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Objective: Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms. Method: Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery–Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays. Results: Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery–Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%). Conclusion: Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Raloxifene for schizophrenia and symptoms of hyperprolactinaemia?" published in previous issue of the journal.

The authors’ comment on an article by Bou Khalil who discussed the potential protective role of orgasm in promoting a positive mood in women suffering from depression. They state that through his approach, Khalil explores the potential biological pathways between orgasm and positive mood. The authors’ opine that women with Female sexual dysfunction (FSD) symptoms may improve over time, but sensitive discussion and understanding of her concerns must be part of the psychiatrist’s role.

The article presents a case study of a 22-year-old woman with suffering with borderline personality disorder and polycystic ovary syndrome (PCOS). The case mentions that the woman has a history of sexual abuse by her stepfather and had multiple psychiatric hospitalizations for suicide attempts, ongoing self-harm and rapid mood swings. It also mentions that the patient received PCOS treatment of metformin, transdermal oestradiol and cyclical progesterone.

The article describes the case of a 29-year-old National Register of Antipsychotic Medication in Pregnancy participant who was diagnosed with schizophrenia and obesity that led her into taking medications such as risperidone and quetiapine during pregnancy. Topics discussed include the introduction of food management, her son's diagnosis with neonatal abstinence syndrome and neonatal hypoglycaemia, and the link between gestational diabetes mellitus (GDM) and obesity.