Selecting the right treatment plan for schizophrenia in postmenopausal women: an update of the literature

ABSTRACT

Introduction

The transition from reproductive to menopausal status constitutes amajor rite of passage for women, biologically, psychologically, and socially. For women with adiagnosis of schizophrenia, this stage of life is complicated by worsening psychotic symptoms and diminished effectiveness of antipsychotic drugs. This frequently leads to increased doses and subsequently increased adverse effects.

Areas covered

The aim of this narrative review is to determine what management changes are needed at this time of life for women with schizophrenia. Searched and highlighted are the areas of sleep, cognition, occupation/employment, psychotic symptoms, side effects of treatment, and non-psychiatric as well as psychiatric co-morbidities which, when not adequately treated, can undermine quality of life and lead to premature death.

Expert opinion

Many of the problems associated with menopause in women with schizophrenia can be prevented or remediated. Nevertheless, more research addressing the changes that occur in women with schizophrenia from pre- to post-menopause will help to bring clinical attention to this important health issue.

KEYWORDS:

• Menopause
• schizophrenia
• sleep
• cognition
• occupation
• comorbidities
• treatment

Article highlights

• Menopause in women with schizophrenia means estrogen decline, which increases symptom severity and undermines response to treatment

• Menopause also means awareness of aging and loss of fertility, loss of sexual desirability

• Menopause is accompanied by vasomotor symptoms, insomnia, weight gain, depression, anxiety, and cognitive problems, which add to the burden of schizophrenia

• Menopause is also accompanied by non-psychiatric comorbidities and caregiving responsibilities and bereavements

• Many of the problems associated with menopause in women with schizophrenia can be prevented or remediated

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with afinancial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One reviewer has received manuscript or speaker’s fees from Astellas, Eisai, Eli Lilly and Company, Elsevier Japan, Janssen Pharmaceuticals, Kyowa Yakuhin, Lundbeck Japan, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, Merck Sharp and Dohme, Nihon Medi-Physics, Novartis, Otsuka Pharmaceuticals, Shionogi, Shire, Sumitomo Pharma, Takeda Pharmaceuticals, Tsumura, Viatris, Wiley Japan, and Yoshitomi Yakuhin. They have also received research grants from Eisai, Mochida Pharmaceutical Co. Ltd, Meiji Seika Pharma, Shionogi and Sumitomo Pharma.

Additional information

Funding

This paper received no funding.