who were treated with MHT during follow-up (1994–2017). 

The investigators calculated the hazard ratios (HRs), adjusting for age and psychotropic drug use, for psychosis relapse as primary outcome and any psychiatric hospitalization as secondary outcome. 

A total of 3,488 women on MHT were included. Use of MHT correlated with a 16-percent lower risk of psychosis relapse (adjusted [a]HR, 0.84, 95 percent confidence interval [CI], 0.78–0.90) versus nonuse. 

Stratifying by age, MHT use correlated with reduced relapse risks when used between the age of 40 and 49 years (aHR, 0.86, 95 percent CI, 0.78–0.95) and 50 and 55 years (aHR, 0.74, 95 percent CI, 0.66–0.83), but not between 56 and 62 years (aHR, 1.11, 95 percent CI, 0.91–1.37). 

The effectiveness of MHT was similar for oestrogen alone or combined with fixed or sequential progestogens (aHRs, between 0.79 and 0.86), transdermal and oral formulations (aHR, 0.75–0.87), and for most specific formulations (aHR, 0.75–0.85), except for tibolone (aHR, 1.04, 95 percent CI, 0.75–1.44), and formulations with dydrogesterone (aHR, 1.05, 95 percent CI, 0.85–1.30). 

Similar results were noted for 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 investigators said.