The Effect of Estrogen Therapy on Somatic and Psychical Symptoms in Postmenopausal Women

Publisher Website
Google Scholar
Abstract
The effect of oral estrogen replacement therapy upon somatic and psychical disturbances and sexuality was studied in a doubleblind investigation in 48 postmenopausal women using hormone preparations with two different levels of micronized estradiol‐17β (E2) as active estrogen component. The patients were treated for 8 months in four 2‐month periods with two preparations containing 1‐2 mg of E2 (TrisekvensR and EstrofemR), with one preparation containing 1‐4 mg of E2 (TrisekvensR forte) and with a placebo preparation. Investigations performed before and during treatment included general clinical chemical analysis, serum levels of FSH, LH and E2 and evaluation of the patients' somatic and psychical disturbances and sexuality.The patients were classified into three subgroups according to their pretreatment scores for mental distress and/or depression: severe (group I), moderate (group II), or no (group III) mental distress and/or depression. No significant differences between the three subgroups were found in pretreatment values from the general clinical chemical analysis or the hormone assays. Estrogen treatment significantly reduced S‐total cholesterol values in all three subgroups; otherwise no significant effects were revealed by the general clinical chemical analysis. During the period of optimal wellbeing, serum E2 levels corresponded to luteal phase values. The gonadotropin levels, although depressed by approx. 50%, were still within the postmenopausal range. There were no significant differences between the two subgroups in hormone levels obtained during optimal estrogen treatment. Twentyone patients had the best test results when treated with the larger dose (TrisekvensR forte) and 23 with the smaller dose (TrisekvensR and EstrofemR) and 4 during placebo treatment. The dose of estrogen did not significantly influence the hormone values found during optimal estrogen treatment. Vasomotoric and physical symptoms improved appreciably during estrogen treatment when compared with placebo or pretreatment scores. A certain placebo effect was noted for physical symptoms, which may be attributed to persisting effects of previous active estrogen treatment. The psychical symptoms too improved considerably during estrogen treatment, although placebo effects were also noted. In 10 patients, detrimental effects on psychical symptoms were observed during active estrogen treatment. Hormone analysis revealed very high E2 and low gonadotropin levels in these patients, which must therefore be considered as overtreated. In one patient with premenopausal depression periods and in 3 who surreptitiously took tranquillizers during the treatment period, no effects of estrogens upon the psychical symptoms were observed. The sexuality of the patients did not improve during estrogen treatment.The authors stress the need to individuate the dosage in estrogen replacement therapy.