Treatment of vasomotor symptoms in the menopausal transition and postmenopausally: psychiatric comorbidity

Abstract

This article aims to educate the nonpsychiatric as well as the psychiatric clinician on the impact of vasomotor symptoms in women with comorbid psychiatric problems and the challenges of treating vasomotor symptoms in these women. The pathophysiology, prevalence and common risk factors associated with disturbing hot flashes in the menopausal transition are reviewed. Hormonal, nonhormonal and behavioral treatment options of vasomotor symptoms for these women are discussed. Special pharmacokinetic implications for hormonal treatment of those women on anticonvulsant medications for the treatment of their mood disorders, on tamoxifen and/or with high or low sex hormone-binding globulin are examined. An in-depth discussion of mood and the menopausal transition, theoretical mechanisms for mood problems with the symptomatic menopause and the impact of stress on the symptomatic menopause are found elsewhere in this clinical review series on psychiatric illness, stress and the symptomatic menopause.

Keywords::

• anticonvulsants
• antidepressants
• anxiety
• bipolar depression
• childhood abuse
• depression
• drug–drug interactions
• estradiol
• gonadal steroids
• hormone replacement
• hot flashes
• liver enzyme inhibition
• menopause
• mood
• night sweats
• perimenopause
• pharmacokinetic
• premenstrual dysphoric disorder
• progestogens
• sex hormone-binding globulin
• symptomatic menopause
• tamoxifen
• vasomotor symptoms

Notes

Used with permission, ©www.afwh.org (2007).

Data taken from [70]. Used with permission, ©www.afwh.org (2007).

Used with permission, ©www.afwh.org (2007).